Drug-Induced Melasma in Patients on 5-Alpha Reductase Inhibitors: A Case Report

    February 2026 in “ Case Reports in Dermatology
    Hiba Elhaj, K.A. Orrell, Renée A. Beach
    TLDR Finasteride can cause melasma, especially in people with darker skin.
    This case report documents two instances of finasteride-induced melasma, expanding the limited literature on this adverse effect. A 53-year-old woman and a 66-year-old man, both with darker skin types, developed melasma after prolonged use of finasteride for frontal fibrosing alopecia and benign prostatic hyperplasia, respectively. Discontinuation of finasteride and targeted melasma therapies, including cysteamine cream, led to partial improvement. The report emphasizes the importance of considering 5-alpha reductase inhibitor exposure in patients with new or persistent facial hyperpigmentation, especially in those with darker skin, to prevent ongoing pigmentation issues.
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      Supplementary Material for: Drug-Induced Melasma in Patients on 5-Alpha Reductase Inhibitors: A Case Report

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      January 2026 in “Figshare”
      This case report highlights two instances of finasteride-induced melasma, expanding the limited literature on pigmentary side effects associated with 5-alpha reductase inhibitors (5-ARIs). A 53-year-old woman and a 66-year-old man, both with darker skin types, developed melasma after prolonged use of finasteride for frontal fibrosing alopecia and benign prostatic hyperplasia, respectively. Discontinuation of finasteride and targeted melasma therapies, including cysteamine cream, led to partial improvement. The report emphasizes the importance of considering 5-ARI exposure in patients with new-onset or refractory facial hyperpigmentation, as early recognition and medication review may help mitigate persistent pigmentation.
      Supplementary Material For: Drug-Induced Melasma In Patients On 5-Alpha Reductase Inhibitors: A Case Report

      research Supplementary Material For: Drug-Induced Melasma In Patients On 5-Alpha Reductase Inhibitors: A Case Report

      January 2026 in “Figshare”
      This case report highlights two instances of finasteride-induced melasma, expanding the limited literature on pigmentary side effects associated with 5-alpha reductase inhibitors (5-ARIs). The first case involved a 53-year-old woman who developed cheek hyperpigmentation after one year of finasteride use for frontal fibrosing alopecia, which improved partially after discontinuation of the drug and treatment with cysteamine cream. The second case described a 66-year-old man with a decade-long history of finasteride use for benign prostatic hyperplasia, who developed melasma unresponsive to topical therapies. His treatment was adjusted to include cysteamine, glutathione, azelaic acid, and a retinoid, and he was advised to consult his urologist about stopping finasteride. The report underscores the importance of considering 5-ARI exposure in patients with new or persistent facial hyperpigmentation, especially in those with darker skin types, to prevent prolonged pigmentation issues.