What is spironolactone?
Dermatologists use Spironolactone for treating hormonal acne in women. Spironolactone is a medication taken by mouth that requires a prescription. Spironolactone tablets are usually taken once a day, and are available in 3 doses – 25mg, 50mg and 100mg. The tablets contain lactose.
Our Dermatologists have considerable experience with the use of Spironolactone for hormonal acne.
Treatments for acne
How does Spironolactone work?
Spironolactone helps control hormonal acne by reducing the effects of androgens on the skin. The main androgens are Testosterone and Dihydrotestosterone (DHT). Spironolactone blocks the receptors for these androgens in the skin. Spironolactone also slows the conversion of Testosterone to DHT by blocking 5-alpha reductase. The effects of Spironolactone are:
- There is less sebum produced by the skin – and the skin looks and feels less greasy. In fact, the skin can become quite sensitive to retinoids after 6 months of Spironolactone because of the drying effect of this medication.
- There are fewer comedones on the skin. Comedones are skin coloured bumps that can’t be squeezed and eventually become acne spots.
- There is less inflammation – as androgens directly cause irritation and inflammation
What are the benefits of Spironolactone?
Spironolactone helps to clear hormonal acne in women. Hormomal acne is very common in women over the age of 20 and is caused by sensitivity to androgens. Hormonal acne also occurs when there are too many androgens in the body.
Spironolactone can also help reduce excessive body hair and slow down female pattern hair loss – as both these conditions are also caused by androgens.
Spironolactone has also been used for many years in combination with other treatments to reduce blood pressure, reduce fluid retention and control congestive heart failure.
What is the evidence for Spironolactone in helping clear acne?
A study of 400 patients receiving Spironolactone over a number of years from Ohio showed 86% of patients improved with Spironolactone therapy (Gradhi et al). The majority of patients had combination treatment with either topical or oral agents. Of these 253 patients had been previously treated for acne with other treatments, 87% improved when Spironolactone was added (5% worsened). 147 patients had not received prior acne treatments, and of these 93% improved with Spironolactone.
In another study of 70 women (Isvy et al), 71% of women had improved acne with Spironolactone.
In another study of 110 women using spironolactone only, 94 patients noted improvement and 61 cleared completely (Charny et al). Improvement rates were 73% on the face and 76% on the back. Although 51 women experienced side effects, only 6 stopped Spironolactone because of side effects.
The references are below.
What are the additional benefits of Spironolactone?
Spironolactone may help reduce body hair and slow down female pattern hair loss in women.
When may a Dermatologist recommend Spironolactone?
Your Dermatologist may recommend Spironolactone if
- You are female (men are not prescribed spironolactone as it can cause growth of breast tissue)
- You have hormonal acne or your acne has a significant hormonal component
- Your acne does not respond well to antibiotics, cream or the oral contraceptive pill
- You have tried a course of Roaccutane (Accutane) and it either did not work fully or your acne came back quite quickly after completing a course
Can Spironolactone be used for acne during the menopause or perimenopause?
Yes, in our experience Spironolactone can be effective of acne that occurs when there is a decline in Oestrogen in the body during the menopause and perimenopause.
When is Spironolactone recommended by Doctors at Belgravia Dermatology?
Your skin will be assessed during your initial consultation. Your doctor may suggest Spironolactone to you if you have hormonal acne that does not improve with conventional treatment. Spironolactone may also be recommended if Roaccutane has not worked or if acne has come back after a course of Roaccutane.
What are the side effects of Spironolactone?
Side-effects of Spironolactone include :
- Passing urine more frequently for the first few weeks – 29%
- Mestrual irregularities – either heavy mesntrual cycles, irregularity in cycles, spotting, discomfort – 22%. Sometimes it is necessary to add the combined oral contraceptive pill to help these side effects.
- Breast tenderness – 17%
- Feeling sick
- Dryness of the skin
- Elevated potassium levels in the blood – 0.75%
- Feminisation of a male baby – it is important to avoid pregnancy while on Spironolactone as it can cause a male baby to become feminised by blocking androgens
A lot of the symptoms may occur early on, when Spironolactone is first started. Many side effects improve with time as the body adjusts to the medication. Sometimes it is necessary to star the combined oral contraceptive pill to control the menstrual side effects.
How long does Spironolactone take to work?
Spironolactone is started at doses of 25-100mg per day and increased every 6 to 8 weeks until a dose that improves the acne is reached. There are many variations to this regime. Improvement in acne can take 3 to 6 months to be seen. The usual dose for skin concerns is 50-150mg per day.
How many appointments are required?
Follow up appointments are required every 6 to 8 weeks (or every 4 weeks if other treatments for acne are also required such as hyfrecation). Regular blood tests to monitor the potassium level are also necsessary. Blood tests are carried out before starting treatment and a few weeks after every change in dose. Once the dose is stabilised blood tests and follow up visits are carried out 3 times a year. Blood tests and follow up appointments must be carried out via the Clinic. We are unable to accept blood test arrangements from other providers.
How long will I be on Spironolactone?
Spironolactone is not a cure for acne but controls the sensitivity of the sebaceous glands to androgens. Spironolactone is taken for as long as the acne is a problem, which may be for several years. It is usually possible to start lowering the dose one year after the acne has been under excellent control.
Spironolactone is not licensed for acne in the UK. What does this mean?
While there are a number of medical reports to show that Spironolactone helps acne, and this is also our experience at Belgravia Dermatology, the quality of evidence to show benefits with Spironolactone alone compared to other established acne treatments is lacking. Low quality evidence, no matter how significant it is, means that such medications are not included in national guidelines. Spironolactone is such a medication.
Until more larger, more statistically sophisticated studies are carried out, Spironolactone will remain unlicensed in the UK. This means that you can only receive a prescription from a doctor who has experience in using this medication for acne, and who has assessed you to deem the benefits outweigh the risks. You must also take the time to read information on unlicensed medications (such as this fact sheet) and agree that you feel the benefits outweigh the risks.
Many medications are used outside a license in the UK, especially in Dermatological practice. While we have a large number of patients on Spironolactone for acne, your Dermatologist may not suggest this treatment to you if they do not believe your situation fulfils the criteria for them to provide you with an unlicensed medication. For those patients receiving Spironolactone all monitoring blood tests, prescribing and follow up consultations will need to take place at the Clinic as NHS GPs are under no obligation to continue prescribing or monitoring unlicensed medications. This means that if you elect to go on Spirinolactone your cannot continue this under the care of your GP.
In the United States, national guidelines support Spironolactone and say that ‘Spironolactone is useful in the treatment of acne in select females’.
Does Spironolactone cause cancer?
At the doses used for medicinal reasons, Spirnolactone has not been associated with cancer. Animal studies in which 150 times the dose used in humans found that there were increased benign and malignant tumours. This is not relevant for the doses used for acne.
Can Spironolactone be taken with the Oral Contraceptive Pill?
Yes, Spironolactone can be taken together with the oral contraceptive pill. Some forms of hormonal acne do not clear with the oral contraceptive pill and Spironolactone can help. Sometimes the Oral Contraceptive Pill is started because Spironolactone has caused irregularities in the menstrual cycle.
Are there any research projects being under taken on Spironolactone?
A study is currently underway at the University of Southampton looking at how good Spironolactone is compared to a dummy pill (placebo). More information on the study can be found here. Local test centres include Epson & St Helier and University Hospital Birmingham. The report of this study will be out in Oct 2021.
If you would like to discuss Spironolactone for acne with a Dermatologist then please call us on 020 7112 8622 to make an appointment.
Appleby P. Cervical cancer and hormonal contraceptives: Collaborative reanalysis of individual data for 16,573 women with cervical cancer and 35,509 women without cervical cancer from 24 epidemiological studies. Lancet 2007; 370: pp. 1609-1621
Author : Dr Sajjad Rajpar, Belgravia Dermatology
Date last reviewed: 1 Dec 2019