Topical Finasteride Therapy in Hirsutism

The article discusses a small study that suggests that topical finasteride treatment may be beneficial for facial hirsutism in women. Hirsutism is a common problem in women, and most hirsute women are found to have abnormally high circulating androgen levels. Treatment for hirsutism necessitates a thorough medical history and physical examination as well as laboratory testing to ascertain the pathogenesis of the disorder. Antiandrogens have been prescribed for more than 3 decades in the treatment of hirsutism. The primary action of these agents is competition with androgens for their receptor. In many countries, cyproterone acetate (CPA) is the most commonly used medication in hirsutism. This drug is not available in the United States. CPA is an antiandrogen with substantial progestational activity, and it is generally used in combination with an estrogen as an oral contraceptive. Although CPA has been shown to have beneficial effects in patients with hirsutism, it has not been found to be more effective or to have fewer side effects than other antiandrogens. In the United States, the aldosterone antagonist spironolactone is the most commonly used antiandrogen in the treatment of hirsutism. It competitively inhibits the interaction of dihydrotestosterone with its receptor. It also has some effect in reduction of synthesis of androgen through inhibition of 17-hydroxylase and 17,20-lyase activity. At relatively high dosages (100 to 200 mg/day), it has demonstrated some effectiveness in the treatment of hirsutism. At these dosages, it frequently causes menstrual irregularity; therefore, it is often used in combination with an oral contraceptive. Flutamide is a nonsteroidal antiandrogen, which was originally used for the treatment of prostate diseases. It has been shown to have some beneficial effects in patients with hirsutism. The rare but potentially serious side effect of hepatotoxicity has probably restrained the widespread use of this medication for treatment of hirsutism.