Acne is caused by multiple factors together at play – skin bacteria, oil production, blocked skin pores and inflammation.  The oil production on our skin is driven by hormones, particularly testosterone, and in the normal setting helps our skin retain moisture.  We see excessive oil production and subsequently acne in our teenagers as hormone production is high during this period of life. 

So how does spironolactone fit in here?  Spironolactone helps blunt the effects of hormones at the level of the skin and we therefore see benefits with acne.  This is particularly helpful with acne in the “beard” distribution in women, as this is thought to be more reflective of “hormonal acne.”

The beauty with spironolactone is its safety profile.  Your doctor may check to see if you have any kidney issues prior to starting as normal kidney function is necessary when taking this. Additionally, someone on spironolactone cannot become pregnant as it can impair the development of the fetus.  But with those caveats, you can stay on oral spironolactone for years and it won’t contribute to antibiotic resistance like long-term antibiotic use will.

So if you’re still struggling with acne and have needed oral antibiotics, you may benefit from spironoloactone dosed anywhere between 50mg – 200mg per day.  Talk to your board-certified dermatologist to see if it’s a good fit for you. 


References:

1. Barbieri JS, Spaccarelli N, Margolis DJ, James WD. Approaches to limit systemic antibiotic use in acne: Systemic alternatives, emerging topical therapies, dietary modification…. J Am Acad Dermatol. 2019 Feb;80(2):538-549.
2. Zaenglein AL, Pathy AL, Schlosser BJ, … Guidelines of care for the management of acne vulgaris. J Am Acad Dermatol. 2016 May;74(5):945-73.e33.
3. Barbieri JS, Choi JK, Mitra N, Margolis DJ. Frequency of Treatment Switching for Spironolactone Compared to Oral Tetracycline-Class Antibiotics for Women With Acne… J Drugs Dermatol. 2018 Jun 1;17(6):632-638.
4. Tan J, Kang S, Leyden J. Prevalence and Risk Factors of Acne Scarring Among Patients Consulting Dermatologists in the USA. J Drugs Dermatol. 2017 Feb 1;16(2):97-102.