Drug-Induced Melasma in Patients on 5-Alpha Reductase Inhibitors: A Case Report

February 2026 in “ Case Reports in Dermatology ”

Hiba Elhaj, K.A. Orrell, Renée A. Beach

finasteride 5-alpha reductase inhibitors melasma frontal fibrosing alopecia benign prostatic hyperplasia cysteamine cream facial hyperpigmentation Propecia BPH

TLDR Finasteride can cause melasma, especially in people with darker skin.

This case report documents two instances of finasteride-induced melasma, expanding the limited literature on this adverse effect. A 53-year-old woman and a 66-year-old man, both with darker skin types, developed melasma after prolonged use of finasteride for frontal fibrosing alopecia and benign prostatic hyperplasia, respectively. Discontinuation of finasteride and targeted melasma therapies, including cysteamine cream, led to partial improvement. The report emphasizes the importance of considering 5-alpha reductase inhibitor exposure in patients with new or persistent facial hyperpigmentation, especially in those with darker skin, to prevent ongoing pigmentation issues.

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