POSTED: 14 Dec 2023

Spironolactone for Acne, Here’s What We Know About This Hormonal Treatment

There’s a vast number of treatment options for acne that ranges from skincare all the way to medical treatments. This is because acne is as diverse as the people it affects and what works for one person may not work for another. Spironolactone is a common and long-standing hormonal treatment for acne. In this article we explore how Spironolactone hormone therapy targets acne, when it’s useful, side effects and limits as well as alternatives.

What is Spironolactone?

This is a prescription medicine that is a common treatment for high blood pressure, heart failure and hyperaldosteronism. Spironolactone is an aldosterone antagonist. It blocks the actions of a hormone called aldosterone which is an androgen that regulates salt and water balance in the body. The main use of Spironolactone is as a diuretic as it helps the body expel excess water and salt. This in turn reduces fluid buildup and helps treat heart failure and high blood pressure.

Beyond these traditional uses, the anti-androgen effects of Spironolactone have expanded its uses over time. Androgens are hormones that can also contribute to acne development by increasing oil production in the skin. Dermatologists discovered that Spironolactone’s ability to block androgen receptors also makes it an effective treatment for acne, particularly in hormonal acne in adult women. This type of acne often flare-ups with the menstrual cycle and presents as deep, cystic bumps usually along the jawline and chin. Additionally, due to its anti-androgen effects, doctors sometimes use spironolactone off-label to treat conditions like polycystic ovary syndrome (PCOS), hirsutism (excessive hair growth) and in some cases female hair loss.

How Spironolactone Treats Acne

Spironolactone works on acne mainly through its anti-androgenic effects. Here are its primary effects on acne lesions:

  • Reduction in Sebum Production: By decreasing sebum production, spironolactone reduces the likelihood of pores becoming clogged. Clogged pores are a primary factor in the formation of acne lesions like blackheads, whiteheads and more severe types of acne like cysts and nodules.
  • Fewer Hormonal Fluctuations: Acne often worsens in relation to menstrual cycles, teenage years, the menopause and other medical conditions that cause fluctuations in hormone levels. Spironolactone can help mitigate these effects which leads to fewer acne flares.
  • Inflammatory Response: Spironolactone may also dampen inflammatory processes linked to acne.

How Effective is it?

There’s good evidence that supports the use of Spironolactone in treating hormonal acne. However, it’s worth noting that it’s not for everyone and the effects vary from person to person. This is why it’s still the subject of ongoing research. To date, here’s what we know about Spironolactone’s effectiveness as an acne treatment:

  • High Success Rate in Certain Types of Acne: Spironolactone is particularly effective for treating hormonal acne in women.
  • Reduces Number of Lesions: Clinical trials and research studies have shown that spironolactone can lead to a significant reduction in the number of acne lesions. Patients often observe a decrease in both the severity and frequency of their acne outbreaks.
  • Long-Term Benefits: Many users of Spironolactone report sustained improvements in their skin condition. However, this usually only lasts whilst patients are taking it. That being said, Spironolactone is generally safe for long-term use for patients who need a lengthy or indefinite course.
  • Comparative Effectiveness: In some cases, spironolactone can be as effective as oral antibiotics for acne, with the advantage of having a lower risk of antibiotic resistance.
  • Impact on Severe and Resistant Acne: For people who have not had a good response to traditional acne treatments, including topical medications and oral antibiotics, spironolactone may offer an alternative.

When To Consider Spironolactone for Acne

Doctors normally take into account a number of factors when considering Spironolactone hormone therapy for acne treatment. The main use is in treating hormonal acne in adult women since this is what the bulk of scientific evidence supports. It is also an option for those who have not seen significant improvements with conventional acne treatments like topical retinoids, benzoyl peroxide or oral antibiotics. Its anti-androgenic effects, which reduce sebum production, make it particularly suitable for individuals with excessively oily skin. In addition, adults with persistent acne that either didn’t resolve post-adolescence or appeared later in life may also find spironolactone beneficial. Other factors that may predict whether Spronolactine treatment is likely to work are if the acne is accompanied by other symptoms of androgen excess, such as hirsutism (excessive hair growth) or hair loss, spironolactone can be particularly effective. Spironolactone is also beneficial in women who experience pre-menstrual acne flare-ups.

The decision to start Spironolactone will ultimately take into account factors like the nature and severity of the acne, your medical history and if you’re using any other medications. Spironolactone is also not for everyone. It is generally not recommended for men for acne treatment, pregnant women or those trying to conceive. Your doctor may also use Spironolactone part of combination therapy with other acne treatments to increase the chances of success.

How Long Does it take to Work & Long Should You Use Spironolactone?

Like any skin treatment, patience is key with spironolactone. Every one’s journey is different but in general, most patients start seeing noticeable improvements in their acne within three to six months of starting treatment. How long your treatment lasts will depend on your individual response. Some people may need to continue the medication long-term to maintain its benefits. Other patients may be able to step down to an alternative treatments like skincare and topical retinoids for long-term maintenance.

Side Effects & Risks

Although Spironolactone is generally safe for most people, there are some side effects that you should know and your doctor will discuss with you. These include increased urination, low blood pressure, menstrual irregularities and breast pain. It’s also not recommended for pregnant women, those trying to get pregnant or people with kidney problems.

Alternatives to Spironolactone

Even though Spironolactone is an effective hormone therapy for certain types of acne, there are other treatments worth considering. Here are the main acne treatment alternatives to Spironolactone:

  • Oral Contraceptives: Birth control pills hat contain both oestrogen and progestin can be an effective hormone therapy for women with acne. They work by regulating androgens.
  • Topical Retinoids: Tretinoin, Adapalene, and Tazarotene are commonly prescribed for various types of acne. They work by promoting regulating oil, reducing inflammation and preventing clogged pores. They can also help with scars, texture and hyperpigmentation.
  • Oral Antibiotics: Oral antibiotics like doxycycline, minocycline or tetracycline can be used to reduce inflammation and bacteria on the skin.
  • Isotretinoin (Accutane): For acne that hasn’t responded to other treatments, isotretinoin tablets can be highly effective. I can treat severe acne and often produces long-term remission. However, it requires strict medical supervision due to its potential side effects. It may also help with scars and texture and dark marks.
  • Topical Antimicrobials: These antibiotic creams or gels work by targeting the bacteria associated with acne. They are sometimes formulated with Benzoyl peroxide or Tretinoin to enhance their effects.
  • Chemical Peels and Laser Therapy: Professional treatments like chemical peels, laser and light therapy can help manage acne. They do so by removing dead skin cells, reducing oiliness and targeting acne-causing bacteria.
  • Lifestyle and Dietary Changes: Some people may find making changes in their diet, managing stress and using a targeted skincare routine can help treat acne.

Spironolactone can be a safe and effective hormone therapy for acne. However, Spironolactone is only effective for acne that is typically classified as hormonal acne. It’s also not a quick fix and will take time to see results which can vary from person to person. Spironolactone is usually used in combination with other acne treatments to provide a more comprehensive treatment. There are also a number of alternative treatments to Spironolactone. If you’re suffering from severe or persistent acne, you should consult with a dermatologist or other skin specialist who can help you determine the best and safest treatment option for you.

At City Skin Clinic, we are devoted to personalised skincare. Through our online skin clinic, our doctors offer safe and effective treatments like Tretinoin and Hydroquinone. We treat a range of skin conditions including  acnehyperpigmentationmelasma and skin ageing. To start your personalised skincare plan, book a virtual video consultation or use our online consultation form. The journey towards great skin starts here.

Authored by:

Dr Amel Ibrahim
Aesthetic Doctor & Medical Director
Founder City Skin Clinic
Member of the Royal College of Surgeons of England
Associate Member of British Association of Body Sculpting GMC Registered - 7049611

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