All about spironolactone

What is Spironolactone?

Spironolactone is a prescription medication. It comes as both a tablet and a topical ingredient. Oral spironolactone is also used to treat high blood pressure. It’s use in dermatology in the treatment of acne is considered as ‘off-licence’, but it has a good amount of evidence to support it’s effectiveness.

How does Spironolactone work?

Spironolactone blocks the effects of certain hormones called androgens (testosterone is a type of androgen). Androgens are often considered ‘male hormones’ but women produce them in low levels. The sebaceous glands in the skin contain androgen receptors. Activation of these receptors can lead to increased sebum production which is implicated in the pathogenesis of acne. It is thought that some women have raised levels of androgens or an increased sensitivity to androgens and are therefore more susceptible to developing acne.

What do dermatologists use spironolactone for?

As well as acne, dermatologists use oral spironolactone to treat certain types of hair loss in females (‘female pattern hair loss’) as well as excessive facial hair in women (‘hirsutism’). It is also used in the management of polycystic ovarian syndrome (PCOS), a condition in which there are increased levels of circulating androgens. Oral spironolactone is not used to treat acne in males because of it’s hormonal effects.

What types of acne does spironolactone work for?

Spironolactone has traditionally been used to treat ‘hormonal acne’. Hormonal acne is characterised by spots around the chin, jawline and side of the face and typically gets worse or is triggered by menstruation. However, is can also be a very effective treatment for for acne that doesn’t fulfil all of these criteria.

What about topical spironolactone?

Oral spironolactone, although generally well tolerated in the doses used for the treatment of acne, can have side effects, as is the cause with any oral medication. Because of this scientists are starting to look at the efficacy of topical spironolactone. One study compared topical spironolactone to topical clindamycin (an antibiotic) in patients with mild to moderate acne. Topical spironolactone appeared to be effective and in some instances out performed clindamycin.

So is Spironolactone a good treatment for me?

It depends on many things like your medical history, your gender, the type of acne and if there are any other factors contributing to your acne. Oral spironolactone can work very well. It is worth being aware that results can take a few months to see a significant improvement.

References

https://www.bad.org.uk/pils/spironolactone/

Ayatollahi A, Samadi A, Bahmanjahromi A, Robati RM. Efficacy and safety of topical spironolactone 5% cream in the treatment of acne: A pilot study. Health Sci Rep. 2021 Jul 1;4(3):e317. 

Noaimi A, Al-Saadi SR. Treatment of Acne Vulgaris by Topical Spironolactone Solution Compared With Clindamycin Solution. Cureus. 2021 Aug 31;13(8):e17606.