QUEBEC CITY — Dosages of the androgen receptor blocker flutamide at 125 mg/day appear to be effective in treating acne in women who have not responded to other medications, James C. Shaw, M.D., reported at the annual conference of the Canadian Dermatology Association.
Flutamide has been reported to be effective in treating acne at doses of 500 mg/day and 250 mg/day. But flutamide has not been used as widely as other androgen receptor blockers such as cyproterone acetate and spironolactone because of an incidence of hepatotoxicity ranging from 1% to 5% at dosages greater than 500 mg/day and in isolated cases at 250 mg/day, according to Dr. Shaw of the division of dermatology at the University of Toronto.
In a review of 32 consecutive women aged 14–51 years who received a prescription for flutamide at 125 mg/day, 17 of the 21 patients who returned for follow-up visits had marked improvement of their acne. The length of treatment in the 21 patients ranged from about 2 months to 21 months, Dr. Shaw and his associates wrote on a poster.
Overall, five women discontinued treatment because of emotional lability (two patients), minor GI distress (two), or a slightly elevated level of alanine aminotransferase (one). With the exception of four patients, none the women had responded adequately to or had tolerated other therapies.
Dr. Shaw said that he regularly conducts liver function tests. Flutamide has been associated with developmental abnormalities in exposed fetal rats, so all patients must be advised about contraceptive use during treatment. The drug is most often used to treat prostate cancer in men and hirsutism in women.
This patient's acne was refractory to treatment with isotretinoin.
Her acne responded to 8 months of flutamide 125 mg/day plus oral contraceptives. Photos courtesy Dr. James C. Shaw