Expanding our Topical Armamentarium: The Potential of Clacosterone in Treating Hidradenitis Suppurativa
Hidradenitis Suppurativa (HS) is a chronic, inflammatory skin disease characterized by recurrent, painful nodules, abscesses, and sinus tracts. These lesions primarily occur in areas of the body where skin rubs together, such as the armpits, groin, buttocks, and under the breasts. HS can significantly impact a patient’s quality of life due to its painful symptoms and the psychological impact of its visible lesions and scarring. Patients are often told they are “dirty,” but the reality is this condition is often genetically driven. Despite affecting up to 4% of the population, treatment options for HS are limited. Currently, the only FDA-approved medications for HS are adalimumab and secukinumab, both of which are systemic therapies. This highlights a significant unmet need for more targeted, effective treatments.
Clacosterone: A Novel Approach
Clacosterone (Winlevi), also known as cortexolone 17α-propionate, is an antiandrogen that was initially studied for effectiveness in treating acne vulgaris. By competitively inhibiting dihydrotestosterone (DHT) from binding to androgen receptors, clacosterone helps reduce lipid synthesis and inflammatory cytokine production in the skin. Because of its role in inhibiting DHT, clacosterone’s ability to treat other DHT related conditions such as androgenetic alopecia and hidradenitis suppurativa is also of interest.
Potential of Clacosterone in HS Treatment
The pathogenesis of HS is not completely clear, but hormonal factors seem to play a role. Many of my female patients experience perimenstrual flares, and the disease typically manifests around puberty. There’s evidence that androgen receptors in HS lesions are overexpressed, which suggests that targeting these receptors can help control the disease. This would also explain why androgen inhibitors such as spironolactone are often effective treatment options for HS.
Recent studies have explored the use of clacosterone in HS with promising results. One case report highlighted a 23-year-old woman with a five-year history of mild HS. She experienced significant improvement after using clacosterone cream. Before treatment, she would develop 5 to 6 painful lesions monthly, primarily during her menstrual cycle. With the application of clacosterone cream, the number of lesions reduced to 2 to 3 per month, and the lesions that did appear were less painful and resolved more quickly.
Clinical Evidence and Studies
In another retrospective study involving 12 patients with HS treated with clacosterone, 83% reported improvements. These improvements included less frequent flares, smaller lesions, and reduced erythema around the lesions. The study concluded that clacosterone could potentially reduce the severity and number of HS nodules and may help prevent disease progression.
Benefits and Future Directions
Clacosterone offers several benefits over traditional treatments like spironolactone. It is a topical treatment, which means it has fewer systemic side effects. This is particularly advantageous for male patients who might experience feminizing effects with systemic antiandrogens like spironolactone. Additionally, clacosterone has not shown significant systemic antiandrogenic effects in studies evaluating its safety as an acne treatment option, making it a safer option for long-term use.
While clacosterone is not a cure-all for HS, its ability to target the hormonal component of the disease offers a new mechanism of action for treatment. In a disease without many options, this is exciting news! Further studies, including randomized controlled trials comparing clacosterone with other topical agents like clindamycin, will be helpful to establish its efficacy and optimal use in HS management.
Conclusion
The introduction of clacosterone as a treatment for hidradenitis suppurativa represents another step forward in managing this challenging condition. Its efficacy in reducing lesion frequency and severity, combined with a favorable safety profile, makes it a promising option for patients suffering from HS. At Pure Dermatology, our board-certified dermatologists stay up-to-date with novel treatments. If you are suffering from hidradenitis suppurativa, or another challenging skin condition, come see us. We are committed to offering cutting-edge treatment options to improve our patients' quality of life.
