Acne treatment – Spironolactone / Aldactone
What is it Spironolactons?
Spironolactons is a potassium-sparing diuretic.
This drug prevents your body from absorbing too much salt and keeps your potassium levels from getting too low.
Spironolactone is used to treat things like;
- heart failure,
- high blood pressure (hypertension)
- hypokalemia (low potassium levels in the blood).
It is also used to treat acne.
How Spironolactons helps acne?
It is also an androgen receptor antagonist. It has been shown to reduce sebum production. This has lead to an increase in the treatment of hyperandrogenism.
Because androgens mediate increased sebum production, they have been implicated in the pathophysiology of acne, hence its use in acne treatment.
What are the side effects of Spironolactons?
The most common side effects are:
- Painful periods and cramping
- Irregular periods
- Breast tenderness
- Breast enlargement
- Elevated potassium levels in the blood
- Decreased sexual drive
- Erectile dysfunction
- Dehydration
- Electrolyte disturbances
- Nausea
- Vomiting
- Abdominal pain or cramps
- Diarrhea
- Gastric bleeding
- Gastritis
- Stomach ulcer
- Headache
- Dizziness
- Drowsiness
- Mental confusion
- Muscle cramps
Effectiveness
There is limited evidence on the safety and efficacy of spironolactone in the treatment of women with acne. For many dermatologists, spironolactone remains an alternative rather than a mainstay treatment for patients with acne. PMID 28560306
However, it is still routinely prescribed and appears well tolerated.
Results
- There is a decrease in breakouts and oiliness of the skin in a few weeks.
- Improvement ranges from a 50% to 100% reduction in acne.
- On average 75% improve PMID: 28560306
Relapse
- Approximately 40% of patients remained clear of acne
- 40% of patients presenting with a mild relapse
- 20% with a relapse that required an additional course of therapy
PMID: 15814882
Points to note
You may also see a warning about breast cancer in the information that comes with the medication. This warning was included after researchers gave animals very high doses of spironolactone. Some of the animals developed breast cancer.
The possibility that this medication increases a woman’s risk of getting breast cancer is still controversial.
We really don’t have evidence that shows taking spironolactone increases the risk of getting breast cancer. In one study, 1,475 patients prescribed spironolactone were followed for 3 to 7 years. During that time, 9 cases of breast cancer were reported. If none of these patients had taken spironolactone, it is expected that about 8 of them would have developed breast cancer during that time. Other studies have shown similar results.