Spironolactone: More Effective For Treating Acne?

We are constantly on the lookout for new acne treatments, and are especially excited when we find possible oral antibiotic alternatives for our clients. We recently came across this article published in the Journal of American Academy of Dermatology (citation below). This study suggests that the medicine spironolactone may be more effective than oral antibiotics in treating acne in women over the long term.

Quick recap on the role hormones play in acne:

Androgen hormones (ex: Testosterone, Androsterone, DHEA-Sulfate) are responsible for triggering oil (sebum) production in our pores. More androgen hormones = more oily skin. The excess oil traps dead skin cells inside our pores, creating the perfect environment for acne to develop. 

While we typically consider androgen hormones “male” sex hormones, the reality is that females produce these too. In females, androgen hormones are produced by the adrenal glands, ovaries, and fat cells. You may be surprised to learn that the typical female of child-bearing age will have more androgen hormones circulating through her body than estrogen. Males have just have a whole lot more, hence why acne is typically more severe in male adolescents than in females. 

Excess androgen levels in women can produce a range of health concerns. For example,  polycystic ovary syndrome, hirsutism (facial hair on the face, chest, and back), and stubborn acne. 

What is spironolactone?

Spironolactone (pronunciation: spy-ren-no-lac-tone) is an anti-androgen medication most commonly prescribed to treat high blood pressure and excess fluid retention. Physicians may also prescribe the medicine  “off label” to treat stubborn acne and excessive hair growth in women who have polycystic ovary disease. 

How is spironolactone helpful in treating acne?

When taken by itself, or in combination with certain oral contraceptives, spironolactone can be quite effective in treating stubborn, cystic and nodular acne. Quite simply, it reduces the levels of androgen hormones. Lower androgen levels –> less oil production in the pores –> less congestion. 

While spironolactone has been known for a while for its role in managing acne, this study suggests that the drug can be tolerated for longer than oral antibiotics (i.e., tetracyclines), and may therefore be more effective over the long term. The authors encourage physicians to consider spironolactone as a first-line therapy alternative to oral antibiotics as a result. But by suggests”, there are a range of disclaimers and follow up questions emerging from this retrospective study. Hopefully this will prompt more prospective studies on the long-term systemic treatment options for acne. In our view, any progress on alternatives to long-term antibiotic use is good news! 

Why would I not run out to my doctor to get this medication?

Huge disclaimer: We at Clinically Clear want our clients to have all of the facts to make informed decisions about their acne treatment options. In this case, we point you to a fact-based study published in peer-reviewed scientific and medical journals. HOWEVER, we aren’t doctors, and therefore can’t recommend (and certainly not prescribe) any medication to anyone. If you are considering a systemic (oral medication) approach to treating your acne, you should see your doctor who can give you advice within the context of your broader health profile. 

What about the side effects?

First, because spironolactone is a diuretic, you may urinate more frequently. If you’ve had issues with potassium levels in the past, you may want to be careful about your salt intake. Your physician will evaluate any other medicines you take for drug interactions. 

Women taking spironolactone should not become pregnant due to the high risk of birth defects. Side effects can also include more painful periods as well as other premenstrual symptoms such as breast tenderness and enlargement. Taking a combined oral contraceptive in addition to spironolactone can help manage these risks and side effect. However, this medicine can have its own set of risks and side effects for individuals with certain health histories. Stay tuned for a future blog post on the role of contraceptive pills in managing acne.

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Source: “Real-world drug usage survival of spironolactone versus oral antibiotics for the management of female patients with acne.” Barbieri, John S. et al.  Journal of the American Academy of Dermatology, Volume 81, Issue 3, 848 – 851.  https://doi.org/10.1016/j.jaad.2019.03.036

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