- Spironolactone is a diuretic medication that is sometimes used by women to treat moderate-to-severe acne
- The FDA approved spironolactone as a medication to treat high blood pressure that results from a hormonal condition called hyperaldosteronism
- Spironolactone is an oral medication taken once per day
- Men are usually advised against using spironolactone for acne because of side effects that include increased feminine features
What Is Spironolactone?
Spironolactone is an oral medication typically used to treat hyperaldosteronism, a condition in which the adrenal glands make too much aldosterone, a hormone that causes the body to retain excess sodium and lose too much potassium. It is part of a class of drugs called aldosterone receptor antagonists, which help the body eliminate excess fluid and sodium and maintain healthy levels of potassium.
As a result, spironolactone helps treat high blood pressure brought on by hyperaldosteronism. It is also prescribed in the treatment of congestive heart failure, cirrhosis of the liver, hypokalemia (low potassium levels), hirsutism (unwanted, male-patterned hair growth), and fluid buildup (called edema) caused by pregnancy.
Though not formally approved for the treatment of acne, some women take spironolactone if other acne treatments have been ineffective.
Does Spironolactone Treat Acne?
Spironolactone has proven to be effective at reducing acne symptoms in women with moderate-to-severe acne. The medication works by slowing the production of androgens, which are male hormones that can, among other things, cause excess oil production in the skin. This can cause hair follicles to clog just under the surface of the skin, resulting in acne.
Types of acne it treats best
Spironolactone is most effective with hormonal acne, which are breakouts triggered by changes in your hormones. Birth control pills can also help prevent acne breakouts and relieve symptoms in part because they also reduce levels of androgens in the body. Women whose hormonal acne doesn’t improve with birth control pills may be advised to try spironolactone.
Hormonal fluctuations are strongest during puberty and menopause, but the years in between can also be marked by hormone-related acne breakouts.
- Puberty: Breakouts during puberty are sometimes caused by changes in androgen levels, but can also be brought on by some external triggers, such as stress (think of the zit that showed up on the first day of school). Acne breakouts can also coincide with your menstrual cycle.
- Menopause: Increasing levels of androgens in menopausal and post-menopausal women mean spironolactone may be an effective treatment when acne develops among women in this age group, too. Hormonal acne in adults tends to develop along the jawline and neck.
In addition to hormonal causes, acne can also result from a bacterial infection, excess oil production, and hair follicles clogged by oil and dead skin cells. In these cases, spironolactone may not be helpful in clearing your skin. Typically, mild acne responds well to topical medications, such as benzoyl peroxide, azelaic acid or salicylic acid. Sometimes antibiotics, such as erythromycin and metronidazole, may be helpful in more severe cases.
Spironolactone is usually prescribed in doses from 25 milligrams (mg) to 200 mg. Pills are taken once daily.
Doctors have differing philosophies when it comes to starting a patient on a new medication. Your physician may recommend a low dose of spironolactone, such as 50 mg, to see if that achieves the desired results. A low dose of a medication often reduces the risk of side effects. Other doctors prefer to start with a higher dose that gets results without serious side effects, and then lower to a dose which will still be effective.
Research shows that low-dose spironolactone—50 to 100 mg—is usually well tolerated and may be enough to reduce acne. If your acne breakout is quite severe, your dermatologist may start you on a stronger dose.
How Long Does It Take to Work?
Spironolactone can be an effective acne treatment, but it doesn’t work overnight. Each person’s hormonal makeup and response to medication are unique characteristics. Likewise, breakouts vary from one individual to another. These differences can affect how long it may take for spironolactone to be effective. In general, however, spironolactone takes about four to eight weeks to show noticeable results.
A study reported in the Journal of Drugs in Dermatology in 2018 found that spironolactone was effective in treatment women with moderate-to-severe acne, and was comparable to the effectiveness of tetracycline-class antibiotics. In a separate study that lasted two years, only 7 percent of the women taking spironolactone reported no improvement.
If spironolactone alone doesn’t work, you may need a combination of treatments. Birth control pills and spironolactone may be safe and effective for some women. Other topical treatments may be helpful to achieve desired results. You may have to try a variety of treatment combinations to achieve clear skin. Working closely with your dermatologist is key.
Common side effects of spironolactone for girls and women can include:
- Breast tenderness and/or breast enlargement
- Painful and/or irregular periods, as well as vaginal bleeding after menopause
- Hair loss
- Photo sensitivity, which means you are especially sensitive to UV rays from the sun and other light sources
- Nausea and vomiting
Because spironolactone affects the production of androgens, hormones that regulate male characteristics, it’s not advisable to take it if you’re a man. Side effects can include gynecomastia, the enlargement of male breasts, and loss of libido.
Does spironolactone make you break out?
When you first start taking spironolactone you may find a new pimple or two until the medication is working and changing your body’s hormonal activity. If you notice symptoms, such as a rash or other skin changes, tell your doctor immediately. The same is true for any other serious side effects, such as severe stomach pain or heart palpitations. For most women, however, spironolactone should lead to clearer skin and not further breakouts.
Spironolactone is a powerful medication that may help reduce moderate or severe hormonal acne breakouts. However, acne may return after you stop taking spironolactone. Spironolactone may be taken for several years, but because of side effects, you may want to limit its use. If you’re not sure if your acne breakout is one that may be best treated by spironolactone, consider signs such as pimples and other lesions along the jawline and neck. Acne that forms in the “T zone” of the forehead and nose is less likely to be triggered by abnormal androgen levels.
It will be important to work with your dermatologist to develop a skincare routine and find the right treatment to help maintain acne-free skin into the future.
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- Barbieri, John S.; Choi, Juliana K.; Mitra, Nandita; Margolia, David J. (2018) Frequency of Treatment Switching for Spironolactone Compared to Oral Tetracycline-Class Antibiotics for Women With Acne: A Retrospective Cohort Study 2010-2016. June 2018 | Volume 17 | Issue 6 | Original Article | 632. jddonline.com/articles/dermatology/S1545961618P0632X/1
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