Spironolactone
A prescription anti-androgen that reduces the oil behind hormonal acne and the follicle-shrinking signal behind pattern hair loss.
Spironolactone is a prescription medicine that blocks androgen hormones, which makes it a useful treatment for hormonal acne and pattern hair loss. It started life in the 1950s as a tablet for high blood pressure and heart failure. Dermatologists later noticed its anti-androgen effect and have used it on skin and hair for over 30 years. It now comes in two forms. The oral tablet is licensed in the UK for heart and blood pressure conditions and is used off-label for acne and hair loss. Topical Spironolactone is different. It is an unlicensed medicine, compounded into creams and serums made individually for each patient, and it delivers the drug directly to the skin or scalp.
What Is Spironolactone and How Does It Work?
Spironolactone was designed to block a hormone called aldosterone in the kidneys, which is how it lowers blood pressure and clears excess fluid. It also blocks androgen receptors. Androgens are the group of hormones, including testosterone and DHT, that drive oil production in the skin and gradually shrink sensitive hair follicles. Both men and women have them. In most people with hormonal acne or pattern hair loss, androgen levels are actually normal. The problem is that their skin and hair follicle cells are more sensitive to them.
By sitting on the androgen receptor, topical Spironolactone dampens that signal exactly where you apply it. Less signal means less oil in acne-prone skin and less of the follicle-shrinking pressure behind pattern hair loss. This may provide the following benefits:
- Clears hormonal acne: it reduces the androgen-driven oil that feeds the deep, tender breakouts of adult hormonal acne, especially along the jaw, chin and lower face.
- Balances oil production: less androgen signal means less sebum, so skin becomes less greasy and pores are less likely to block.
- Reduces hair shedding: by blunting the androgen effect at the follicle, it can slow the shedding and thinning of pattern hair loss.
- Supports regrowth in combination: it protects follicles from the hormone signal whilst stimulating ingredients like Minoxidil encourage new growth.
How City Skin Clinic Uses Spironolactone
Hormonal acne and pattern hair loss rarely have a single driver. So we almost never use Spironolactone on its own. Your doctor designs a compounded formula around your skin or scalp, your medical history and your goals, and includes Spironolactone where they judge it will help. It is one ingredient in a treatment built for you rather than a product off a shelf. We may use topical Spironolactone in these treatments:
These are the ingredients we may combine it with, depending on what your skin or hair needs:
- Tretinoin: unclogs pores and speeds up cell turnover in acne formulas, and can improve absorption in hair formulas.
- Azelaic Acid: calms inflammation, targets acne-causing bacteria and helps fade the marks breakouts leave behind.
- Clindamycin: a topical antibiotic that reduces the bacteria and inflammation in active acne.
- Minoxidil: the first-line hair growth stimulant. Spironolactone protects the follicle from the androgen signal whilst Minoxidil stimulates regrowth.
- Caffeine: a supporting active that stimulates the follicles and scalp circulation.
- Melatonin: a supporting active that helps protect follicles.
- Hydrocortisone: calms irritation caused by stronger actives.
How Do You Get Topical Spironolactone in the UK?
You cannot buy Spironolactone over the counter in any form, because it is a prescription only medicine. The two routes differ from there. Oral Spironolactone is a licensed tablet, so any suitable prescriber can prescribe it and a regular pharmacy can dispense it. Its use for acne and hair loss is off-label, and in practice that usually means a private GP or dermatologist rather than the NHS. Topical Spironolactone is harder to find. It is only available as an unlicensed compounded medicine, made for one named patient by a specialist compounding pharmacy against a prescriber’s formula.
Our online clinic offers topical custom skin and hair loss treatments. You complete an online consultation form or virtual video consultation with one of our doctors. They will design a compounded formula around your skin or scalp, which can include Spironolactone if they deem it safe and appropriate for you. Treatments are made by a specialist pharmacy and delivered to your door. The same doctor looks after you throughout your treatment and you can reach them directly by email at any time.
Personalised Treatment Fees (3 Month Supply)
VIRTUAL CONSULTATION£30
Your doctor will design a personalised skincare treatment and program for you to follow. The cost of the consultation will be deducted from any skincare purchase.
PERSONALISED TREATMENT£90-150
A 3-month supply (if used on face) of your cream or gel treatment. £90 for a once-daily formula and £150 for twice-daily treatment. Delivery and your doctor's ongoing aftercare included.
PERSONALISED HAIR LOSS TREATMENT£120
A 3 month supply (100ml) of a serum designed around your hair loss, health and goals.
Treatment Time
15 Minutes
Duration of effect
3-4 Months
Back to Work
Same Day
There is no subscription. You order your next course only when you are ready.
Oral vs Topical Spironolactone
The choice between the two forms matters more for Spironolactone than for most skin and hair medicines. This is because they behave differently in the body, carry different risks and are not interchangeable. Here is how the two routes compare:
| Oral Spironolactone | Topical Spironolactone | |
|---|---|---|
| How you take it | A tablet taken daily, usually with food | A serum, cream or gel applied to the skin or scalp |
| Licensing in the UK | Licensed for heart and blood pressure conditions. Use for acne and hair loss is off-label | Unlicensed compounded medicine, made individually for each patient |
| Evidence base | Larger evidence base, including clinical trials in acne | Smaller but growing, with early studies in acne and hair loss |
| Side effects | Can include breast tenderness, dizziness, menstrual changes and raised potassium | Mainly local irritation where applied. Systemic effects are possible but uncommon |
| Who it may suit | Women with hormonal acne or pattern hair loss. Generally unsuitable for men | Women, and some men with hair loss where a doctor judges it appropriate |
How Effective Is Topical Spironolactone?
The honest answer is that topical Spironolactone is promising rather than proven. Its evidence base is smaller than the oral tablet’s, but the early results point the same way. In acne, small placebo-controlled studies of topical Spironolactone gel have shown improvement over placebo, and a systematic review supports its use with fewer side effects than the tablet. In hair loss, a systematic review covering both men and women found topical Spironolactone effective and safer than oral, particularly alongside Minoxidil, though the studies are small and larger trials are still needed.
Results build slowly whichever condition you are treating. Acne tends to respond within 3 to 6 months. Hair loss is slower and usually needs 6 to 12 months of consistent use before you see change, and continued use is needed to keep the benefit.
What Strengths Does Topical Spironolactone Come In?
Topical Spironolactone is compounded to a doctor’s prescription, so the strength is set for each patient rather than fixed by a manufacturer. The main strengths we use are 1% for hair loss formulas and 5% for acne formulas. Your doctor confirms the right strength for you based on your skin or scalp and your medical history, and the base and any added actives are tailored in the same way.
What Are the Side Effects of Topical Spironolactone?
Every effective medicine has side effects, and being clear about them is part of prescribing well. Topical Spironolactone is generally well tolerated because so little of it is absorbed into the body. These are the side effects to know about:
- Local skin reactions: the most common effects are mild irritation, redness, itching or dryness where you apply it. In acne, some people notice a brief flare before things settle.
- Systemic effects: because a small amount can be absorbed, effects like breast tenderness, dizziness or changes to the menstrual cycle are possible. They are uncommon with topical use and far less likely than with the tablet.
- Raised potassium: high potassium is a known risk of oral Spironolactone. With topical use the risk is low, but it matters if you have kidney problems or take medicines that raise potassium.
- Allergy: as with any topical medicine, a true allergic reaction is possible.
If you develop severe irritation, signs of an allergic reaction or any side effect that worries you, stop the treatment and contact your doctor. Side effects with the oral tablet are a different and larger conversation, which is one reason the two forms are prescribed so differently.
Who Should Not Use Topical Spironolactone?
Spironolactone needs careful patient selection, and some people should not use it at all. Topical Spironolactone is not suitable if any of the following apply:
- Allergy: anyone who has reacted to Spironolactone before should not use it.
- Pregnancy, breastfeeding or trying to conceive: Spironolactone is not safe in pregnancy because its anti-androgen effect can interfere with the normal development of a male baby. It is not used whilst breastfeeding or when trying for a baby, and premenopausal women using it need effective contraception.
- High potassium levels: hyperkalaemia makes any form of Spironolactone unsafe.
- Significant kidney or liver disease: Spironolactone affects potassium and kidney function, so these conditions usually mean avoiding it.
- Medicines that raise potassium: potassium-sparing diuretics, potassium supplements, ACE inhibitors and some antibiotics like trimethoprim can interact. Your doctor needs a full list of everything you take.
- Under 18: our treatments are for adults aged 18 and over only.
Google Reviews
I would highly recommend City Skin Clinic. I have had a great experience with Dr Amel so far. She is extremely knowledgable and has explained my treatment plan in detail. I had a lot of questions initially and this was met with fast and in depth responses by Dr Amel. The ordering and delivery of the product is quick and easy and Dr Amel has remained in contact throughout my treatment to check progress. It has only been a couple of months but I have already seen an improvement in my hair and trust that I will continue to do so.
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I’ve been going to see Amel for about a year now and am very happy with the results. The service she provides is very personalised and has made a real difference to how my skin looks and feels. I would definitely recommend City Skin Clinic even if you have tried other, similar services.
Dr Amel is fantastic - she was very transparent in her call with me in terms of what she thought would be best for me, and has over the course of the year since always been very prompt and generous in her responses to my email queries. Highly recommended!
City Skin Clinic allows me to get tretinoin delivered when I am running out rather than a subscription basis. Not only that but I cannot praise their customer service enough. They have been so helpful in all skincare advice not just the tretinoin. The response times are incredible and I feel like a valued customer with a personalised advisor. I have used other companies before and have been recommended others, but I’m not even tempted to move away from City Skin Clinic. They really are amazing.
I'm very pleased with the service and product I have received from City Clinic. The process for prescription is easy enough to follow and I'm very satisfied with my skin improvement.
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I appreciate the prompt responses and the treatment I am receiving is going well.
I used the online consultation form and received a very quick response with detailed advice about a treatment plan. My two prescription products arrived a couple of days later in the post and I've already had great results in reducing pigmentation on my face after only 4 weeks of use. I'm really pleased with the results and the service and advice I've received from City Skin Clinic has been excellent.
City Skin Clinic helped me find a Treatment plan that really helped my skin problem of pigmentation /malasma.
Amel is amazing she always takes time to understand your concern and will always give you the best treatment and advice and the results have been amazing. Thank you!
I’ve been receiving treatment at City Skin Clinic with Dr Amel and I couldn’t be happier with the experience. From the start, Dr Amel was professional, knowledgeable and genuinely attentive to my skin concerns — she took the time to listen and tailor a plan that suited my needs. Many aspects of the process were clear and reassuring, and I felt well supported throughout. What stood out most was the ongoing support: Dr Amel has continued to check in, answer my questions promptly, and adapt my plan as needed, which has made a real difference in my progress. Overall, a thorough, caring and highly recommended clinic experience.
I cannot recommend Dr Amel highly enough. She is genuinely the best skincare specialist I’ve ever worked with. From the very first consultation she took the time to understand my concerns in detail, explain the science behind everything, and create a personalised plan that actually delivered results rather than promises.
My skin has transformed under her care. Years of stubborn hyperpigmentation, uneven tone and texture that I thought I’d never get on top of have improved more than I thought was possible. Every step of the process has been guided, monitored and adjusted so thoughtfully. She never rushes, she always explains the why behind each change, and she makes you feel like you’re in the hands of someone who genuinely cares about your outcome.
What stands out most is how responsive and reassuring she is. Anytime I had a question or worry, she replied with real clarity and expertise. She pays close attention to detail, picks up on things I wouldn’t even notice, and makes you feel completely supported throughout the whole treatment plan.
If you want a clinician who is knowledgeable, meticulous, honest, and truly invested in achieving the best results for you, Dr Amel is exactly that. My confidence in my skin has never been better, and I’m so grateful to her for the care, patience and expertise she’s given me.
I got in touch having been frustrated with breakouts and early ageing signs. I have been so impressed by the level of communication, empathy and support I have received. It feels so much more caring/personal than booking with other well known brands in this space (who often more of a subscription based model) I would really recommend this company - and Dr Amel - to anyone wanting professional advice and support with their skin concerns
In desperation I trawled the internet looking for alternatives and found this wonderful company. From the very first video consultation, I was listened to and given a plan which worked! I cannot praise Amel enough. She has given such good advice; she responds almost immediately and is so very sensible. I feel cared forand know I am in the most professional and capable hands. My skin has improved significantly and is now brighter, more even toned and hydrated. I am impressed to the extent that I paid for my darling daughter to have a consultation as well. In her words- "Amel is just lovely. She is THE best!" What more can I say??? I won't be going anywhere else as I have complete faith in the company and highly recommend them.
I had a fantastic experience with CitySkinClinic. The online consultation was incredibly convenient and cost just £30 - excellent value for such a professional and personalised service. I was pleased and surprised that the cost of the consultation came off the price of the treatment Dr Amel was extremely easy to talk to, answering all my concerns with great care and professionalism. She was very prudent and thoughtful in her recommendations which made me feel confident and well looked after
Since using the cream my skin has noticeably improved in texture and firmness making me look healthier and less tired. My sun damage spots have also disappeared
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I'm not even halfway through my treatment for hyperpigmentation and I've achieved amazing results thanks to City Skin Clinic. The service has been effortless, professional, reliable and most of all very personalised unlike some of the other online clinics where you just fill in a form and wait for treatment in the post. I would definitely recommend to anyone who wants even looking skin!
Really great online service provided. Very friendly and approachable Doctors who are extremely quick to respond, and offer advice on not only services and products they offer, but also non prescription skincare products. Would highly recommend!
Frequently asked questions
Authored by:
Aesthetic Doctor & Medical Director BSC (HONS) MBBS MRCS PHD
Founder City Skin Clinic
Member of the Royal College of Surgeons of England
Associate Member of British Association of Body Sculpting GMC Registered - 7049611