Hidradenitis suppurativa treated with finasteride

Background: Hidradenitis suppurativa ( HS) is a distressing condition for which no satisfactory treatment is available. Studies on hormonal mechanisms responsible for HS point towards altered end- organ sensitivity, probably related to the enzyme 5 alpha reductase that converts testosterone to dihydrotestosterone. Finasteride, an inhibitor of type II 5 alpha reductase, has been reported to be effective in recalcitrant HS. Aim: To study the effectiveness and tolerability of finasteride in patients with HS in a preliminary trial. Methods: Seven patients ( five women and two men) with HS that was not responding well to antibiotics were treated with finasteride at a dose of 5 mg/ day as monotherapy. Clinical response was assessed at regular intervals. Patients were followed up for periods varying from 8 months to 2 years. Results: Six patients improved significantly and three of them had complete healing of lesions. Two patients who were followed up for more than 1 year experienced remissions lasting 8 - 18 months. The drug was generally well tolerated; however, two women complained of breast enlargement. Conclusion: The results of this preliminary study suggest that finasteride is an effective therapeutic option in HS.