What is the role of spironolactone in the treatment of acne vulgaris?

Updated: Mar 26, 2019
  • Author: Jaggi Rao, MD, FRCPC; Chief Editor: William D James, MD  more...
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Spironolactone may also be used in the treatment of acne vulgaris. [50] Spironolactone binds the androgen receptor and reduces androgen production. Adverse effects include dizziness, breast tenderness, and dysmenorrhea. [35] Dysmenorrhea may be lessened by coadministration with an oral contraceptive. In two 2017 retrospective studies, spironolactone has been shown to be effective in reducing inflammatory lesions in multiple areas of the body with minimal adverse effects. [51, 52] Currently, more high-powered randomized controlled trials are needed to assess the efficacy of spironolactone monotherapy in treating acne, but spironolactone should be considered in recalcitrant acne, in women who do not tolerate or have contraindications to oral contraceptives, and to prevent antibiotic resistance. [35] A 2015 large retrospective study of healthy women aged 18-45 years confirms potassium monitoring is unnecessary for these patients while taking spironolactone. [53] Pregnancy must be avoided while taking spironolactone because of the risk of feminization of the male fetus, and spironolactone is not recommended for males because of the potential for gynecomastia. [35, 51] While a black box warning regarding possible cancer risk was placed on spironolactone many years ago after rats fed high doses of the medication developed both benign and malignant tumors, several large retrospective and longitudinal studies have found no association with cancer. [54]


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