Spironolactone and cyproterone acetate

Spironolactone

What it is: Women who experience acne tend to have higher levels of androgens (male sex hormones). Spironolactone is an androgen receptor blocker. In other words, it prevents the cells of the body from interacting with androgens. Less androgens typically means less acne. Spironolactone is taken in pill form and can be used with other topical acne treatments. It is especially effective when hirsutism is present. Hirsutism means excessive hair growth in women. Spironolactone is also used to treat this condition.

Study results: Spironolactone has been shown to improve acne symptoms in several studies, both on its own and coupled with oral contraceptives. In a study published in the Journal of the American Academy of Dermatology in 2008, 85% of women achieved very good results with a combination of spironolactone and an oral contraceptive with drospirenone. Another study published in the European Academy of Dermatology and Venereology showed "clinically significant improvement" in 85.71% of subjects taking spironolactone alone.

Side effects: Side effects are common. Studies show upwards of 50% of women experiencing menstrual irregularities. Spironolactone may create breast tenderness, headache, or fatigue, and can also have a diuretic effect. In pregnant women, feminization of the male fetus is also possible. However, an 8-year study published in the Journal of Cutaneous Medical Surgery concluded, "...there were no cases of serious illness attributable to spironolactone use."

Note: Asian women sometimes respond differently to hormonal treatment. However, a study using 116 Japanese women completed in 2006 showed that "...spironolactone is effective and safe for the treatment of acne in Asian females..."

Men: Spironolactone is usually reserved for use in females because gynecomastia (breast growth) can occur in males who take the drug.

Spironolactone member reviews

Cyproterone acetate

What it is: Acne-prone women tend to have higher levels of androgens (male sex hormones). Cyproterone acetate is an anti-androgen, which helps suppress the male sex hormones testosterone and dihydrotestosterone (DHT). Less androgens typically means less acne. Cyproterone acetate is administered in pill form and also sometimes as a lotion. In both forms it has been shown to reduce sebum (skin oil) production. It can normally be used alongside other topical acne treatments. It is also used to treat polycystic ovary syndrome, excessive hair growth (hirsuitism), alopecia, and other diseases where androgen action is involved. Cyproterone acetate is a main ingredient in Diane-35, one of the most effective oral contraceptives at treating acne.

Side effects: The most notable side effect is liver toxicity. In combination with oral contraceptives, there is an increased risk of blood clots. Osteoporosis is also a potential side effect with long-term use.

Note: Asian women sometimes respond differently to hormonal treatment. If you are of Asian descent, be sure to ask your doctor if he/she is aware of your particular circumstance before embarking on treatment.

Men: Cyproterone acetate is usually reserved for use in females because gynecomastia (breast growth) and galactorrhea (milk production) may occur in males who take the drug.

Diane-35 (oral contraceptive plus cyproterone acetate) member reviews

References

“Frequently Asked Questions: Acne.” Womenshealth.gov. 1 Jan. 2005. National Women’s Health Information Center. 8 Jan 2009. link.

Farquhar C, Lee O, Toomath R, Jepson R. “Spironolactone versus placebo or in combination with steroids for hirsutism and/or acne.” Comment in American College of Physicians Journal Club. 2004 May-Jun; 140(3):74.

Krunic A, Ciurea A, Scheman A. “Efficacy and tolerance of acne treatment using both spironolactone and a combined contraceptive containing drospirenone.” Journal of the American Academy of Dermatology. 2008 Jan;58(1):60-2.

Sato K, Matsumoto D, Iizuka F, Aiba-Kojima E, Watanabe-Ono A, Suga H, Inoue K, Gonda K, Yoshimura K. “Anti-androgenic therapy using oral spironolactone for acne vulgaris in Asians.” Aesthetic Plastic Surgery. 2006 Nov-Dec;30(6):689-94.

Shaw JC. “Low-dose adjunctive spironolactone in the treatment of acne in women: a retrospective analysis of 85 consecutively treated patients.” Journal of American Academy of Dermatology. 2000 Sep;43(3):498-502.

Shaw JC, White LE. “Long-term safety of spironolactone in acne: results of an 8-year followup study.” Journal of Cutaneous Medicine and Surgery. 2002 Nov-Dec;6(6):541-5. Epub 2002 Sept 12.

Turowski CB, James WD. “The efficacy and safety of amoxicillin, trimethorprim-sulfamethoxazole, and spironolactone for treatment-resistant acne vulgaris.” Advances in Dermatology. 2007;23:155-63.

Yemisci A, Gorgulu A, Piskin S. “Effects and side-effects of spironolactone therapy in women with acne.” Journal of the European Academy of Dermatology and Venereology. 2005 Mar;19(2):163-6.