Spironolactone for Acne: What It Is, Results, Side Effects and More

• Spironolactone is a diuretic medication that is typically prescribed to treat disorders such as hyperaldosteronism, heart failure, high blood pressure and edema by reducing fluid buildup in the body
• This oral medication is also prescribed for women with moderate-to-severe hormonal acne
• Spironolactone is not usually prescribed for men because it suppresses male hormone activity resulting in a feminizing effect 

Spironolactone is an oral prescription medication that is typically prescribed for a number of cardiovascular diseases, notably high blood pressure. It is also a treatment for hyperaldosteronism, a condition in which the adrenal glands produce too much aldosterone hormone. Due to the qualities of this medication, dermatologists also prescribe spironolactone for acne as it has demonstrated effectiveness against hormonal acne in women.

What Is Spironolactone? 

Spironolactone is an oral medication that is FDA-approved for the treatment and management of several health conditions including cardiovascular diseases, edema resulting from kidney and liver diseases, and hyperaldosteronism.

This drug is a diuretic, meaning it helps reduce excess fluid and sodium buildup through elimination in the urine. It achieves this by blocking activity of the hormone aldosterone, which regulates blood pressure and blood volume.

Does Spironolactone Treat Acne?

Spironolactone is prescribed off-label to treat moderate-to-severe acne, and in the past, was reserved for women as an alternative acne treatment rather than a primary consideration due to the lack of studies on its safety and efficacy. 

While this point of view has changed, and there are dermatologists prescribing this medication, there still needs to be further studies before it is chosen as a first-line choice.

With that said, spironolactone has been proven to effectively treat acne.

The medication works by inhibiting androgen production in the body, as well as blocking its effects. Androgens are male sex hormones which can cause excessive oil production in the skin, which results in clogged pores and the development of acne. 

Of note is that once off this medication, acne can once again return, as it can not alter hormonal levels permanently. 

Types of acne it treats best

Spironolactone is most effective against hormonal acne, that is, acne caused by fluctuations in hormones which trigger oil production, a key contributor to acne formation. As such, this medication is well-suited for women post puberty, as well as later in life during perimenopause and menopause when androgen hormone fluctuations are greatest.

But this medication is not limited to hormonal acne, and can be prescribed for women who are unable to take or respond to conventional acne treatments, or who have persistent or severe acne, or hirsutism (excessive growth of male-pattern hair). 

This medication can also be an alternative for women who do not want to take birth control as an acne treatment.

Those with mild or infrequent breakouts would not benefit from an oral medication and would respond well to topical medications, such as benzoyl peroxide, azelaic acid or salicylic acid. 

Dosage

The specific dose will be determined by your dermatologist, and will vary from person to person based on a number of factors including medication history and acne severity. 

Spironolactone is most often first prescribed in low doses of 25 mg to 100 mg. If symptoms persist, the dose is then up-titrated (slowly increased) up to 200 mg per day until the desired effect is reached –  while keeping side effect risks to a minimum. This medication is taken once daily or as a divided dose. 

Spironolactone can be used as long-term therapy—for many years—and once the acne is well-controlled, maintenance therapy can follow with a reduced dose for as long as necessary. 

As with most oral drug regimens, patients are monitored for results, as well as to reduce the risk of potential side effects. In a literature review of spironolactone and acne, researchers examined a number of studies on the topic and found little evidence to support the average recommended dose of  ≤100 mg per day as an effective treatment. They did find that 200 mg per day was effective, but this dose was associated with greater menstrual side effects. 

These side effects were reduced when spironolactone was combined with oral contraceptives, which supports some studies’ conclusions that this drug should be part of combined therapy and not used as monotherapy.  

How Long Does It Take to Work? 

Every person will respond differently to treatment based on their individual characteristics and results will also depend on the efficacy of the other medications chosen for their drug regimen.

On average, spironolactone takes about 3–6 months to see noticeable results.

Results 

Science acknowledges this medication can effectively treat acne in women, but some studies indicate it is more efficacious when used alongside other medications. 

For example, in one review of study material, spironolactone was shown to be as effective in treating women with moderate-to-severe acne as an antibiotic when used as monotherapy; however, the study does not include any figures to indicate the rate of success.

In a separate small study of women treated with low-dose spironolactone, only 33% had a significant improvement and 33% had a partial improvement. 

A recent study examined the results of prior studies on this medication as a sole medication and when used in combination therapy. While 86% of all patients saw improvement in their acne, the least effective was spironolactone as a single therapy, while combination therapy with spironolactone, and a topical and oral treatment produced the greatest results.  

Another study found that spironolactone was as effective in treating moderate-to-severe acne as tetracycline-class antibiotics. This is of significance when thinking about the impact of antibiotic-resistance. 

With continued research and clinical studies on this medication, a recent study indicates that spironolactone is emerging as an important alternative to antibiotics.

Side Effects

Spironolactone for acne is associated with mild side effects and less common, severe side effects; severity and frequency is associated with higher doses. 

Mild side effects:

• Breast tenderness and/or breast enlargement
• Dry skin
• Drowsiness
• Decreased libido
• Frequent urination
• Hair loss
• Hyperkalemia, an excess of potassium in the blood
• Nausea and vomiting
• Painful and/or irregular periods, as well as vaginal bleeding post menopause
• Photosensitivity

Severe side effects:

• Allergic reaction
• Imbalance in electrolytes
• Reduced kidney function
• Stevens-Johnson syndrome, a rare serious skin disorder

It is very important to practice stringent birth control while on this medication as the antiandrogen effect of spironolactone can cause feminization of a male baby.

Does spironolactone make you break out? 

When you first start taking spironolactone you may experience an increase in acne breakouts, but these will resolve once the medication slowly starts to take effect; this is entirely normal. It takes time for spironolactone to regulate hormones, and for the skin to react and begin healing.  

Takeaway 

Spironolactone is an established medication that is FDA-approved to treat specific health conditions such as cardiovascular diseases, edema and hyperaldosteronism. 

As an anti-androgen, spironolactone can treat and prevent acne by suppressing hormone activity and reducing the presence of oil on the skin. While low-dose spironolactone is the norm for acne treatment, there is still on-going research and discussions as to what the optimal dose would be.

This medication is for those with moderate-to-severe acne symptoms, for treatment-resistant acne and for those who do not want to take birth control to treat their acne. There are a number of side effects associated with this medication, some severe.