Department of Dermatology, Massachusetts General Hospital, 50 Staniford Street, Suite 200, Boston, MA, 02114, USA.
Harvard Medical School, Boston, MA, USA.
Am J Clin Dermatol. 2020 Apr;21(2):245-254. doi: 10.1007/s40257-019-00493-z.
Androgenetic alopecia (AGA) and acne vulgaris are two conditions commonly seen by dermatologists. Androgens and the androgen receptors play an essential role in the manifestation of both conditions, and some systemic therapies function by interfering in this pathway. The use of topical antiandrogen therapies has gained traction in recent years due to their potential efficacy in treating AGA and acne vulgaris, as well as their reduced adverse effects compared with systemic drugs. This review discusses the role of androgens in skin physiology and pathology and assesses the potential efficacy and safety of three topical antiandrogen therapies in the treatment of AGA and acne vulgaris. A literature review utilizing the PubMed, US Clinical Trials, and SCOPUS databases was conducted to search for randomized clinical trials, systematic reviews, cohort studies, case reports, and other relevant published studies on the pathogenesis and treatment of each condition with topical finasteride, ketoconazole shampoo, and cortexolone 17α-propionate (C17P). The results demonstrated that topical formulations of finasteride, ketoconazole, and C17P are promising treatments for male pattern hair loss, especially topical finasteride in combination with topical minoxidil. Limited studies have shown C17P to have potential in treating acne vulgaris in both males and females. Minimal adverse effects have been reported in clinical trials for all topical therapies, although topical finasteride is still contraindicated in pregnancy. Recognizing the preliminary evidence, more peer-reviewed studies on topical antiandrogen treatments for AGA and acne vulgaris are necessary before definitive recommendations can be made regarding efficacy and safety. There is also a critical need to include more women in study populations for these treatments.
雄激素性脱发（AGA）和寻常痤疮是皮肤科医生常见的两种疾病。雄激素和雄激素受体在这两种疾病的表现中起着至关重要的作用，一些全身治疗方法通过干扰这一途径发挥作用。近年来，由于局部抗雄激素治疗在治疗 AGA 和寻常痤疮方面具有潜在疗效，且与全身药物相比不良反应较少，因此越来越受到关注。本文讨论了雄激素在皮肤生理和病理中的作用，并评估了三种局部抗雄激素疗法在治疗 AGA 和寻常痤疮中的潜在疗效和安全性。利用 PubMed、US Clinical Trials 和 SCOPUS 数据库进行文献复习，检索了关于局部非那雄胺、酮康唑洗发水和皮质酮 17α-丙酸酯（C17P）治疗每种疾病的发病机制和治疗的随机临床试验、系统评价、队列研究、病例报告和其他相关已发表研究。结果表明，局部非那雄胺、酮康唑和 C17P 的制剂是治疗男性型脱发的有前途的方法，特别是局部非那雄胺与局部米诺地尔联合使用。有限的研究表明 C17P 对男性和女性寻常痤疮有潜在疗效。所有局部治疗的临床试验均报告了很少的不良反应，尽管局部非那雄胺仍在妊娠期禁用。鉴于初步证据，在针对 AGA 和寻常痤疮的局部抗雄激素治疗的疗效和安全性方面做出明确建议之前，还需要进行更多的同行评议研究。对于这些治疗方法，还迫切需要在研究人群中纳入更多女性。
