Hidradenitis suppurativa/acne inversa is a chronic inflammatory skin condition characterized by deep-seated painful nodules, abscesses, and draining sinus tracts that appears on apocrine gland-rich skin regions of the body. 

Observational results show that the condition often manifests after puberty, has pre-menstrual flares in women, improves during pregnancy, and worsens post-partum, indicating a role for hormones, notably androgens, in its etiology. End-organ androgen hypersensitivity has been proposed because of the lack of widespread reporting of elevated androgen levels in serum. A systematic review was done to find and report evidence for antiandrogen therapy alternatives for hidradenitis suppurativa/acne inversa.

On December 1, 2018, a literature search was undertaken in several medical electronic databases using the terms “hidradenitis”, “suppurativa”, “acne inversa”, and “antiandrogen”. Following that, the primary therapy possibilities were employed as distinct keywords alongside the illness phrases in a separate search.

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Cyproterone acetate, spironolactone, finasteride, and metformin were the most common therapy alternatives found. Following the use of a standard extraction form for eligibility, one randomized controlled crossover study and seven case series were discovered. Existing research does not provide a strong evidence-based recommendation for the use of antiandrogens in the treatment of hidradenitis suppurativa/acne inversa. More randomized controlled studies are needed to determine the function of hormone therapy as an alternate or concurrent therapy with antibiotics or biologics.

Reference: link.springer.com/article/10.1007/s40257-019-00442-w