Cortexolone 17α-propionate (
clascoterone) is a novel topical
androgen antagonist that is being analyzed for its ability to treat
acne. The pathogenesis of
acne is attributed to multiple factors, including altered sebum production, inflammatory processes, dysregulation of the
hormone microenvironment, and the proliferation of the skin commensal bacteria, Propionibacterium acnes (P. acnes).
Androgens induce the proliferation and differentiation of sebocytes, (cells that comprise the sebaceous gland), help regulate the synthesis of the
lipids that are incorporated into sebum and stimulate the production of
cytokines that are found in inflammatory
acne lesions. Several studies have established that
clascoterone is a potent
antiandrogen that is well tolerated and has selective topical activity. Its potency as an
acne therapeutic is currently being analyzed in a large phase 3 clinical trial. The study described herein elucidates for the first time the mechanism of action of
clascoterone.
Clascoterone was found to bind the
androgen receptor (AR) with high affinity in vitro, inhibit AR-regulated transcription in a reporter cell line, and antagonize
androgen-regulated
lipid and inflammatory
cytokine production in a dose-dependent manner in human primary sebocytes. In particular, when compared to another AR antagonist,
spironolactone,
clascoterone was significantly better at inhibiting inflammatory
cytokine synthesis from sebocytes. Therefore,
clascoterone may be an excellent candidate to be the first topical
antiandrogen to treat
acne. J Drugs Dermatol. 2019;18(5):412-418.