There is a vast number of treatment options for acne, ranging from skincare all the way to medical treatments. This is because acne is as diverse as the people it affects. So, what works for one person may not work for another. Spironolactone is a long-standing medicine that is increasingly popular as a hormonal treatment for acne. In this guide, we explore how spironolactone’s androgen-blocking action can treat hormonal acne. We also review its effectiveness as an anti-hormone therapy, its side effects and limits, and the alternatives.
What is Spironolactone?
Spironolactone is a prescription medicine that doctors commonly use to treat high blood pressure (hypertension), heart failure and hyperaldosteronism. It comes as generic tablets, or under brand names like Aldactone tablets or Carospir oral suspension. It is also available in topical form, in compounded skin creams. Spironolactone is an aldosterone antagonist, which means it acts on the kidney tubules to block a hormone called aldosterone. Aldosterone is a mineralocorticoid hormone that your adrenal glands make. It regulates the salt and water balance in your body. So, the main use of spironolactone tablets is as a potassium-sparing diuretic. It works by helping the body expel excess water and salt. This in turn reduces fluid retention, which helps treat conditions like ascites, heart failure and high blood pressure.
Beyond these traditional FDA-approved uses, the anti-androgen effects of spironolactone have widened its role over time. Androgens are hormones that can contribute to acne by increasing oil production in the skin. Dermatologists discovered that spironolactone’s anti-androgen action also treats acne, particularly hormonal acne in adult women. This type of acne often flares up with the menstrual cycle. It shows up as deep, cystic bumps along the jawline and chin. In addition, its anti-androgen effects give it other off-label uses. Doctors sometimes prescribe it for conditions like polycystic ovary syndrome (PCOS), hirsutism (excessive hair growth) and, in some cases, female hair loss.
How Spironolactone Treats Acne
Spironolactone treats acne mainly through its anti-androgen effects. Its primary effects on acne lesions are:
- Less sebum: by lowering sebum production, spironolactone makes pores less likely to clog. Clogged pores are a primary cause of acne lesions like blackheads, whiteheads and more severe types like cysts and nodules.
- Fewer hormonal fluctuations: acne often worsens around menstrual cycles, the teenage years, the menopause and other causes of hormonal swings. Spironolactone can soften these effects, which leads to fewer flares.
- Calmer inflammation: spironolactone may also dampen the inflammatory processes linked to acne.
How Effective is it?
There is good evidence for spironolactone in treating hormonal acne through its androgen-blocking action. However, it is not for everyone, and the effects vary from person to person. That is why it is still the subject of ongoing research. To date, here is what we know about its effectiveness as an acne treatment:
- High success in hormonal acne: spironolactone is particularly effective for hormonal acne in women.
- Fewer lesions: clinical trials show that spironolactone can lead to a significant reduction in the number of acne lesions. People often see a drop in both the severity and the frequency of breakouts.
- Long-term benefits: many people report sustained improvement, though this usually only lasts whilst they keep taking it. That said, spironolactone is generally safe for long-term use for those who need a long or indefinite course.
- Comparable to antibiotics: in some cases, spironolactone can work as well as oral antibiotics, with the advantage of a lower risk of antibiotic resistance.
- An option for resistant acne: for people who have not responded well to traditional acne treatments, including topical medicines and oral antibiotics, spironolactone may offer an alternative.
When to Consider Spironolactone for Acne
Spironolactone is not licensed in either topical or oral form for treating acne, but doctors can prescribe it off licence for this purpose. The NHS does not usually offer it, so you will need a consultation with a private provider to see if it is right for you. Doctors normally weigh up a number of factors before considering spironolactone for acne.
The main use is for hormonal acne in adult women. This is what most of the scientific evidence supports. It is also an option when conventional treatments like topical Retinoids, benzoyl peroxide or oral antibiotics have not helped much. Because its anti-androgen effects lower sebum, it suits people with very oily skin particularly well. In addition, adults with persistent acne that either did not clear after adolescence, or appeared later in life, may also benefit. Another good sign is acne with other features of androgen excess, such as hirsutism (excessive hair growth) or hair loss. Spironolactone is also helpful for women who get pre-menstrual flare-ups.
When deciding whether spironolactone is right for you, your doctor weighs up several factors. These are the severity of your acne, your medical history and any other medicines you take. Spironolactone is not for everyone, though. Doctors do not usually give it to men for acne, to pregnant women, or to those trying to conceive. Your doctor may also combine spironolactone with other acne treatments to improve your chances of success.
How Long Does Spironolactone Take to Work?
Like any skin treatment, patience is key with spironolactone. Everyone’s journey is different. In general, though, most people start to see improvement within three to six months of starting treatment. How long your treatment lasts will depend on your individual response. Some people need to continue long-term to keep the benefits. Others may be able to step down to alternative treatments like skincare and topical Retinoids for long-term maintenance.
Side Effects & Risks
Although spironolactone is generally safe for most people, it does have some side effects that your doctor will discuss with you. Common side effects of oral treatment include raised potassium levels, increased urination, drowsiness and low blood pressure. You may also have an allergic reaction, menstrual irregularities, a skin rash, gynaecomastia or breast pain. Doctors do not recommend it during pregnancy or breastfeeding, and it may not suit people with liver disease, Addison’s disease or kidney problems. With oral treatment, you will usually need regular blood tests to monitor kidney function and adjust your dose. These also check your electrolyte levels, to prevent imbalances like high potassium, or low sodium, magnesium or calcium. Spironolactone also interacts with a number of medicines. These include potassium supplements, ACE inhibitors, digoxin, eplerenone and non-steroidal anti-inflammatory drugs (NSAIDs).
Alternatives to Spironolactone
Even though spironolactone is an effective hormone therapy for certain types of acne, there are other treatments worth considering. We have already covered a newcomer called Winlevi in another post, but below are the main acne treatment alternatives to spironolactone:
- Oral contraceptives: birth-control pills that contain both oestrogen and progestin can be an effective hormone therapy for women with acne. They work by helping to regulate androgens.
- Topical Retinoids: tretinoin, adapalene and tazarotene treat many types of acne. They work by regulating oil, reducing inflammation and preventing clogged pores, and they can also help with scars, texture and hyperpigmentation.
- Oral antibiotics: oral antibiotics like doxycycline, minocycline or tetracycline can reduce inflammation and bacteria on the skin.
- Isotretinoin (Accutane): for acne that has not responded to other treatments, isotretinoin tablets can be highly effective. It can clear severe acne and often produces long-term remission. However, it needs strict medical supervision because of its potential side effects. It may also help with scars, texture and dark marks.
- Topical antimicrobials: these antibiotic creams or gels target the bacteria linked to acne. Doctors sometimes formulate them with benzoyl peroxide or tretinoin to boost their effect.
- Chemical peels and laser therapy: professional treatments like chemical peels, laser and light therapy can help manage acne. They work by removing dead skin cells, reducing oiliness and targeting acne-causing bacteria.
- Lifestyle and dietary changes: some people find that changes to their diet, managing stress and a targeted skincare routine help treat their acne.
Spironolactone can be a safe and effective hormone therapy for acne. However, it only works for acne that is hormonal in nature. It is also not a quick fix, and results take time and vary from person to person. Doctors usually combine spironolactone with other acne treatments for a more complete approach, and there are several alternatives too. If you are struggling with severe or persistent acne, it is best to consult a dermatologist or other skin specialist. They can help you find the safest, most effective option for you.
At City Skin Clinic, we are passionate about personalised skincare. Whilst we do not prescribe oral spironolactone, our doctors can include topical spironolactone in bespoke acne treatments, alongside ingredients like tretinoin, azelaic acid, clindamycin and niacinamide where appropriate, through our online clinic. Our doctors treat acne, hyperpigmentation, melasma, rosacea and skin ageing through bespoke compounded treatments designed around you. To start your personalised plan, book a virtual video consultation or use our online consultation form. The journey towards great skin starts here.
This article is intended for general informational purposes only and is not a substitute for medical advice, diagnosis or treatment. Always consult a qualified medical provider for any health concerns or questions you might have.
