Spironolactone

Spironolactone (Aldactone) is an Androgen Inhibitor medication. These medications block the effect of androgen (male) hormones that contribute to acne symptoms in some individuals. Spironolactone is occasionally used for the treatment of acne, primarily in women.

Spironolactone is not a common treatment for acne, but many patients have reported positive results with this medication. Multiple clinical research studies have also found that Spironolactone can be an effective treatment for acne. Spironolactone is available in oral and topical formulations, but this medication is more commonly administered orally.

Spironolactone inhibits the activity of androgens (male hormones) by blocking the androgen receptor (AR) and inhibiting androgen production. Spironolactone is commonly used off-label to treat a variety of dermatological conditions caused by high androgen levels, such as hair loss, hirsutism and acne. Spironolactone is also used to treat polycystic ovary syndrome.

Androgen hormones stimulate the growth and activity of the sebaceous glands, and production of sebum, which contributes to the pathogenesis of acne. Elevated levels of androgen hormones can trigger acne symptoms during puberty. Studies of adult females with acne have shown that many of these women have abnormally high levels of androgen hormones in their blood. Spironolactone may help improve acne symptoms by reducing the effects of elevated androgen levels. The inhibition of androgen activity can decrease the activity of the sebaceous glands, which can improve acne  symptoms in some patients.

Both oral and topical Spironolactone have been reported to be effective treatments for acne, but the effects (and side effects) are more pronounced with oral Spironolactone. Several studies have indicated that topical Spironolactone can be an effective acne treatment for men and women. Spironolactone is often combined with complementary acne treatments (eg. Antibiotics, Retinoids). For some individuals, Androgen Anhibitors may be a good alternative to Retinoids in the treatment of sebaceous hyperplasia (over-active sebaceous glands).

Spironolactone is generally well reviewed by patients, but the majority of people taking this medication do report mild side effects. Spironolactone works well for many acne sufferers who have acne and oily skin that is caused by elevated levels of androgen hormones. Oral Spironolactone is usually only prescribed to women. Because Spironolactone inhibits the action of androgen hormones, it can have feminizing effects on males. Common side effects of Spironolactone treatment include: menstrual irregularities, ataxia, drowsiness and nausea. Allergic reactions are possible with this medication and may result in rashes, fever and other symptoms. Some studies have suggested that Spironolactone may be carcinogenic, however those results were obtained in rats and used dosages more than 100x higher than the commonly used with humans. Carcinogenicity studies in humans and primates have been inconclusive.

Spironolactone affects the balance of hormones in the body and it is not used in women who are pregnant or may become pregnant. The use of Spironolactone is not recommended for persons taking certain medications used to treat hypertension and depression.

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