The Role of Androgens in Hidradenitis Suppurativa and the Potential Benefits of Antiandrogen Therapy

The document discusses the role of androgens in hidradenitis suppurativa (HS) and the potential benefits of antiandrogen therapy. The authors, Gee and Dawber, critique a review by Mortimer and Lunniss, arguing that while the review suggests a lack of apocrine sensitivity to androgens based on enzyme activity studies, it overlooks the importance of androgen response at the receptor level. They highlight that finasteride, a 5α-reductase inhibitor, showed benefits in 4 cases of HS, suggesting androgen involvement. They note that observational studies indicate HS flares premenstrually but not during anovulatory cycles, and affected women often have acne and hirsutism, which are androgenic conditions. Despite conflicting views on the role of androgens in HS, the authors advocate for the use of antiandrogen therapy, such as Dianette, in female patients without contraindications, as an adjunct to other treatments. They also mention the efficacy of high-dose cyproterone acetate, emphasizing that even brief remission can be significantly beneficial for refractory cases of HS.