Hidradenitis Suppurativa: A Practical Review of Possible Medical Treatments Based on Over 350 Hidradenitis Patients

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.

Oral DHT blockers like finasteride are preferred for their ease of use, effectiveness, and long-term safety data, while topical treatments like RU58841 lack extensive safety data and can be more cumbersome to apply. Oral treatments are generally considered more effective and convenient despite potential side effects.

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.

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.

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 user is considering using tretinoin with topical finasteride due to poor absorption and side effects from oral finasteride. They are also contemplating switching to topical dutasteride, while others suggest trying oral minoxidil or lower oral doses.