Spironolactone in Dermatology: Uses in Acne and beyond
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Spironolactone is a synthetic aldosterone receptor antagonist, first developed for use in congestive heart failure. The antiandrogenic effects of spironolactone have been used by dermatologists to diminish the effects of testosterone on skin and hair in females. In a retrospective review of 400 patients prescribed systemic spironolactone (50–100 mg/day) for acne, 86% of patients improved. Spironolactone has been used for treatment of acne, FPHL, HS and hirsutism. Combination of spironolactone with other therapies may yield enhanced efficacy.

In a study of 59 patients with acne and polycystic ovarian syndrome (PCOS) over a mean duration of 408.9 days (88.1%) were treated with spironolactone, while (11.9%) were given spironolactone and oral antibiotics (doxycycline or minocycline). (42%) of the spironolatone montherapy had improvement in their acne compared with (29%) of the combination therapy group.

The use of spironolactone as treatment for female pattern hair loss (FPHL) has been effective. An analysis combining data from two studies (n = 17, n = 39) suggested that 74.3% of patients taking spironolactone had improvement or stabilization in their FPHL. Spironolactone is generally well tolerated, with AEs causing premature cessation of treatment in 15% of patients. Frequently reported AEs include hypotension, diuresis, menstrual irregularities, nausea, diarrhoea, breast tenderness, fatigue and light-headedness.

A pragmatic approach may be to monitor electrolytes prior to initiation for all patients. In a healthcare system, spironolactone presents a lowcost, effective and alternative treatment option for various androgen-driven conditions.

source: https://europepmc.org/article/med/32571540