Approach to the Management of Patients With Hidradenitis Suppurativa: A Consensus Document

A woman with androgenic hair loss, likely due to PCOS, is seeking topical treatments as oral medications are not an option. Suggested treatments include topical finasteride, spironolactone, and clascoterone, with spironolactone and clascoterone being safer options due to lower systemic absorption risk.

The user has been using oral Dutasteride, RU58841, and Minoxidil for three years without success and is considering adding topical Finasteride or Dutasteride to target DHT both locally and systemically. Other users suggest sticking to a consistent treatment plan, exploring different combinations, and considering other factors like potential misdiagnosis or inconsistent medication use.

The user is using a combination of oral Dutasteride and Minoxidil, and a topical formula with Finasteride, Minoxidil, and Hydrocortisone, along with rosemary oil, coconut oil, ginseng, and a derma roller. They are also using LLLT therapy and are questioning the timing of the laser cap session in relation to the topical application.

Finasteride effectively treated hormonal acne for multiple users, including the original poster. Topical treatments like Winlevi are effective but expensive and not always covered by insurance.

The user is experiencing diffuse thinning and inflammation despite using 2.5mg dutasteride daily, ciclopirox, and ketoconazole shampoos. They are considering treatments like hydroxychloroquine and JAK inhibitors due to suspected scarring alopecia and have faced challenges in obtaining a scalp biopsy.

Topical dutasteride may have limited absorption due to its higher molecular mass compared to finasteride, potentially affecting its efficacy in suppressing DHT locally. Microneedling might enhance dutasteride absorption, possibly offering stronger local DHT suppression with fewer systemic effects.