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5a-R type 1 inhibition found to be ineffective

I've already mentioned this new study in a couple of other threads, and I decided I should bring it to everyone's attention by posting the full abstract. It's very disappointing that even a potent systemic 5a-reductase type 1 inhibitor apparently had no effect on the course of acne! I have one minor idea about why it failed, but I'd like to know what other people have to say about it first, before I mention it. But in any event, this is clearly a setback for people who advocate the use of certain foods and/or supplements that they CLAIM to be 5a-reductase inhibitors. Notice the participation of all the heavy-hitters in this study, including Sawaya, Leyden, and Whiting:

J Am Acad Dermatol. 2004 Mar;50(3):443-7.

"A systemic type I 5 alpha-reductase inhibitor is ineffective in the treatment of acne vulgaris"

Leyden J, Bergfeld W, Drake L, Dunlap F, Goldman MP, Gottlieb AB, Heffernan MP, Hickman JG, Hordinsky M, Jarrett M, Kang S, Lucky A, Peck G, Phillips T, Rapaport M, Roberts J, Savin R, Sawaya ME, Shalita A, Shavin J, Shaw JC, Stein L, Stewart D, Strauss J, Swinehart J, Swinyer L, Thiboutot D, Washenik K, Weinstein G, Whiting D, Pappas F, Sanchez M, Terranella L, Waldstreicher J.

University of Pennsylvania Hospital, 36th and Spruce Streets, Philadelphia, PA 19104, USA.

Excessive sebum production is a central aspect of the pathophysiology of acne vulgaris. Sebaceous gland function is under androgen control and it is hypothesized that dihydrotestosterone is formed by the action of 5 alpha-reductase. Type I is the controlling isoenzyme. This study describes a 3-month, multicenter, randomized, placebo-controlled clinical trial with a potent, selective inhibitor of type I 5 alpha-reductase used alone and in combination with systemic minocycline. Inhibition of type I 5 alpha-reductase was not associated with clinical improvement of acne when used alone and did not enhance the clinical benefit of systemic minocycline. These results indicate the need for further work at the molecular level to better understand the action of androgens on sebaceous gland function.

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