Spironolactone for Acne – Everything You Need to Know

Spironolactone for acne - the complete guide for acne sufferers.

When your acne isn’t occasional and you have been suffering from acne for years long, you know that maintaining a proper skincare regimen is not enough. You need to seek a dermatologist to prescribe you proper medication according to your acne condition.

All those who deal with hormonal and cystic acne need to take medications as part of their treatment. Spironolactone is one of them. Although, this medicine is originally made for treating high blood pressure and heart failure, dermatologists recommend spironolactone for acne.

What is Spironolactone?

Spironolactone is a pill that was formulated to treat hypertension and cardiovascular conditions. But soon after, it is being prescribed by dermatologists to cure hormonal acne in women. Not approved by FDA for any skin-related conditions, Spironolactone has been used to treat acne for over 30 years.

According to Joshua Zeichner, Director of Cosmetic and Clinical Research in Dermatology,

“Spironolactone is a high blood pressure medication used off-label at low doses to treat acne – that means it is not officially approved for acne.”

The question is if Spironolactone was not meant for acne then what makes it work for acne. Let’s have a brief encounter.

How Spironolactone Works for Acne?

Spironolactone basically works by blocking the male hormone receptors that can lead to breakouts. A report published in PubMed, a research journal, proves that spironolactone inhibits male hormone receptors in the sebaceous glands.

Joshua Zeichner explains, “It blocks the effect of hormones like testosterone on your oil glands. If the oil glands are not stimulated as much they do not make as much oil, which means less shine, fewer blockages in the pores, and less food to feed acne-causing bacteria in the skin.”

Besides, Spironolactone has also been presented as one of the four hormonal agents in the treatment of acne vulgaris in the American Academy of Dermatology (AAD) 2016’s guideline. The recommendation of Spironolactone and oral corticosteroids were rated a B because of inconsistent patient-oriented evidence while the oral contraceptives were rated an A.

Who Are the Ideal Candidates for Spironolactone?

Knowing if Spironolactone is the right choice for you isn’t that difficult. Below is a brief guide and after all you can contact your dermatologist for further advice.

Spironolactone is specifically very efficient for adult women who

  • Suffer from premenstrual or postmenstrual acne. The high levels of hormones before menstruation build great tendency in women to break out. And Spironolactone actually inhibits the male hormone testosterone resulting in less oil production that helps in clearing hormonal acne.

Dr. Emmy Graber, president of Dermatology Institute of Boston said, “Female patients with hormonal acne that typically flares before or after menstrual cycles may be ideal candidates for spironolactone.”

In addition to that, Dr. Shari Marchbein, clinical professor of dermatology at New York University of Medicine, told in an interview, “Spironolactone, at its appropriate dose, can help with these cystic flares, in particular the ones that women develop with their hormonal changes during the month.”

  • Suffer from Polycystic Ovarian Syndrome(PCOS) or hirsutism.

According to Dr. Graber, “Some PCOS patients have irregular cycles, but there are also patients with irregular menstrual cycles who don’t have PCOS, that might be good candidates for spironolactone.”

  • Failed other therapies for adult acne like anti-biotic treatment.

For example patients who have recurred acne after a course of Isotretinoin (a derivative of vitamin A that restricts sebaceous gland function and is used to treat severe inflammatory acne.)

What is the Right Dosage?

The right dosage of spironolactone depends on the severity of acne. Anyhow, doctors usually recommend either 50mg/day or 100mg/day i.e. once or twice a day. In case you do not clear in a month, the dosage can range up to 200mg/day which is the maximum dose.

Dr. Emmy Graber says, “The dosing varies greatly from patient to patient. Some patients might come back in three months with only slight improvement which would be an indication that they might need a higherdose. ”

How Much Time Does it Take to Clear Up?

The time it takes to clear acne flares after consuming spironolactone depend from person to person. According to Dr. Marchbein, “12 weeks is the typical amount of time to see clearance.”

Apart from this, many users report a clearance in as few as 3 weeks while some also report in as much as 4 months after taking spironolactone.

How Does Spironolactone Intake Benefit You?

You need to be fully aware of all the benefits that spironolactone holds for you. The benefits are more collective rather than specific. Scroll down to view the brighter side of spironolactone.

Safe for Long-term Use

Although there are many short-term and minimal side effects of spironolactone, it is perfect to use in the long run. It lies in the safe spectrum of medications.

Dr. Marchbein says, “It is an incredibly safe medication. The reports of it being associated with breast cancer and other cancers like uterine and ovarian have been completely debunked.”

Furthermore, a research conducted by PubMed whose main objective was to observe safety of spironolactone in acne with an 8 year follow-up declares it to be completely safe.

According to a study of 110 patients given spironolactone for acne, published in International Journal of Women’s Dermatology, negates any link of spironolactone with cancer. So, you really don’t need to worry about taking spironolactone for months.

Controls Acne Related to PCOS

Polycystic Ovary Syndrome (PCOS) is a hormonal disorder that usually occurs due to excess male hormones (androgens) in females. Spironolactone can be a ‘miracle pill’ for you if you are suffering from hormonal acne that is caused to you because of PCOS.

Dr. Sejal Shah, cosmetic dermatologist and founder of Smarter Skin Dermatology in NYC explains, “When using it to treat acne, spironolactone is only used in women and tends to work best for women with hormonal acne, menstrual flares, adult-onset acne, or conditions with hormone abnormalities and acne (e.g. PCOS).”

Treats Hirsutism

Hirsutism is an ‘excess hair growth on face or body’ condition that occurs in female due to the presence of elevated male hormones. Spironolactone is effective in treating hirsutism.

Often, oral contraceptives are used to treat hirsutism in young women. But according to studies spironolactone used along with contraceptives work best for hirsutism. When 50 to 200mg of spironolactone is used daily into two divisions, it works better than placebo and oral contraceptives alone.

What are the Side Effects of Spironolactone?

While we have gone through the benefits of Spironolactone, the spironolactone side effects can’t be overlooked. There are many short-term and minimal side effects of spironolactone. Let’s discuss them in brief detail.

Short-term Side Effects

These effects are common and occur to very few people. You would be very lucky if you aren’t one of them.

Dr. Marchbein says, “Sometimes taking the medication twice a day helps with any symptoms. However, these are fairly low percentages and overall very well tolerated, so they should not deter patients from taking drugs.”

Some of the common side effects are listed below:

  • Dizziness and headache
  • Vomiting and diarrhea
  • Stomach pain
  • Breast tenderness
  • Irregular menstrual periods

Things You Should Know Before Taking Spironolactone

Besides the common side effects, there are things you should know before using spironolactone.

Do Not Expect Instant Results

The time it takes to improve acne differs from person to person. Do not expect an instant result.

According to Dr. Zeichner, “It takes about three months at the right dose to get the full effect. If the dose is too low in effect for you, you may need to increase the dose and need to wait a few months for that dose to kick in.”

Not for Use during Pregnancy

Spironolactone is not suitable for use during pregnancy. Apart from that it also prevents fertilization i.e. you can’t conceive while on spironolactone.

Besides, as published in a report in International Journal of Women’s Dermatology, the anti-androgynous effect of spironolactone can cause the feminization of the male fetus during early pregnancy.

You Will Get More Tired than Usual

Since this pill is primarily used for lowering blood pressure it can make you feel tired. Dr. Sejal Shah explains, “Spironolactone blocks the hormone aldosterone, which can lead to fatigue. In addition, it can lower the blood pressure, and if this drop is sudden, you may feel tired.”

It is a Diuretic Pill

Spironolactone is a diuretic pill i.e. you will urinate frequently. Some of the patients report peeing every 30 minutes.

Decide whether to use spironolactone or not, on the basis of this comprehensive post and obviously with your dermatologist’s advice. We hope this is going to prove really helpful for your guidance.

Sheikh has been blogging regularly at CAA for over 5 years. He spends majority of his time studying health and technology or participating in discussions about these niches (online or offline).


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