5-Alpha reductase inhibitors in androgenetic alopecia: Shifting paradigms, current concepts, comparative efficacy, and safety

Rachita Dhurat; Aseem Sharma; Lidia Rudnicka; George Kroumpouzos; Martin Kassir; Hassan Galadari; Uwe Wollina; Torello Lotti; Masa Golubovic; Iva Binic; Stephan Grabbe; Mohamad Goldust

doi:10.1111/dth.13379

5-Alpha reductase inhibitors in androgenetic alopecia: Shifting paradigms, current concepts, comparative efficacy, and safety

Dermatol Ther. 2020 May;33(3):e13379. doi: 10.1111/dth.13379. Epub 2020 Apr 24.

Authors

Rachita Dhurat¹, Aseem Sharma², Lidia Rudnicka³, George Kroumpouzos^{4

5

6}, Martin Kassir⁷, Hassan Galadari⁸, Uwe Wollina⁹, Torello Lotti¹⁰, Masa Golubovic¹¹, Iva Binic¹², Stephan Grabbe¹³, Mohamad Goldust^{14

15

16}

Affiliations

¹ Department of Dermatology, LTMMC and LTMGH, Mumbai, India.
² Department of Dermatology, L.T.M.M.C. and L.T.M.G.H., Sion Hospital, Mumbai, India.
³ Department of Dermatology, Medical University of Warsaw, Warsaw, Poland.
⁴ Department of Dermatology, Alpert Medical School of Brown University, Providence, Rhode Island, USA.
⁵ Department of Dermatology, Medical School of Jundiaí, São Paulo, Brazil.
⁶ GK Dermatology, PC, South Weymouth, Massachusetts, USA.
⁷ Worldwide Laser Institute, Dallas, Texas, USA.
⁸ College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, United Arab Emirates.
⁹ Department of Dermatology and Allergology, Städtisches Klinikum Dresden, Academic Teaching Hospital of the Technical University of Dresden, Dresden, Germany.
¹⁰ University of Studies Guglielmo Marconi, Rome, Italy.
¹¹ Clinic for Dermatovenerology, Clinical Center Nis, Nis, Serbia.
¹² Psychiatry Clinic, Clinical Center Nis, Nis, Serbia.
¹³ Department of Dermatology, University Medical Center of the Johannes Gutenberg University, Mainz, Germany.
¹⁴ University of Rome G. Marconi, Rome, Italy.
¹⁵ Department of Dermatology, University Medical Center Mainz, Mainz, Germany.
¹⁶ Department of Dermatology, University Hospital Basel, Basel, Switzerland.

PMID: 32279398
DOI: 10.1111/dth.13379

Abstract

Androgenetic alopecia (AGA) is a multifactorial disease that carries a significant psychological burden with it. Dihydrotestosterone, the main pathogenic androgen in AGA, is produced by conversion of testosterone, which is catalyzed by the 5-alpha reductase (5-AR) isoenzyme family. Finasteride and dutasteride are inhibitors of these enzymes. Finasteride, which is a single receptor 5-alpha reductase inhibitor (5-ARI), acts by blocking dihydrotestosterone (DHT). Dutasteride, a dual receptor DHT blocker, has a higher potency than its predecessor, finasteride. This review corroborates the evidence of superiority of dutasteride over finasteride, and its comparable safety profile concerning fertility, teratogenicity, neurotoxicity, and hepatotoxicity.

Keywords: 5-alpha reductase inhibitors; androgenetic alopecia; dutasteride; finasteride.

Publication types

Review

MeSH terms

5-alpha Reductase Inhibitors* / adverse effects
Alopecia / drug therapy
Androgen Antagonists
Dutasteride / adverse effects
Finasteride* / adverse effects
Humans

Substances

5-alpha Reductase Inhibitors
Androgen Antagonists
Finasteride
Dutasteride