A Comparison of the Relative Efficacy of Antiandrogens for the Treatment of Acne in Hyperandrogenic Women

Abstract

Two of the newer antiandrogens, flutamide and finasteride, have proved to be as effective in treating hirsutism as cyproterone acetate (CPA). The authors compared four antiandrogen regimens in 48 hyperandrogenic women whose chief complaint was acne. The women were consecutive white women with moderate or severe acne and increased serum levels of testosterone, androstenedione, and dehydroepiandrosterone sulfate. Acne was evaluated using Cook scores for diffusion of facial lesions and the severity of lesions. Nearly one third of the women also had mild hirsutism, but only 17% had menstrual irregularity. For 1 year the women received one of four regimens: 2 mg of CPA plus 35 μg of ethinyl estradiol for 3 weeks each month; 50 mg of CPA on days 5 to 15, with 25 μg of ethinyl estradiol added on days 5 to 25; 250 mg of flutamide daily; or 5 mg of finasteride daily. The women used mechanical contraception during the treatment year. All four regimens led to a significant reduction in Cook acne scores (Fig. 1). The results obtained with high-dose CPA were more marked than those achieved with low-dose CPA or flutamide, but not significantly so (Fig. 2). All three of these treatments were more effective than finasteride. No side effects were observed. Neither flutamide nor finasteride altered menstrual function, and all treated women continued to have normal blood glucose and liver enzyme values. It seems that most antiandrogenic regimens effectively treat acne in hyperandrogenic women (though finasteride is less effective) and that low doses may suffice.