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

January 2026 in “ Figshare ”

figshare admin karger, Elhaj H., Orrell K., Beach R.A.

finasteride 5-alpha reductase inhibitors melasma frontal fibrosing alopecia cysteamine cream glutathione azelaic acid retinoid benign prostatic hyperplasia 5-ARIs

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.

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