Can acne on the chin and lower jaw be a side effect of spironolactone or minoxidil (Rogaine)?

Acne on the Chin and Lower Jaw as a Side Effect of Spironolactone or Minoxidil

Acne on the chin and lower jaw is not a documented side effect of either spironolactone or minoxidil; in fact, spironolactone is actually used to treat acne, particularly hormonal acne that commonly appears on the lower face in women. 1

Spironolactone and Acne

Mechanism and Use

• Spironolactone is a synthetic 17-lactone steroid with anti-androgenic properties that has been used off-label for treating acne for over 30 years 1
• It works by inhibiting androgen receptors on sebocytes and reducing sebum production, which helps improve acne 1
• Spironolactone may be effective for acne in women of all ages and is not limited to those with acne specifically on the lower face 1

Efficacy for Acne Treatment

• Multiple large retrospective studies support spironolactone's effectiveness in treating acne 1
• In a study of 110 women with acne treated with spironolactone, 94 patients (85.5%) saw improvement in their acne severity scores 2
• Low-dose spironolactone (50 mg/day) combined with topical benzoyl peroxide has proven effective in improving moderate adult female acne with an acceptable side effect profile 3

Common Side Effects of Spironolactone

• Menstrual irregularities (15-30% of patients) 1
• Breast tenderness (3-5%) 1
• Dizziness (3-4%) 1
• Nausea (2-4%) 1
• Headache (2%) 1
• Polyuria (1-2%) and fatigue (1-2%) 1

Important Note on Acne Distribution

• Spironolactone is particularly effective for hormonal acne that often appears on the chin and jawline 1
• It would be unusual for spironolactone to cause acne in these areas, as it is specifically used to treat acne in these locations 1

Minoxidil and Acne

• There is no evidence in the provided literature that minoxidil (Rogaine) causes acne on the chin or lower jaw [1-4]
• Minoxidil is primarily used for treating hair loss and is not associated with acne development in the provided evidence [1-4]

Clinical Considerations

For Patients with Chin/Jaw Acne

• If a patient is experiencing acne on the chin and lower jaw while taking spironolactone, it is more likely that:
  • The medication hasn't had sufficient time to work (several months of treatment may be required) 1
  • The dosage may need adjustment (doses range from 25-200 mg/day) 3, 4
  • The acne may be due to other factors (hormonal fluctuations, stress, cosmetics, etc.) 1

For Women with Hormonal Acne

• Spironolactone is actually a recommended treatment option for women with acne, particularly when it appears on the lower face 1
• Long-term safety studies show that spironolactone is safe for treating acne in women, with no serious illnesses attributed to its use after 200 person-years of exposure 5

Alternative Considerations

• If acne persists or worsens while on spironolactone, consider:
  • Combination therapy with topical treatments 3
  • Evaluation for other hormonal issues 1
  • Assessment of other potential acne triggers 1

Monitoring and Follow-up

• Allow adequate time for spironolactone to take effect (several months) before determining efficacy 1
• Side effects are common (59% of patients) but usually not severe enough to discontinue treatment (only 15% discontinue due to side effects) 5
• Potassium monitoring is not required in young healthy women without risk factors for hyperkalemia 1