Current Systemic Treatment Strategies for Hidradenitis Suppurativa

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.

Topical androgen receptor antagonists may not be necessary if 5-AR inhibitors like finasteride or dutasteride effectively reduce DHT levels. Combining a 5-AR inhibitor with a topical androgen antagonist could potentially enhance treatment, but oral use of androgen antagonists is too risky due to severe side effects.

The conversation discusses using zinc sulphate and azelaic acid to inhibit 5 alpha-reductase activity, which could potentially treat androgen-related skin conditions like hair loss. Combining these with vitamin B6 could enhance the effect, potentially offering an alternative to finasteride.

The user has been using oral minoxidil and dutasteride for hair loss without success and is considering adding topical 17α-estradiol, Pyrilutamide, Clascoterone, or cetirizine. They have confirmed low serum DHT levels and are exploring additional treatments due to genetic sensitivity to DHT and prostaglandin D2.

Finasteride may cause acne for some users, possibly due to increased testosterone or estrogen levels. Zinc, gluconic acid, and B5 cream are suggested treatments for managing this acne.

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.