Spironolactone in Acne Treatment

Spironolactone Is an Anti-androgen Medication That May Be Somewhat Effective for Women

Spironolactone in Acne Treatment

Article Summary

Spironolactone is an oral medication prescribed almost always to females that suppresses the production of male hormones (androgens) in the body. Higher levels of male hormones in both males and females lead to more skin oil production and more acne. Spironolactone reduces male hormone levels, thus decreasing skin oil production and ultimately decreasing acne symptoms.

Spironolactone is almost always only prescribed to females because it can cause feminizing effects when taken by males. Doctors normally prescribe it to female patients along with the birth control pill (combined oral contraceptive - COC). 

As with any medication, spironolactone can cause side effects, one of the most common in women being menstrual irregularities, such as increased or decreased bleeding or breakthrough bleeding (bleeding between periods). Menstrual side effects can be reduced by taking spironolactone with a COC.

Important: Because spironolactone can cause birth defects, women who are pregnant or may become pregnant should not take it, and should exercise caution while breastfeeding as well, since studies on rats indicate that spironolactone can cause tumors in the fetus.

 
Spironolactone is an oral medication that is primarily used in medicine to treat heart failure and high blood pressure. While it has not been approved by the U.S. FDA (Food and Drug Administration) to treat acne, doctors sometimes prescribe it for that purpose as well. This is called off-label prescribing, and it is a common practice with many medications.1

 

The reason that doctors prescribe spironolactone to treat acne is that it is an anti-androgen.1High levels of androgens (male hormones that are present in both males and females) contribute to acne. As a 2014 article in Clinics in Dermatology states, “Androgens play an important role in [skin oil] production and excretion. This subsequently contributes to the formation of acne lesions.”2Because anti-androgens reduce the amount of androgens in the body, they can help clear up acne lesions.

Androgens play an important role in skin oil production
Because spironolactone’s anti-androgen activity can cause undesirable side effects, such as breast enlargement in men, it usually is prescribed only to women when treating acne. The recommended dosage for acne treatment ranges from 25–200mg per day. Once acne is reduced, the recommended maintenance dosage ranges usually from 25–50mg per day. Researchers recommend starting with a low dose and increasing the dose only if necessary to control acne symptoms.

Oral Spironolactone

Spironolactone usually is prescribed with a combined oral contraceptive (COC, more commonly known as the birth control pill), though it can be taken alone.

Doctors also sometimes combine spironolactone with oral antibiotics. This is controversial since antibiotics produce only moderate benefit and come with a plethora of side effects. However, according to a 2012 review in The Journal of Clinical and Aesthetic Dermatology: 

Journal of Clinical and Aesthetic Dermatology

“Spironolactone has been used safely and effectively in combination with oral antibiotics including tetracyclines, erythromycin, and amoxicillin.”3


Oral Spironolactone Is Moderately Effective in Treating Acne

Six small studies performed to date indicate that oral spironolactone is at least moderately effective in treating acne. While the studies used different methods and looked at different numbers of patients, the results of each study show at least moderate improvement in acne in the majority of patients.4-9 It should be noted that although two of the studies included male patients, doctors almost always prescribe spironolactone only to women.



Studies Testing Oral Spironolactone on Acne

 

Topical Spironolactone Appears to Also Be Moderately Effective in Treating Acne

Spironolactone it is almost always prescribed for acne in its oral form, but is also available in topical form. 

Topical Spironolactone for Acne
We only have two studies that examine the effectiveness of topical spironolactone for treating acne, but it appears to also be effective. The first, an Italian study, found that one month of treatment with topical spironolactone either cleared or significantly improved acne in the vast majority of patients.10 The second study found that six weeks of treatment with topical spironolactone decreased the number of acne lesions by 71%.11



Studies Testing Topical Spironolactone on Acne


What Are the Side Effects of Oral Spironolactone?

As with all medications, spironolactone can cause side effects, particularly at higher doses. Most people tolerate low doses of spironolactone well, even for long periods of time. Side effects that can occur at dosages higher than 100mg per day include:

  • Menstrual irregularities, such as increased or decreased menstrual bleeding or breakthrough bleeding, which is bleeding that occurs between periods. Adding a COC to the treatment reduces these side effects.
  • Tenderness or enlargement of the breasts, in both males and females. Adding a COC to the treatment can reduce this side effect.
  • Orthostatic hypotension, which is a sudden drop in blood pressure when standing up that can result in dizziness or fainting.
  • Reduced libido (sex drive).
  • Excessively high potassium level in the blood. This is a dangerous side effect that can cause life-threatening heart problems. However, it is not common in healthy young people. Because of this side effect, people with kidney problems should not use spironolactone. In addition, spironolactone cannot be used with certain medications, including diuretics (medications that increase urination and can result in too much potassium in the blood) and ACE inhibitors, which often are used for high blood pressure.3

Side effects that do not seem to be related to dose include:

  • Tiredness
  • Headache
  • Lightheadedness
  • Dizziness3

Spironolactone can also come with these other side effects:

Oral Spironolactone Side Effects


Contraindications

Males should not take spironolactone because it can cause side effects related to its anti-androgen effects. These include impotence, enlarged breasts, and loss of libido.

Women who are pregnant or may become pregnant should not take spironolactone because it can cause birth defects, especially feminization of a male fetus. This is one reason that spironolactone often is prescribed with a COC.3

While the American Academy of Pediatrics classifies spironolactone as “probably compatible” with breastfeeding, women who are breastfeeding should carefully approach the decision to take spironolactone, as studies in rats indicate that it can cause tumors in the fetus.3

Talk to Your Doctor

Spironolactone

The Experts at Acne.org

Our team of medical doctors, biology & chemistry PhDs, and acne experts work hand-in-hand with Dan (Acne.org founder) to provide the most complete information on all things acne. If you find any errors in this article, kindly use this Feedback Form and let us know.

References:

  1. Zaenglein, A. L. et al. Guidelines of care for the management of acne vulgaris. J. Am. Acad. Dermatol. 74, 945–973 (2016).
  2. Lam, C. L. & Zaenglein, A. L. Contraceptive use in acne. Clin. Dermatol. 32, 502–515 (2014).
  3. Kim, G. K. & Del Rosso, J. Q. Oral spironolactone in post-teenage femal patients with acne vulgaris. J. Clin. Aesthet. Dermatol. 5, 37–50 (2012).
  4. Goodfellow, A. et al. Oral spironolactone improves acne vulgaris and reduces sebum excretion. Br. J. Dermatol. 111, 209–214 (1984).
  5. Muhlemann, M. F., Carter, G. D., Cream, J. J. & Wise, P. Oral spironolactone: an effective treatment for acne vulgaris in women. Br. J. Dermatol. 115, 227–232 (1986).
  6. Shaw, J. C. Low-dose adjunctive spironolactone in the treatment of acne in women: a retrospective analysis of 85 consecutively treated patients. J. Am. Acad. Dermatol. 43, 498–502 (2000).
  7. Yemisci, A., Gorgulu, A. & Piskin, S. Effects and side-effects of spironolactone therapy in women with acne. J. Eur. Acad. Dermatol. Venereol. 19, 163–166 (2005).
  8. Sato, K. et al. Anti-androgenic therapy using oral spironolactone for acne vulgaris in Asians. Aest. Plast. Surg. 30, 689–694 (2006).
  9. Krunic, A., Ciurea, A. & Scheman, A. Efficacy and tolerance of acne treatment using both spironolactone and a combined contraceptive containing drospirenone. J. Am. Acad. Dermatol. 58, 60–62 (2008).
  10. Califano, L., Cannavò, S., Siragusa, M. & Girardi, R. [Experience in the therapy of acne with topical administration of spironolactone as an antiandrogen]. Clin. Ter. 135, 193–199 (1990).
  11. Afzali, B. M., Yaghoobi, E., Yaghoobi, R., Bagherani, N. & Dabbagh, M. A. Comparison of the efficacy of 5% topical spironolactone gel and placebo in the treatment of mild and moderate acne vulgaris: a randomized controlled trial. J. Dermatolog. Treat. 23, 21–25 (2012).
See More References

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