By Dr Davin Lim
Best Taken: AM or PM oral medication
Caution: Check potassium levels
Best for: Acne, hair loss, oily skin
Mode of action: Antiandrogen
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What is the science behind spironolactone?
Spironolactone is an anti-male hormone (anti-androgen) medication. It works by blocking the male hormone receptor and reduces the level of the male hormones, testosterone and DHEAS. This tablet was first used as a fluid tablet and increases urine production because it lowers blood pressure and reduces fluid retention.
Spironolactone is an oral medication & not a cream because androgens (the target for spironolactone) are found circulating in the bloodstream.
What skin conditions can be treated with spironolactone?
Hormonal acne: It’s the impact spironolactone has on the hormones that give it its acne fighting reputation. This is because it blocks the effect that male hormones have on oil glands and can be used as an alternative to Accutane or Oratane.
Hair loss in women: Due to its impact on hormone regulation, the drug has recently been prescribed for women experiencing hair loss, also known as androgenic alopecia.
Excessive unwanted hair: On the other hand excessive hair known as hirsutism, commonly seen with PCOS can be treated with spironolactone.
Oily skin: can also be effectively treated with this medication. Most patients only require a very small dose of between 50 to 75 mg.
To see if you are a good candidate for this medication, book in with one of the medical dermatologists @cliniccutis.
*Disclaimer: I am a procedural dermatologist, I do not treat medical conditions such as hair loss, acne or other conditions that require prescriptions/tablets.
What type of acne does spironolactone treat?
For a dermatologist to identify a potential candidate for antihormonal therapy based upon the pattern of acne they must consider...
- Acne flare ups that cycle with menstruation
- Women with adult-onset acne or persistent-recurrent acne past teenage years, even in the absence of clinical or laboratory signs of hyperandrogenism. This subset of acne is termed adult female jawline hormonal acne.
- Women on oral contraceptives (OCs) who exhibit moderate to severe acne, especially with a hormonal pattern clinically
- Women not responding to conventional therapy and not wanting to use oral isotretinoin / Oratane / Accutane
Should I take spironolactone for acne?
Spironolactone can be used to treat hormonal acne, in addition to facial & truncal acne. It works by blocking androgens (hormones) that bind to the oil gland. The most common dose for acne is between 50 to 100 mg.
How quickly does this medication work?
It can take about 10 to 12 weeks for the drug to have a noticeable effect on acne. The first signs that this is working is a reduction in oil production. Spironolactone can also treat female pattern hair loss. In this role it may take up to 6 months before noticing any changes.
Does acne get worse before better on spironolactone?
Skin purging is not common on spironolactone, unlike retinoid therapy. The flipside is that you won’t get outstanding results in the first few weeks. Most women should expect it to take around 12 weeks for the benefits to start showing.
Does acne come back after spironolactone?
Spironolactone is not a cure-all pill and won't rid you of acne forever. It can however act as a temporary solution for hormonal acne, until your hormones ‘normalize’. To date there are only a few predictable cures for acne such as...
- Isotretinoin or Oratane/Accutane: one cycle cures approximately 60% of patients.
- PDT or photodynamic therapy: this destroys the oil glands.
- AGNES or RF destruction of the pilosebaceous units.
- Case report of microneedling RF to the depth of the oil glands.
What does spironolactone do for PCOS?
Hormones such as testosterone are responsible for hair growth on the face, chest, and stomach which may affect some young women with PCOS. Spironolactone may work against by lowering the level of these hormones, which lessens hair growth and improves acne. Other medications for PCOS include metformin, isotretinoin, finasteride & cyproterone acetate.
How does spironolactone work for the treatment of hormonal acne?
This medication is known as an antiandrogen. This means it work by modulating the signal of hormones that bind to the oil gland, thereby reducing the activity. Cyproterone acetate can also do the same.
What foods should be avoided if I am taking this medication?
Spironolactone is a potassium-sparing diuretic (water pill). It prevents your body from absorbing too much salt and keeps your potassium levels from getting too low. Hence it is important to avoid food rich in potassium, for example bananas. Other foods that high in potassium include:
- Leafy greens, such as spinach & kale
- Fruits, such as tomatoes, cucumbers, zucchini, eggplant and pumpkin.
- Root vegetables, such as carrots,& potatoes
- Tree fruits, such as avocados, apples, bananas & oranges
- Peas & beans.
- Milk, yoghurt and meat.
Note - it does not mean you can not take the above foods, it just means that you should be mindful of potassium intake. A simple blood test will check your levels.
Can I use this medication long term?
Yes, this medication can be a safe, long term treatment option for hormonal acne, & hair loss. Your doctor may elect to perform blood pressure tests as well as potassium levels intermittently.
Can spironolactone affect facial hair?
The most commonly used anti-androgen for treating female facial hair is spironolactone. However, the results are modest and take at least 6 months to be noticeable. Depending on the severity, this can be combined with cyproterone acetate, and a cream based solution called Vaniqa.
Can spironolactone be effective in treating hair loss?
Yes! This tablet is frequently combined with other medications such as minoxidil & cyproterone acetate for the management of female pattern hair loss. Much like it’s effect in the treatment of hormonal acne, spironolactone blocks male hormones such as testosterone from binding to the hair follicle.
What happens when you stop spironolactone?
If you stop taking this drug, your hormonal influx returns to normal. In the context of acne, you may get recurrence of pimples and start retaining water & increase your blood pressure. Discuss cessation with your treating specialist.
Why do I pee more when I am taking spironolactone?
Spironolactone is a diuretic, also known as a 'water tablet'. It will make you go to the toilet more often to pass urine. If urination wake you up at night, consider taking this tablet in the morning.
What are the side effects of spironolactone?
Most people do not experience side effects on this drug, however, side effects that can occur with spironolactone include:
- Nausea and vomiting
- High potassium levels
- Leg cramps
- Irregular menstrual cycles or bleeding after menopause
* Potassium levels should be checked at baseline & after each dose escalation.
Is there an alternative to spironolactone?
There are alternatives instead of spironolactone for the treatment of skin conditions such as acne, excessive oil production & hair loss. Cyproterone acetate is another anti hormone medication frequently used by dermatologists. Accutane is another drug that can reduce oil production, whilst finasteride can slow down hair loss. Your medical dermatologist will discuss these medications with you.
Can spiro cause weight gain?
There are some rumors that spironolactone can cause weight gain, but there isn't much evidence it actually does. The package insert for the drug doesn't list weight gain as a side effect, in fact due to the diuretic effect of this medication, it can cause weight loss.
Davin’s pro tip on the use of Spironolactone
This is one versalite drug that can effectively & predictably treat conditions including hormonal acne, excessive oil production, hair loss & paradoxically unwanted excessive hair (hirsutism). It is particularly useful in the management of adult female acne. Surprisingly, a low dose of between 50 to 100 mg taken once a day is effective. Most patients experience very little, if any side effects.
*Disclaimer: I am a procedural dermatologist & I do not prescribe spironolactone, nor any other medication unless it is pertaining to a procedure. For medical dermatology consultations please book in with one of my colleagues @cliniccutis.