From the Guidelines
Spironolactone for acne typically requires 3-6 months of continuous use before significant improvement is seen, and it may need to be taken long-term for ongoing benefits. The medication works by blocking androgen receptors and reducing sebum production, addressing hormonal acne particularly in women. Treatment usually starts at 25-50mg daily, potentially increasing to 100-200mg daily based on response and tolerance, as suggested by recent guidelines 1. Most patients who respond well continue treatment for years, with attempts to taper or discontinue often resulting in acne recurrence. When discontinuation is desired, it should be done gradually under medical supervision.
Some key points to consider when using spironolactone for acne include:
- Starting dose: 25-50mg daily, potentially increasing to 100-200mg daily based on response and tolerance 1
- Duration of treatment: typically 3-6 months before significant improvement is seen, and may need to be taken long-term for ongoing benefits
- Side effects: may include irregular periods, breast tenderness, and potassium level changes, requiring periodic blood tests during treatment 1
- Contraindications: generally not recommended for men or pregnant women due to feminizing effects and potential birth defects, respectively 1
It's also important to note that spironolactone is not FDA-approved for the treatment of acne, but it is conditionally recommended based on moderate certainty evidence from several studies 1. Potassium monitoring should be considered in older patients, patients with medical co-morbidities, and patients taking medications affecting renal, adrenal, and hepatic function 1. Overall, spironolactone can be an effective treatment for hormonal acne in women, but it should be used under medical supervision and with careful consideration of potential side effects and contraindications.
From the Research
Duration of Spironolactone Treatment for Acne
- The duration of spironolactone treatment for acne can vary, but studies have shown that it can be effective for long-term treatment 2.
- A retrospective review of 395 adult patients found that the median duration of spironolactone treatment was 13 months, with few adverse effects 2.
- Another study found that patients received spironolactone for a median of 2 to 102 months, with significant improvement seen within the first 3-6 months 3.
Efficacy of Spironolactone for Acne
- Spironolactone has been shown to be effective in reducing acne lesions and improving acne severity, with a meta-analysis finding a significant reduction in total lesion count and acne severity index after 8 weeks 4.
- A study found that 66.1% of patients had a complete response to spironolactone treatment, and 85.1% had a complete or partial response greater than 50% 2.
- Another study found that 63.4% of women on treatment with spironolactone and topical retinoids had an excellent or clear outcome, and 85.4% were considered to have a good, excellent, or clear response 3.