What is spironolactone used for?

Spironolactone was first used to treat high blood pressure and water retention, which is the licensed indication for the medication. Spironolactone also has an anti androgen effect. Dermatologists use spironolactone to treat acne in women and occasionally female pattern hairloss.

Why are androgens important in acne?

Androgens (“male hormones”) are normally produced by both men and women. Most people with acne have normal hormone levels. In women who menstruate hormone levels fluctuate throughout the menstrual cycle. At certain times of the month in women as oestrogen levels drop, androgen levels can be higher in comparison. 

Due to its anti androgen actions spironolactone is now widely used as an oral medication for treating acne vulgaris among female patients. It can be particularly helpful in acne that gets worse before the menstrual period starts. By blocking androgen hormones, this treatment reduces sebum production helping many women manage their acne.

Studies have shown that Spironolactone is an effective treatment for hormonal acne, with up to 85% of patients experiencing improvement. A recent randomised controlled trial of 133 patients showed superior results in spironolactone therapy compared with doxycycline.

Treatment typically involves initially stepwise increasing the dose and blood test monitoring. 

Spironolactone is usually prescribed at a dose of 50–100 mg daily with meals, but many women with sporadic outbreaks can take doses as low as 25 mg daily. ¹

Although spironolactone is used in this context with clinical success, its use based on clinical experience, case series, and small trials.

Understanding Hormonal Acne

Studies have shown that about 70% of women with acne complain of a flare 2–7 days before the onset of menstruation. This appears to affect all ethnic groups but perhaps not equally.²

Hormonal acne can be a difficult skin condition to deal with, and can persist in adult women. 

PCOS can be another possible factor which drives development of acne. Treating this type of acne can involve use of oral medications like spironolactone, but certain contraceptive pills can be helpful in controlling the acne. Topical treatments are often used alongside hormonal treatment.

Spironolactone in Comparison with Other Treatments

Publications have shown comparable or superior outcomes when treating hormonal acne with spironolactone in comparison with oral antibiotics.

Prescribing long courses of oral antibiotics for acne has been historically common. Current  acne guidelines recommend oral antibiotics are limited to three to six months to reduce the  antimicrobial resistance.³

Having started oral antibiotics it can be difficult to stop them as patients often report flares of acne and therefore alternative treatment such as spironolactone have a role in acne management.⁴ 

In women with acne that persists despite topical treatment, prescribing oral spironolactone alongside topical treatment has the potential to reduce long term oral antibiotic use.

Oral isotretinoin is more effective in most people than either antibiotics or spironolactone.

Effectiveness of Spironolactone for Hormonal Acne

Approximately two thirds of patients report significant improvements in their acne with use of spironolactone.

Real-World Results

Hormonal acne treatment with spironolactone has seen impressive results in various studies. The success rates that patients speak of range from 50% improvement up to 86%, so it’s an option worth looking into for those dealing with such issues. People who are responding often report complete clearance after around 5-6 months. 

Clinical Studies

The effectiveness of spironolactone in treating hormonal acne has been confirmed by many clinical studies. A study ⁵ with 110 female individuals taking part saw a drastic increase in results when the drug was used alongside existing treatments – 87% of women reported positive effects on their skin condition using the CASS score to evaluate severity levels before and after treatment.

Will Spironolactone work for me?

Spironolactone is prescribed for adult women with acne but can not be used in men or those trying to become pregnant due to potential impacts on hormones. A doctor will take into account any contraindications such as pregnancy, breastfeeding and existing kidney conditions before beginning a course of spironolactone. Blood test monitoring is often carried out before and whilst taking spironolactone, since the drug may affect potassium levels in some cases. The frequency of the blood tests will depend on your medical history and risk factors.

Reasons not to take this medicine

• Patients with kidney disease or those taking medications affecting potassium levels should exercise caution with spironolactone due to potential adverse effects on kidney function and the risk of hyperkalemia.
• Pregnant or breastfeeding women should not take spironolactone unless the potential benefit outweighs risk as it has shown to result  in feminisation of male babies in animal studies.

Age and Gender Considerations

For female patients, spironolactone can be an efficient treatment for acne that has not responded to topical therapies. Studies have revealed its effectiveness and safety in adult women. Men should not use this medication as it can result in impotence, loss of libido or gynecomastia.

Potential Side Effects of Spironolactone

The most common reported side effects are menstrual irregularity, breast tenderness, occasional fluid retention and, rarely, melasma. 

As outlined above avoiding pregnancy is important due to potential abnormalities to the male fetus and as potassium levels can increase with spironolactone they should be monitored.

• Irregular periods: Spironolactone may cause irregularities in menstrual cycles for some individuals. It is advisable to discuss any changes in menstrual patterns with your Dermatologist or whoever has prescribed you the medication.
• Breast tenderness: Some individuals may experience breast tenderness as a side effect of spironolactone. If this occurs, it is important to consult with the  dermatologist who prescribed you the medication. 
• Increased urination: Some individuals taking spironolactone may experience an increase in urination, which is a common response to the medication's diuretic effect.
• Fatigue: Fatigue can be a potential side effect of spironolactone, and individuals should promptly inform their doctor if they experience persistent or severe tiredness while using the medication.

Treatment Process: Dosage, Duration, and Monitoring

Spironolactone treatment is usually initiated at a low dose of 25mg  and then gradually increased after being monitored through regular check-ups and blood tests with a usual maximum dose of 100mg a day. Adjustment or discontinuation once satisfactory results are achieved. The duration of spironolactone treatment will vary depending on each individual case.

Summary

When it comes to adult women with hormonal acne, spironolactone may be an effective treatment. Research has shown its efficacy and side effects are manageable. Spironolactone can work alongside other existing acne treatments. If you are interested in trying spironolactone please discuss the treatment with your Dermatologist.

Frequently Asked Questions