Acne Spironolactone Treatment

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Karen Kagha, MD, FAAD, is a Boston-based board-certified dermatologist. She is currently a Cosmetic and Laser Fellow at Harvard Massachusetts General Hospital. 

While hormonal acne is often thought to be just for teens, it's perfectly normal (and extremely common) to experience hormonal acne as an adult. Whether you’ve tried tweaking your diet or have seen a dermatologist about prescription acne medications like tretinoin, sometimes these small adjustments just aren't enough to clear tough breakouts.

Acne Treatments In Addition To Hormonal Birth Control

Typically, when topical ingredients aren't cutting it, your dermatologist might recommend a medication called Spironolactone—an oral blood pressure medication that can be prescribed off-label to treat hormonal acne. And when used as directed, it's actually quite effective (in fact, one study found that 86% of patients saw their acne improve on spironolactone therapy, and most saw results after three to six months of use).

So, who is a candidate for using Spironolactone for acne, and how does it work? Ahead, dermatologists share everything you need to know.

Who should use it: In general, women with hormonal acne or women who have been resistant to other acne treatments in the past. It is not recommended for men or for women who are looking to become pregnant. You must have a prescription to use Spironolactone.

Spironolactone Found To Improve Acne In Adult Women

Spironolactone is an oral form of medication that was initially developed to treat mild blood pressure irregularities and water retention. However, women with combination skin taking the drug for those aforementioned reasons soon found that one of the side effects was improved skin—in particular, fewer spots and breakouts. Soon after this discovery (and plenty of clinical studies), dermatologists began prescribing Spironolactone off-label to treat difficult hormonal acne cases in women.

Board-certified dermatologist Dr. Justine Kluk clarifies what is meant by off-label use: “It’s not actually specifically licensed for treating acne in absence of a syndrome like PCOS, but dermatologists can prescribe the drug on an off-label basis for women who have a hormonal pattern to their spots and whose acne hasn’t responded to first-line therapies such as prescription creams, antibiotics, and even Accutane.

The impact Spironolactone has on hormones is what give it those acne-clearing superpowers. It works by blocking the effect that androgens (hormones like testosterone) have on the body. Increased androgens can increase sebum production, which leads to clogged pores and acne flare-ups. So essentially, Spironolactone gets to the root of the cause by blocking the hormones at the core of the problem, which means the acne glands and hair follicles won’t get overloaded, thus reducing the likelihood of developing pimples.

My Personal Journey Taking Spironolactone For Acne

And like most skincare products, topical or oral, you have to give Spironolactone some time to work. Kluk says it takes around three months to see results.

Just how promising are those results? In one study, 85% of patients saw an improvement in their acne, and 55% were completely clear of acne after taking Spironolactone. Another study offered similar results, demonstrating that acne of all severity responded to Spironolactone.

The good thing is that there’s no time limit to how long you can take the drug, unlike the antibiotics that are often prescribed for acne. But Kluk says that many patients see improvement after just two rounds of treatment and find that they don't have to continue taking the medication.

Can Spironolactone Help Cure My Hormonal Acne?

Spironolactone is a prescription medication that should only be used under the direct supervision of a physician. Because the drug tampers with hormone levels and testosterone, it’s recommended for use by women only. It also can’t be prescribed for those who are trying to get pregnant, so bear this in mind if you’re planning to conceive any time soon. Dr. Colbert also notes that in some cases, Spironolactone may alter blood potassium levels, therefore, people with kidney disease should not take it,

The negative side effects associated with taking oral doses of Spironolactone include electrolyte imbalance, breast tenderness, irregular periods, and increased urination, says Raffy. 

Spironolactone is a diuretic, so it removes excess fluid from the body via urination. Colbert recommends that patients stay well-hydrated and carry a water bottle while taking Spironolactone to minimize dehydration from the diuretic effect.

Spironolactone Use In Adult Female Acne

Spironolactone can alter the body's electrolyte balance (think potassium, magnesium, and calcium)—thereby leading to low sodium. An imbalance of electrolytes can lead to muscle cramps, which can be particularly problematic during menstruation, when cramps are already an issue. If experiencing any form of cramps or dizziness, speak to a doctor.

While the medication helps with breakouts, it also alters the hormonal balance. As many know from experiencing hormonal breakouts, acne can result.

Spironolactone blocks certain hormones and lowers blood pressure—both of which can cause fatigue. If you feel suddenly tired (and that's unusual) it's best to seek the advice of an expert before continuing the medication.

Hormonal Acne: Spironolactone Treatment

Takes every opportunity to use high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial guidelines to learn more about how we keep our content accurate, reliable and trustworthy.Acne is a skin condition which causes whiteheads, blackheads, and inflamed red lesions to form on the skin. Recalcitrant acne is a condition where acne does not respond to any of the common treatments. Acne is caused from an over production of oil (sebum). Sebum is produced by androgens, one of the hormones secreted by the ovaries, which also increases hair follicle production.

Women with too much androgen, a condition called hyperandrogenism, can exhibit recalcitrant acne, truncal obesity, hair loss, hirsutism (excessive hairiness), infertility, polycystic ovaries (PCOs), and irregularities in menstrual cycle. Recalcitrant acne can be treated with hormonal preparations such as estrogen, oral contraceptive pills, and low-dose glucocorticoids. These hormones possess anti-androgenic characteristics and help in decreasing the production of androgen. Your dermatologist may recommend treating your symptoms with Spironolactone if hormonal preparations are unsuccessful in resolving your symptoms.

Spironolactone has been widely used for over 50 years to treat fluid retention, mild high blood pressure, and a few rare hormonal problems. It was subsequently found to be highly effective in the treatment of certain hormonally-related conditions in women, including adult acne, unwanted facial or body hair, and pattern hair loss of the scalp. Spironolactone is used for treatment of acne in female patients who are resistant to any other treatment. It lowers the production and circulation of androgens which in turn reduces the follicle and sebum production. Spironolactone acts as anti-androgen where the androgen receptor is blocked and inhibits 5a-reductase enzyme activity in androgens.

Spironolactone Acne Gel

Spironolactone is taken regularly for 4 months to have a beneficial effect. If the result is effective, then it can be continued for 6 to 12 months.

Spironolactone should not be used with drugs called angiotensin converting enzyme (ACE) inhibitors. If your blood pressure is normal, spironolactone will not affect it. If you are being treated for high blood pressure now, please tell Dr. Resnik as spironolactone may increase their effect. This drug is not safe for pregnant women and is not to be used by men as it can cause feminization. Also it is not prescribed for any patients with kidney related disorders. Potassium and salt contents in food, whole-grain cereals, chickpeas, potatoes, and bananas should be avoided.

In women this treatment may cause irregularity in their menstrual cycle. Hence, spironolactone plus oral contraceptives such as OrthoTricyclin or OrthoCyclen is an excellent combination treatment for androgenic acne.

Spironolactone For Acne: Complete Guide + My Experience