Spironolactone (also called "aldactone") is an oral medication that may be prescribed for the treatment of acne.
Spironolactone is most commonly prescribed as a diuretic ("water pill") to control blood pressure, but has been increasingly used by dermatologists to control acne and excess hair growth. Spironolactone is particularly helpful for post-adolescent women with persistent acne, or to treat what is referred to as "hormonal acne".
How Does Spironolactone Work?
Spironolactone can block the effects of certain types of hormones called "androgens". (Testosterone is a type of androgen). By blocking androgens, spironolactone helps to reduce oil (sebum) production and reduce the number of acne flares.
How Is Spironolactone Taken?
The optimal dose of spironolactone varies for each individual. Spironolactone may be started at doses as low 50 mg daily and increased to as high as 200 mg daily, but most patients respond well at doses of 100 mg daily.
The goal of treatment is to bring the acne under control and maintain clear skin with the lowest dose possible. Some people may remain on spironolactone for many years if it provides sufficient relief and remains well tolerated.
Results of treatment may be seen within one month of starting treatment. However, it may take 2 to 3 months of use to see the full benefit of spironolactone use.
Side Effects of Spironolactone
Serious side effects with spironolactone are extremely rare. The most common side effect is irregularity of menstrual cycles, especially with doses over 100 mg daily. However, this can often be controlled with the use of birth control pills. (The use of birth control pills can also help to treat hormonal acne.)
Read the medication guide that you receive with the medication for a complete list of possible side effects.
Semin Cutan Med Surg 2008 Sep;27(3):188-96. George R, Clarke S., Thiboutot D.
Acne affects more than 40 million people, of which more than half are women older than 25 years of age. These women frequently fail traditional therapy and have high relapse rates even after isotretinoin.
Hormonal therapy remains an important part of the arsenal of acne treatments available to the clinician. Women dealing with acne, even those without increased serum androgens, may benefit from hormonal treatments. The mainstays of hormonal therapy include oral contraceptives and antiandrogens such as spironolactone, cyproterone acetate, or flutamide.
Efficacy and tolerance of acne treatment using both spironolactone and a combined contraceptive containing drospirenone.
J Am Acad Dermatol. 2008 Jan;58(1):60-2. Epub 2007 Oct 26. Krunic A, Ciurea A, Scheman, A
The use of either oral contraceptives or antiandrogens has been shown to be helpful in the treatment of women with acne.
One study demonstrated that treatment using both spironolactone and a combined contraceptive containing drospirenone yielded safe and effective results in 85% of individuals.
The combination of EE/DRSP and SL (spironolactone) 100 mg daily appears to have efficacy and is well tolerated in the treatment of severe papular and nodulocystic acne in women.
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Last updated: 12/13/2021