Treating Acne with Spironolactone

An Acne Treatment for Women with Hormonal Acne

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Spironolactone is used to treat many different disorders, from high blood pressure to fluid retention. Although the U.S. Food and Drug Administration doesn't recognize spironolactone as an acne treatment, it is often prescribed off-label to treat hormonally influenced breakout in women.

This medication isn't a first line of defense against acne breakouts. It is only effective against acne caused by hormonal fluctuations.

But it can be especially helpful for women with hormonal disorders that trigger acne or who suffer with other problems, like unwanted facial hair.

Spironolactone is only available by prescription from your doctor. It is also sold under the brand name Aldactone.

How it Works

Spironolactone is in a group of drugs classified as anti-androgens. Androgen hormones, like testosterone, are typically thought of as male hormones. But androgens are also present in the female body, although in lower levels.

Some women produce more androgen hormones than needed. Anti-androgens like spironolactone block androgen receptors in the body, preventing cells from absorbing androgen hormones. Simply, spironolactone limits hormonal fluctuations that can contribute to acne breakouts. Hormones, specifically androgens, have been linked to the development of acne.

More About Hormones and Acne

Because of the way spironolactone works, only women whose acne has a hormonal basis will see results with this medication.

But for those women who have hormonal acne, the drug can do a good job in helping to manage breakouts.

Common Usage Directions

When using spironolactone as an acne treatment, the most common dosage is between 50 to 100 mg daily. Many dermatologists start off prescribing 25 mg and work up to the target dosage over the course of several weeks.

Your doctor will determine the most appropriate dosage for you, depending on your personal situation.

If your breakouts only tend to occur around the time of your monthly cycle, your dermatologist may have you use spironolactone for the week just prior to your period.

More About Premenstrual Acne

Spironolactone is often prescribed along with oral contraceptives. It can also be used in conjunction with other topical acne medications.

Possible Side Effects

Side effects with low dose spironolactone aren't as common as with higher doses, but most often include:

Other side effects can be:

Both blood potassium levels and blood pressure should be checked periodically while you're taking this medication. Also, you shouldn't get pregnant while taking it. And this medication isn't a good choice for you if you have kidney problems, or a history (or family history) of breast cancer, uterine cancer, or ovarian cancer.

Tips for Using Spironolactone

  • Take your pill with a meal if it upsets your stomach.
  • Drink plenty of water. Spironolactone acts as a diuretic.
  • Be patient. It will probably take several weeks before you really notice an improvement in your skin.
  • Let your doctor know if you develop any side effects.


"Adult Acne: Effective Treatment Available." AcneNet. 20 Sep 2007. American Academy of Dermatology. Accessed 4 Feb 2008.

Krunic A., Ciurea A. Scheman A. "Efficacy and tolerance of acne treatment using both spironolactone and a combined contraceptive containing drospirenone." Journal of the American Academy of Dermatology 2008; 58(1): 60-62.

Shaw JC. "Low-dose adjunctive spironolactone in the treatment of acne in women: a retrospective analysis of 85 consecutively treated patients." Journal of the American Academy of Dermatology 2000; 43(3): 498-502.

"Spironolactone." Medline Plus. 01 May 2007. National Institutes of Health. Accessed 08 Feb 2008.

Williams C, Layton AM. "Persistent acne in women: implications for the patient and for therapy." American Journal of Clinical Dermatology 2006; 7: 281-90.

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