Spironolactone is an aldosterone antagonist that is approved by the FDA as a diuretic and as an antihypertensive drug. For many years, it has also been prescribed off-label for treating acne in women and for other dermatological concerns. Because of its hormonal effects, it is not a recommended treatment for acne in men. In clinical trials, oral administration of spironolactone consistently outperforms a placebo. A topical spironolactone gel can be made by a compounding pharmacy for local administration that may help decrease systemic side effects.

What Does it Treat?

Spironolactone gel is primarily used for hormonal-pattern acne but it has been effective at treating acne of various types. When acne is related to hormones it often includes deep inflammatory papules located mostly on the lower half of the face and upper part of the neck.

Spironolactone has been shown to decrease androgen-stimulated sebaceous activity. Even in women who do not have elevated androgen levels, spironolactone has been shown to effectively decrease acne lesions. In fact, most women who respond well to spironolactone do not actually have elevated circulating androgen levels, which means it may be targeting the skin directly.

Spironolactone is sometimes used on its own but can also be combined with other acne treatments. Combining oral contraceptives with spironolactone may help decrease menstrual side effects and increase the efficacy of the both drugs. In addition, it is helpful to be taking birth control while using spironolactone because the drug can adversely affect a pregnancy. When being treated with this medication, patience is required. It can take up to 4-8 weeks to tell that spironolactone gel is working for treating acne.

Side Effects

Side effects are usually minimal and may include erythema and stinging in the application area. When taken orally, spironolactone can cause menstrual irregularities, nausea, fatigue, and other symptoms. These symptoms may be reduced with topical application. Spironolactone has been used for decades as a systemic treatment for acne. Recent research suggests that topical application may be effective, especially for mild to moderate acne, while having a better side effect profile than oral administration.

Research

Treatment of Acne With Spironolactone: A Retrospective Review of 395 Adult Patients at Mayo Clinic, 2007-2017. – Journal of the European Academy of Dermatology and Venereology

Comparison of the efficacy of 5% topical spironolactone gel and placebo in the treatment of mild and moderate acne vulgaris: a randomized controlled trial. – Journal of Dermatological Treatment

Topical spironolactone inhibits dihydrotestosterone receptors in human sebaceous glands: an autoradiographic study in subjects with acne vulgaris. – International Journal of Tissue Reactions