Finasteride, sold under brand names like Propecia and Proscar, is prescribed primarily to treat male pattern baldness (androgenetic alopecia) and benign prostatic hyperplasia (BPH) in men. The drug alters the body’s hormonal balance to achieve its therapeutic effects. Some users express concern about potential side effects, particularly the development of acne. Understanding finasteride’s influence on the skin requires examining its mechanism of action and reported incidence rates.
Finasteride’s Effect on Skin and Acne Incidence
Finasteride’s effect on the skin is not a universally reported side effect. In clinical trials, the incidence of acne is considered uncommon, often showing no significant difference compared to the placebo group. However, anecdotal reports suggest that a new onset or an exacerbation of pre-existing breakouts can occur after starting the medication.
For individuals who experience a change, the skin may become oilier, which can lead to clogged pores and the formation of blemishes. These breakouts typically present as mild to moderate acne, such as whiteheads, sometimes appearing on the face or upper back. Conversely, some users report the opposite effect, observing reduced skin oiliness or improved skin quality while on the medication. This varied response highlights the complex nature of hormonal changes on individual skin physiology.
Hormonal Shifts and the Development of Breakouts
The connection between finasteride and acne is rooted in the drug’s interference with the endocrine system. Finasteride functions as a specific inhibitor of the Type II 5-alpha reductase enzyme. This enzyme is responsible for converting the androgen testosterone into the more potent androgen, dihydrotestosterone (DHT).
By blocking this conversion, finasteride significantly lowers systemic DHT levels, often by up to 70% in the blood serum. This reduction in DHT is the intended effect for treating hair loss and BPH. However, the body compensates for this reduction by increasing the circulating levels of free testosterone, which may rise by approximately 10% to 20%.
This relative increase in testosterone is believed to be the primary driver behind finasteride-related acne. Testosterone, and other androgens, directly stimulate the sebaceous glands in the skin to produce sebum, an oily substance. An elevation in free testosterone can lead to an overproduction of sebum, which then mixes with dead skin cells to clog pores and initiate the acne process. Although the sebaceous glands contain the Type I 5-alpha reductase enzyme, the systemic shift in the balance of androgens is sufficient to trigger a breakout in sensitive individuals.
Strategies for Managing Finasteride-Related Acne
For individuals experiencing acne after beginning finasteride, several practical steps can be taken to manage the condition. A key initial step is maintaining an appropriate skincare regimen, including the use of non-comedogenic products that will not further clog pores. Daily cleansing helps remove excess oil and debris from the skin’s surface.
Over-the-counter topical treatments are often effective for mild to moderate breakouts. Products containing benzoyl peroxide (typically 2.5% to 5% concentration) help kill acne-causing bacteria and reduce inflammation. Alternatively, salicylic acid (about 2%) is a beta-hydroxy acid that helps exfoliate the pore lining and clear blockages. For more persistent acne, a topical retinoid like adapalene 0.1% gel can be applied at night to regulate cell turnover and prevent new blemishes.
The skin often requires time to adjust to new hormonal levels, and initial acne flare-ups may resolve naturally within the first first few months. If topical treatments do not yield improvement after four to six weeks, or if the acne becomes severe or cystic, consultation with the prescribing physician or a dermatologist is advised. A specialist can assess the severity and duration of the breakout and determine if a prescription-strength treatment or an adjustment to the overall regimen is necessary.