Does Spironolactone Work for Acne?

I treat many patients with acne. You may be surprised to know that most of these patients are adult women. There is misconception that acne is a skin condition seen only in teenagers. For this reason, acne in adulthood can be especially frustrating. My patients often ask, “I didn’t have acne as a teenager, why did I get this now?” Well the answer is HORMONES!

Unfortunately, the hormonal fluctuations that occur monthly in women can wreak havoc on your skin. There are many options to treat acne but one that can be especially useful in adult women with hormonal acne is spironolactone. Spironolactone belongs to a class of medications known as anti-androgens. Androgens are sex hormones that cause the monthly breakouts that many women experience. Anti-androgens stop the effects of androgens by blocking the receptors in the skin. The result is less acne.

Spironolactone was not originally developed to treat acne. Its use in acne is “off-label;” however, spironolactone is being prescribed more frequently to treat hormonal acne with good results. In clinical studies over 80% of women treated had improvement in their acne.

What are the side effects of spironolactcone? We used to check potassium levels because it was believed spironolactone could affect potassium levels. However, a recent study found that in young healthy women, spironolactone had no effect of potassium. Of course, with any hormone therapy birth control is a must to prevent pregnancy while on this medication.

How long does spironolactone take to work in acne? In my experience, women usually notice improvement in the first 6 weeks. I know hormonal acne can be frustrating. Ask your dermatologist about spironolactone as an option if conventional therapies don’t work.