From the Guidelines
Finasteride can potentially cause acne in some users, though it's not among the most common side effects. If you're experiencing acne while taking finasteride, you have several options. First, continue your finasteride as prescribed (typically 1mg daily for hair loss or 5mg for prostate issues) but add a topical acne treatment containing benzoyl peroxide (2.5-5%) or salicylic acid (2%) applied once or twice daily to affected areas. For moderate acne, consider adding adapalene 0.1% gel at night. If these measures don't help after 4-6 weeks, consult your prescribing physician about possible alternatives to finasteride or a referral to a dermatologist. The acne may be related to hormonal changes caused by finasteride, which blocks the conversion of testosterone to dihydrotestosterone (DHT), potentially altering your skin's oil production. Some men experience this as a temporary side effect that resolves within a few months as your body adjusts to the medication. Maintaining good skin hygiene, using non-comedogenic products, and avoiding touching your face can also help manage the acne while continuing finasteride treatment.
According to the most recent guidelines 1, the management of acne vulgaris involves a comprehensive approach, including topical and oral treatments. For patients experiencing acne while taking finasteride, the addition of topical treatments such as benzoyl peroxide or salicylic acid can be effective in managing acne symptoms.
Key considerations for managing acne in patients taking finasteride include:
- Maintaining good skin hygiene
- Using non-comedogenic products
- Avoiding touching the face
- Considering alternative treatments or referral to a dermatologist if symptoms persist
It's essential to weigh the benefits and risks of finasteride treatment against the potential side effects, including acne. Patients should be informed about the possible risks and benefits of finasteride and monitored closely for any adverse effects.
In terms of treatment duration, there is no specific guideline for the treatment of acne caused by finasteride. However, the general approach to managing acne involves a trial of topical treatments for 4-6 weeks before considering alternative options or referral to a specialist.
Overall, the management of acne in patients taking finasteride requires a comprehensive approach, considering the potential hormonal changes caused by the medication and the individual patient's skin type and symptoms.
From the Research
Acne Treatment Options
- Topical therapies such as retinoids, benzoyl peroxide, azelaic acid, and/or combinations of topical agents are first-line treatments for acne vulgaris 2
- Combination therapy is often used to address the multifactorial pathophysiology of acne, and may include oral antibiotics, hormonal agents, and systemic retinoids 3, 2
- For more severe disease, oral antibiotics such as doxycycline and minocycline, hormonal therapies such as combination oral contraception or spironolactone, or isotretinoin may be recommended 2
Finasteride and Acne
- Finasteride, an antiandrogen that specifically inhibits the 5α-reductase enzyme, has been shown to have good efficacy in the treatment of moderate acne in women 4
- A study comparing the efficacy, tolerability, and safety of montelukast versus finasteride for the treatment of moderate acne in women found that finasteride had more efficacy than montelukast in treating moderate acne in normo-androgenic women 4
- However, there is limited information available on the use of finasteride in men with acne, and its potential effects on acne in this population are not well understood
Treatment Considerations
- Oral antibiotics are commonly used to treat acne vulgaris, primarily in patients presenting with moderate to severe facial or truncal disease severity, and are most appropriately used in combination with a topical regimen containing benzoyl peroxide and a topical retinoid 5
- The choice of treatment for acne should be individualized based on the severity of the disease, the presence of scarring or significant psychosocial distress, and the patient's medical history and preferences 2, 6