Treating Acne with Spironolactone

An Acne Treatment for Women with Hormonal Acne

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

This medication isn't used as a first line of defense against acne breakouts. Spironolactone is only effective against acne caused by hormonal fluctuations, for example women who break out around the time of their monthly cycle.

It's especially helpful for women with hormonal disorders that trigger acne or who suffer with other problems, like unwanted facial hair.

This is a treatment option for adult women only. It's not prescribed for men with acne, or for young teens and tweens.

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

How Spironolactone Works

Spironolactone is in a group of drugs classified as anti-androgens. Hormones, specifically androgens, have been linked to the development of acne.

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.

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.

How Spironolactone Is Taken

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.

Spironolactone is often prescribed along with oral contraceptives. It can also be used in conjunction with other topical acne medications. It tends to work best as an additional acne treatment, rather than the sole treatment.

Possible Side Effects of Spironolactone

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.

Sources:

Friedman AJ. "Spironolactone for Adult Female Acne." Cutis. 2015 Oct; 96(4):216-217.

Hassoun LA, Chahal DS, Sivamani RK, Larsen LN. "The Use of Hormonal Agents in the Treatment of Acne." Seminars in Cutaneous Medicine and Surgery. 2016 Jun; 35(2):68-73.

Husein-ElAhmed H. "Management of Acne Vulgaris with Hormonal Therapies in Adult Female Patients." Dermatologic Therapies. 2015 May-Jun; 28(3):166-172.

Kamangar F, Shinkai K. "Acne in the Adult Female Patient: a Practical Approach." International Journal of Dermatology. 2012 Oct; 51(10):1162-1174.

Kim GK, Del Rosso JQ. "Oral Spironlactone in Post-teenage Female Patients with Acne Vulgaris." Journal of Clinical and Aesthetic Dermatology. 2012 Mar; 5(3):37-50.

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