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I asked my dermatologist about possibly prescribing me flutamide, and he had no idea what I was talking about - he said he'd never heard of it.

From DermatologyTimes.com:

Maligned flutamide exhibits acne, AGA benefits

Feb 1, 2002

By: Beth Kapes

Dermatology Times

São Paulo, Brazil - Contrary to foregoing reports of significant side effects and high cost, Denise Steiner, M.D., Ph.D., contends that the anti-androgen drug flutamide 250 mg (Euflex, Euflexin) is a safe and effective therapy for treating female acne and androgenetic alopecia with an overall positive relation of cost to benefit.

"Flutamide blocks the peripheric androgen receptors, and almost all peripheric androgen receptors are located at the sebaceous glands and at the keratinocytes in the bulb area. It blocks the linkage between the androgen and the receptor, so the action of this is complex inside the cellular nucleus," said Dr. Steiner, department of dermatology, Clinica Stockli, São Paulo, Brazil. "As flutamide does not have any hormonal features, it has little side effects, and so it differentiates itself from the other anti-androgen drugs."

An agent often pushed aside by spironolactone due to its more significant side effects, including risks of lipid abnormalities and fatal hepatitis, flutamide has its benefits. "In one of our studies, 71.4 percent of patients improved with two months treatment," Dr. Steiner said. "There were no hormonal alterations and the liver enzymes were altered in only 7.1 percent of patients, and skin dryness was shown in only 4.8 percent."

The presence of hirsutism, irregular menstrual periods, cushingoid features, increased libido, acanthosis nigricans, deepening of the voice, evidence of insulin resistance, or androgenetic alopecia are all signs of hyperandrogenism - a diagnosis that often coincides with the presence of an endocrine abnormality and the sudden onset of severe adult female acne.

"The definition of adult female acne is not well established. While it does have a well-known clinical presence, its etiopathogenic basis remains controversial," Dr. Steiner said. "Its onset at the adult age and the worsened of the hyperandrogenic characteristics have led us to the use of this anti-androgen drug. This is why flutamide is also well known for treating hirsutism."

Success is moderate, good

Dr. Steiner points to a study that involved treating women with hirsutism, acne, or alopecia. The investigators reported an 80 percent success rate for women with acne or alopecia when treated with flutamide. The research also indicates that flutamide was significantly superior to spironolactone for treating androgen dependent conditions in women. Several additional studies on the use of flutamide to treat androgen dependent hirsutism in women all suggest moderate to good success rates.

"As for AGA, the mechanism of action resides in the blockage of androgen receptors, as it does for the acne," Dr. Steiner said.

Flutamide's reputation became scarred with the study by Wallace, et. al., in the December 1993 issue of the Annals of Internal Medicine which reported hepatotoxicity as result of the drug's use. The Food and Drug Administration also reported 20 patients who died and 26 who were hospitalized for hepatotoxicity due to flutamide between February 1989 and December 1994. In order to monitor the symptoms of hepatotoxicity, such as nausea, vomiting, fatigue, and jaundice, dermatologists generally recommend the monitoring of serial blood aminotransferase levels during the first few months of flutamide treatment.

Smaller doses equally effective

A drug that is taken orally, flutamide was initially given to patients at high dose rates of up to 250 mg TID, however, more recent studies indicate a similar improvement in hirsutism with doses as low as 62.5 mg a day - a dosage that also lowers the risk of side effects. "For treatment of female acne and AGA, the drug is taken orally and becomes hydroxyflutamide, the active metabolite, with a half-life of five to six hours," Dr. Steiner said. "Essentially, the side effect risk of flutamide is no better or worse than other oral antiandrogen drugs."

"The key message to my colleagues is that from our studies we have found flutamide to be a safe drug for female acne and AGA with a quick action against disease," Dr. Steiner said. "As a result, the relation of cost to benefit is also very good."

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Another article says:

"Whereas flutamide caused a dramatic (80%) decrease in total acne, seborrhea, and hair loss score after only 3 months of therapy, spironolactone caused only a 50% reduction in acne and seborrhea, with no significant effect on the hair loss score. Four patients in the spironolactone group but only one in the flutamide group stopped the medication because of adverse side effects. CONCLUSION: The present data obtained in a randomized prospective study clearly demonstrate that the pure antiandrogen flutamide is superior to spironolactone in the treatment of female hirsutism and its related androgen-dependent symptoms and signs in women."

Here is a short summary of the article.

Here is the article itself: Comparison of flutamide and spironolactone in the treatment of hirsutism: a randomized controlled trial.

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Another article says:

"Whereas flutamide caused a dramatic (80%) decrease in total acne, seborrhea, and hair loss score after only 3 months of therapy, spironolactone caused only a 50% reduction in acne and seborrhea, with no significant effect on the hair loss score. Four patients in the spironolactone group but only one in the flutamide group stopped the medication because of adverse side effects. CONCLUSION: The present data obtained in a randomized prospective study clearly demonstrate that the pure antiandrogen flutamide is superior to spironolactone in the treatment of female hirsutism and its related androgen-dependent symptoms and signs in women."

Here is a short summary of the article.

Here is the article itself: Comparison of flutamide and spironolactone in the treatment of hirsutism: a randomized controlled trial.

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Thanks for the article. I have been taking Spiro for years now and it worked great up until this past year. I have been breaking out more and more so I might ask my hormone nurse about this drug.

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Hi there,

I have been reading this old topic...and my question is - can flutamide be used by men to reduce acne and hair loss? I believe it can but I don't know if this will be as effective as seen in women ( drecrease in acne about (80%)

thanks

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