Spironolactone: an alternative to antibiotics for acne vulgaris?

Facial acne treatments can include topical therapies, vitamin A derivatives, or antibiotics. Some may cause complications, so could spironolactone help?

An interesting, current study on spironolactone in the treatment of facial acne

What is spironolactone?

Spironolactone is a potassium-sparing diuretic and is therefore primarily used in the treatment of high blood pressure and heart failure. However, it also has an effect on testosterone balance. Its anti-androgenic effect lowers testosterone levels. This is why the drug is also prescribed to some women for forms of hisurtism, acne and alopecia.

Is spironolactone effective for acne?

A recent analysis has compared the effect of the diuretic with that of a placebo. The authors conducted a randomised controlled trial. Half of the test subjects took spironolactone for 24 weeks (with an initial dose of 50 mg, which was increased to 100 mg after six weeks) and the other half received a placebo.

The outcomes were measured using quality of life questionnaires (Acne-specific Quality of Life, or "Acne-QoL") and an assessment of the clinical picture by the study physicians.

How does the drug compare with placebo?

The questionnaires were analysed after 12 and 24 weeks. At both time points, the improvement in quality of life was more pronounced for the women taking spironolactone. Although one of the QoL symptom scores was already higher at week 12, the change was even more marked at week 24. The same applies to the subjective perception of disease burden: the difference between the two groups was minimal at week 12, but statistically significant at week 24.

An objective improvement in acne was observed in 19% of spironolactone patients after 12 weeks, but only in 6% of women in the placebo arm.

Is spironolactone well tolerated?

In the study, treatment with the diuretic resulted in more undesirable side effects: More women in the verum arm complained of headaches than was the case in the placebo group. An increased incidence of serious side effects was not found.

Key take away for medical practice

The data show that treatment with spironolactone appears to improve acne symptoms in women, at least in comparison to placebo. The diuretic may be a good alternative to antibiotic therapy.

  1. BMJ 2023;381:e074349