Photosensitivity from Bicalutamide: Does it occur in women using bicalutamide for hair loss?

Photosensitivity with Bicalutamide

Bicalutamide is increasing used in post menoapausal women for the treatment of female pattern hair loss (andorgenetic alopecia). It’s an “off label” use as this drug is mainly approved and used to treat prostate cancer in men.

Bicalutamide is a closely related medication to “flutamide” - which had also once been used as an anti-androgen.

Does bicalutamide cause photosensitivity in women?

BICALUTAMIDE PHOTOSENSITIVITY STUDIES IN WOMEN

Flutamide can cause photosensitivity reactions. The question then arises - can bicalutamide cause photosensitivity in female patients using the drug for androgenetic hair loss?

The short answer is that bicalutamide is not commonly reported in the published medical literature to cause photosensitivity in women at low doses like 12.5 mg or 25 mg used in hair loss. Of 316 patients treated with bicalutamide for androgenetic alopecia in the study by Ismail and colleagues, only 1 had reported photosensitivity. That’s about 0.3%. In the smaller study by Fernandez Nieto and colleagues (17 patients), there were no reports of photosensitivity reactions.

BICALUTAMIDE PHOTOSENSITIVITY STUDIES IN MEN

To date, there are mainly four reports of bicalutamide causing photosensitivity and all are in male patients using the drug for prostate cancer:

Kurumaji Y. 2007: 76 year old male and 77 year old male

Sasada et al, 2012: 59 year old male

Lee et al, 2016: 71 year old male

Summary

These above reports are helpful for us to know about as we enter the new world of using bicalutamide for female pattern hair loss. It appears that photosensitivity is not very common and generally occurs within 1-2 months. Photosensitivity may not require all patients to discontinue the drug provided good sun protection is used.

It also appears the photosensitivity rashes respond quickly to treatment. In the Lee et al study, rashes disappeared within a few days of using prednisone use and did not return even with continuing the medication.

MALE PROSTATE CANCER REFERENCES

Lee K et al. Drug-induced photosensitivity to bicalutamide - case report and review of the literature. Photodermatol Photoimmunol Photomed. 2016 May;32(3):161-4.

Kurumaji Y. Photosensitivity due to bicalutamide. J Environ Dermatol Cutan Allergol 2007; 1: 185–195. 2.

Sasada K, Sakabe J, Tamura A, et al. Photosensitive drug eruption induced by bicalutamide within the UVB action spectrum. Eur J Dermatol 2012; 22: 402– 403.

Kumar RJ, Barqawi A, Crawford DE. Adverse events associated with hormonal therapy for prostate cancer. Rev Urol 2005; 7(Suppl 5): S37–S43.

WOMEN’S HAIR LOSS REFERENCES

Ismail et al. Safety of oral bicalutamide in female pattern hair loss: A retrospective review of 316 patients. J Am Acad Dermatol. 2020 Nov;83(5):1478-1479.

Fernandez-Nieto et al. Oral bicalutamide for female pattern hair loss: A pilot study. Dermatol Ther . 2019 Nov;32(6):e13096.