Spironolactone for Acne – read this first!

woman with acne on spironolactone

50 million people in America struggle with Acne. The American Academy of Dermatology outlines the way to treat and prevent acne. Treatment should start by an assessment of acne severity and skin type. For most people, a right combination of topical medications such as benzoyl peroxide with the right medicated and moisturizer should be effective enough to control acne. 15-20 % of people with acne would need the addition of oral medications. The most effective oral medications for Acne if Accutane (isotretinoin) (read more here about Accutane for hormonal acne). Nevertheless, it’s not for everyone. It is contaminated in pregnancy and requires careful monitoring by a dermatologist during the treatment. Women with hormonal related acne can add to their medicated acne treatment skincare, birth control pills or Spironolactone.

Is Spironolactone a hormone?

Spironolactone is not a hormone. it's actually a diuretic that also works as an androgen blocker. It blocks the effects of male hormones in the body like testosterone, which can contribute to oil production and acne.

Who should consider Spironolactone?

Spironolactone should be never be used without a proper topical skincare routine. In case that there no improvement with topical medications in 6 months. Spironolactone can be considered. Spironolactone can be prescribed only to healthy, adult women with hormonal related moderated to severe acne that did not respond to topical treatment. It is especially recommended to would with Polycystic ovary syndrome. (PCOS)

Since it does affect and typically lower testosterone levels, it's not for male patients. It's also not recommended for females who are pregnant or trying to become pregnant and people patient that have any medical conditions that cause electrolyte imbalances.
Spironolactone should never be used by women with heart failure or kidney disease.

For how long do people with acne get Spironolactone?

Same as for oral antibiotics and birth control pills Spironolactone does not cure acne. The idea, is to use the drug to reduce acne breakouts to a controllable level. Once there is a significant reduction of the severity of the acne, results should be maintained for the long term by continued use of and effective anti-acne maintenance topical treatment such as MDacne. Dermatologists would usually prescribe Spironolactone for 6-12 months.

When should I expect improvement?

An improvement in acne is usually expected in 6-8 weeks.

What are the adverse effects of Spironolactone?

The most common side effects of spironolactone are breakthrough bleeding or spotting, followed by amenorrhea and lightheadedness. Other less common side effects of long-term use of Spironolactone during treatment for acne include irregular menstruation, urinary frequency, dizziness, headaches, nausea, vomiting, breast tenderness, and breast enlargement.  Because of its anti-androgenic effects, Spironolactone has been hypothesized to be associated with an increased risk of estrogen-sensitive cancers but there is currently no evidence to support this in human subjects. Additionally, a recent study investigated hyperkalemia as a potential complication of this potassium-sparing diuretic in healthy young women with acne who are the typical demographic for off-label Spironolactone use. With the exclusion of women with heart failure or kidney disease, this study showed that serum potassium levels were not found to be elevated above those of the controls and it was concluded that routine potassium monitoring is unnecessary for this relatively young and healthy cohort.

What are the usual doses?

Spironolactone dosage varies between 100-200mg/day.

Can it be combined with other medications?

The medication can cause your body to hold on to potassium, so it's also important to keep potassium consumption in check." In other words, you might need to cut, or at least reduce, bananas and avocados from the diet. Spironolactone shouldn't be combined with other diuretics or potassium supplements. bloodwork should be performed every three to six months while you're taking Spironolactone to make sure potassium levels are in the normal range.

Is Spironolactone better than oral antibiotics for acne?

The chronic use of oral tetracycline antibiotic medications, which is common in the treatment of acne, has been associated with an increased risk of antibiotic resistance upper respiratory tract infections, and inflammatory bowel disease. For the right patients (healthy adult woman), Spironolactone—with a similar side effect profile regardless of the duration of treatment—may be a safer treatment option than oral antibiotic medications for chronic acne treatment.

References:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5440451/

Effective anti-acne treatment to treat before Spironolactone

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