From the Guidelines
Spironolactone is conditionally recommended for the treatment of acne, particularly for hormonal acne, based on moderate certainty evidence from recent studies 1. However, its effectiveness for non-hormonal acne is not well established. Spironolactone works by blocking androgen receptors and reducing sebum production, making it more suitable for hormonal acne, especially in women with breakouts along the jawline, chin, and lower face that worsen around menstruation. For non-hormonal acne caused by factors like bacteria, inflammation, or skin cell turnover issues, other treatments are more appropriate, such as:
- Topical retinoids (like tretinoin 0.025-0.1%)
- Benzoyl peroxide (2.5-10%)
- Salicylic acid products
- Oral antibiotics like doxycycline (50-100mg daily) for moderate to severe cases, as recommended by recent guidelines 1. It is essential to consult with a dermatologist to properly diagnose the type of acne and recommend targeted treatments. Additionally, when using spironolactone, potassium monitoring should be considered in older patients or those with medical comorbidities, and patients should avoid a diet high in potassium 1.
From the Research
Spironolactone and Non-Hormonal Acne
- Spironolactone, an aldosterone antagonist, has been used off-label to treat various dermatological conditions, including acne, due to its antiandrogenic properties 2.
- Studies have shown that spironolactone can be effective in treating adult female acne, with one study finding that low-dose spironolactone (25-50 mg/day) combined with topical benzoyl peroxide improved moderate acne in Thai women 3.
- A retrospective review of 395 adult patients at Mayo Clinic found that spironolactone treatment resulted in a complete response in approximately two-thirds of patients, with efficacy observed across all severity subtypes of acne 4.
- A systematic review and meta-analysis of 1,086 patients found that spironolactone was effective in reducing total lesion count and acne severity index, with a significant improvement in acne severity index compared to the topical group 5.
- While spironolactone is not typically considered a first-line treatment for non-hormonal acne, it may be considered for patients with severe or resistant acne, particularly those with hormonal imbalances or androgen-mediated conditions 6.
Mechanism of Action
- Spironolactone's antiandrogenic properties make it suitable for treating conditions caused by excess androgen production, including acne 2.
- The medication works by blocking the effects of androgens, such as testosterone, which can contribute to acne development 3.
- By reducing androgen-mediated sebum production and inflammation, spironolactone can help improve acne symptoms 4.
Efficacy and Safety
- Studies have consistently shown that spironolactone is effective in treating acne, with significant improvements in lesion count and acne severity index 3, 4, 5.
- The safety profile of spironolactone is generally excellent, with few adverse effects reported in clinical trials 3, 4, 5.
- However, patients should be monitored for potential side effects, such as menstrual irregularities, breast tenderness, and dizziness 3.