What is Spironolactone?
Spironolactone is an oral medication that helps clear hormonal acne in women in their 20’s and 30’s as well as women in the perimenopause and menopause. Spironolactone helps cystic acne as well as comedones. Spironolactone is only available on prescription. Spironolactone tablets are available in 3 sizes – 25mg, 50mg and 100mg. You should only take Spironolactone for acne if this has been recommended to you by a Dermatologist.
We are very experienced in providing treatment with Spironolactone for acne in Birmingham. Spironolactone can be an excellent treatment for chronic acne.
What are the benefits of Spironolactone?
Spironolactone helps with skin and hair conditions that are caused by androgens including:
- Hormonal acne for women in their 20’s and 30’s
- Acne during the perimenopause
- Acne caused by HRT or Testosterone as part of HRT
- Female pattern hair loss
- Excessive body hair
Spironolactone may be used alone or in combination with other treatments for acne.
How does Spironolactone help hormonal acne?
Androgens are “male” hormones but they are also present in women. The main androgens in the body are Testosterone and Dihydrotestosterone.
Hormonal acne can occur if hair follicles are very sensitive to androgens, even when androgen levels are normal. Hormonal acne also occurs if androgen levels are raised or in conditions like polycystic ovarian syndrome.
In some women, hormonal acne is caused by a sensitivity to Progesterone.
Spironolactone can help control hormonal acne because it blocks the effects of androgens and progesterone on the skin.
What are the benefits of Spironolactone?
By reducing the activity of hormones on the hair follicles and sebaceous glands, Spironolactone provides the following benefits:
- Fewer inflamed spots – especially nodules, and cysts.
- Fewer comedones – comedones are skin coloured bumps that are under the skin which become inflamed spots
- Less greasiness in the skin. The skin visibly looks and feels less oily. This can lead to retinoids causing irritation 6 months after starting Spironolactone.
How effective is Spironolactone for acne in women?
A number of medical reports have been published to show that Spironolactone is effective. Overall, our experience is that Spironolactone helps control hormonal acne in about 60 to 65% of women.
A large study treated 400 women with Spironolactone. In this study, 147 women had never received other acne treatments before. In this group, 93% of patients found their acne improved with Spironolactone. The other 253 patients were already on acne treatments, and adding Spironolactone improved acne in 87% of women.
A summary of studies of Spironolactone for acne have shown improvement rates of:
- 93% of 147 women who had never been treated for acne and 87% of 253 women who had previous treatment for acne (Gradhi et al) improved with Spironolactone
- 71% in 70 women (Isvy et al) improved Spironolactone
- 55% in 110 women cleared completely with Spironolactone and another 30% improved significantly (Charney et al).
Some important points to consider if you are thinking about taking Spironolactone for acne:
- Spironolactone does not work for everyone but helps at 65% of women with hormonal acne (if not more). It is not possible to predict who may benefit and who may not.
- Some women may clear completely with Spironolactone. In other women, Spironolactone may reduce the rate of acne but not clear it completely. This means you may still need other acne treatments while taking Spironolactone.
- Spironolactone can take 3 to 6 months to have its full effects. Waiting for the results can be very frustrating.
- Spironolactone only works while you are taking it. This means your acne may come back when you stop. Women may be on Spironolactone for 1 or 2 years or sometimes for several years.
- Spironolactone can cause side effects. About 1 in 20 of women may need to reduce or come off Spironolactone because of side effects (see below).
What are the risks of taking Spironolactone?
It is important to consider the risks of taking Spironolactone as well as the benefits. As with any other medication, Spironolactone can have side effects. About 1 in 20 women may experience side effects which require them to come off medication or reduce their dose.
Side effects from Spironolactone include:
- There may be a flare in acne which occurs in about 5% of people.
- Passing urine more frequently for the first few weeks – 29%. This settles within a month.
- Menstrual irregularities – either heavy menstrual cycles, irregularity in cycles, spotting, discomfort or amenorrhoea (when the periods stop all together) – 22%. Sometimes it is necessary to add the combined oral contraceptive pill to help these side effects.
- Breast tenderness – 17%
- Breast swelling – this can occur in women
- Bloating
- Headache
- Feeling sick
- Dryness of the skin
- Fatigue
- Reduced libido
- Elevated potassium levels in the blood – 0.75%-2% for those under 45 years of age. The rate may be as high as 16% for women who are over 46 years of age.
- Reduced kidney function
- Reduced sodium levels in the blood
- Feminisation of a male baby – it is important to avoid pregnancy while on Spironolactone as it can cause a male baby to become feminised by blocking androgens
- Theoretical risk of cancers with very long term use – At the doses used for medicinal reasons, Spironolactone has not been associated with cancer. Animal studies in which 150 times the dose used in humans found that there were increased benign and malignant tumours. This does not appear to be relevant for the doses used for acne.
Low potassium diet
You should not take any supplements that contain Potassium. It is also helpful to avoid large quantities of foods which are high in potassium, and to cook potatoes and vegetables in such a way so as to reduce their potassium content. There are a variety of resources on the Internet on low potassium diets.
A low potassium diet is more important if you are over 45 years of age or if you have any other conditions of the kidney or take medications that could affect potassium levels in your body.
It can be helpful to see a private registered dietitian.
How long is a course of Spironolactone?
You would require Spironolactone for as long as your acne is a problem. Most women will be on treatment for a year or two and some women may need treatment for several years. It is possible to reduce the dose and try without medication a year into treatment after the acne has been controlled fully.
How long does Spironolactone take to work?
Spironolactone is started at doses of 25-100mg per day and increased every 6 to 8 weeks until a dose that improves the acne is reached. There are many variations to this regime. Improvement in acne can take 3 to 6 months to be seen. The usual dose for skin concerns is 50-150mg per day.
Pregnancy and breast feeding
Pregnancy and breast feeding must be avoided while taking Spironolactone.
How many appointments are required?
You will require regular consultations and blood tests if you choose to go on Spironolactone. It is important to factor the costs of these in when considering a course of Spironolactone.
Consultation
On average, follow up appointments are required every 6 to 8 weeks. A consultation may be required sooner and more frequently if you experience side effects. Please review information on follow up consultations at the Clinic.
Once your skin and medications are stable consultations are required every 4 months.
Blood tests
Regular blood tests are required to monitor potassium levels and kidney function.
- A blood test will be required 2 and 6 weeks after starting treatment and after any change in dose.
- Once the dose is stabilised, blood tests are required every 3 to 4 months while you are on treatment.
- For those under 45 years of age, it is reduced to 6 monthly in the second year of treatment.
- For those over 45 years of age, blood tests may be required monthly in the first 3 to 6 months especially if there are any changes.
Spironolactone is not licensed for acne in the UK. What does this mean?
It is very important to understand that Spironolactone is an unlicensed medication for acne. For those patients receiving Spironolactone all monitoring blood tests, prescribing and follow up consultations will need to take place at our Clinic as NHS GPs are under no obligation to continue prescribing or monitoring unlicensed medications. This means that if you elect to go on Spironolactone you cannot continue this under the care of your GP. You should factor this in when considering the costs of private Spironolactone treatment.
Even though Spironolactone works for acne, it is not in the UK Guidelines for Acne Treatment. One of the reasons for this is because the quality of evidence to show benefits with Spironolactone alone compared to other established acne treatments is lacking. Low quality evidence, no matter how significant it is, means that such medications are not included in national guidelines.
Until more larger and statistically sophisticated studies are carried out, Spironolactone will remain unlicensed in the UK.
You can only receive a prescription from a doctor who has experience in using this medication for acne, and who has assessed you to deem the benefits outweigh the risks. You must also take the time to read information on unlicensed medications (such as this fact sheet) and agree that you feel the benefits outweigh the risks.
Many medications are used outside a license in the UK, especially in Dermatological practice. While we have a large number of patients on Spironolactone for acne, your Dermatologist may not suggest this treatment to you if they do not believe your situation fulfils the criteria for them to provide you with an unlicensed medication.
Appointments for Spironolactone
If you are interested in discussing Spironolactone as a treatment for acne, then please contact us on 0121 285 4540 to organise an appointment.
What are the benefits of Spironolactone?
Spironolactone helps with skin and hair conditions that are caused by androgens including:
- Hormonal acne for women in their 20’s and 30’s
- Acne during the perimenopause
- Acne caused by HRT or Testosterone as part of HRT
- Female pattern hair loss
- Excessive body hair
Spironolactone may be used alone or in combination with other treatments for acne.
How does Spironolactone help hormonal acne?
Androgens are “male” hormones but they are also present in women. The main androgens in the body are Testosterone and Dihydrotestosterone.
Hormonal acne can occur if hair follicles are very sensitive to androgens, even when androgen levels are normal. Hormonal acne also occurs if androgen levels are raised or in conditions like polycystic ovarian syndrome.
In some women, hormonal acne is caused by a sensitivity to Progesterone.
Spironolactone can help control hormonal acne because it blocks the effects of androgens and progesterone on the skin.
What are the benefits of Spironolactone?
By reducing the activity of hormones on the hair follicles and sebaceous glands, Spironolactone provides the following benefits:
- Fewer inflamed spots – especially nodules, and cysts.
- Fewer comedones – comedones are skin coloured bumps that are under the skin which become inflamed spots
- Less greasiness in the skin. The skin visibly looks and feels less oily. This can lead to retinoids causing irritation 6 months after starting Spironolactone.
How effective is Spironolactone for acne in women?
A number of medical reports have been published to show that Spironolactone is effective. Overall, our experience is that Spironolactone helps control hormonal acne in about 60 to 65% of women.
A large study treated 400 women with Spironolactone. In this study, 147 women had never received other acne treatments before. In this group, 93% of patients found their acne improved with Spironolactone. The other 253 patients were already on acne treatments, and adding Spironolactone improved acne in 87% of women.
A summary of studies of Spironolactone for acne have shown improvement rates of:
- 93% of 147 women who had never been treated for acne and 87% of 253 women who had previous treatment for acne (Gradhi et al) improved with Spironolactone
- 71% in 70 women (Isvy et al) improved Spironolactone
- 55% in 110 women cleared completely with Spironolactone and another 30% improved significantly (Charney et al).
Some important points to consider if you are thinking about taking Spironolactone for acne:
- Spironolactone does not work for everyone but helps at 65% of women with hormonal acne (if not more). It is not possible to predict who may benefit and who may not.
- Some women may clear completely with Spironolactone. In other women, Spironolactone may reduce the rate of acne but not clear it completely. This means you may still need other acne treatments while taking Spironolactone.
- Spironolactone can take 3 to 6 months to have its full effects. Waiting for the results can be very frustrating.
- Spironolactone only works while you are taking it. This means your acne may come back when you stop. Women may be on Spironolactone for 1 or 2 years or sometimes for several years.
- Spironolactone can cause side effects. About 1 in 20 of women may need to reduce or come off Spironolactone because of side effects (see below).
What are the risks of taking Spironolactone?
It is important to consider the risks of taking Spironolactone as well as the benefits. As with any other medication, Spironolactone can have side effects. About 1 in 20 women may experience side effects which require them to come off medication or reduce their dose.
Side effects from Spironolactone include:
- There may be a flare in acne which occurs in about 5% of people.
- Passing urine more frequently for the first few weeks – 29%. This settles within a month.
- Menstrual irregularities – either heavy menstrual cycles, irregularity in cycles, spotting, discomfort or amenorrhoea (when the periods stop all together) – 22%. Sometimes it is necessary to add the combined oral contraceptive pill to help these side effects.
- Breast tenderness – 17%
- Breast swelling – this can occur in women
- Bloating
- Headache
- Feeling sick
- Dryness of the skin
- Fatigue
- Reduced libido
- Elevated potassium levels in the blood – 0.75%-2% for those under 45 years of age. The rate may be as high as 16% for women who are over 46 years of age.
- Reduced kidney function
- Reduced sodium levels in the blood
- Feminisation of a male baby – it is important to avoid pregnancy while on Spironolactone as it can cause a male baby to become feminised by blocking androgens
- Theoretical risk of cancers with very long term use – At the doses used for medicinal reasons, Spironolactone has not been associated with cancer. Animal studies in which 150 times the dose used in humans found that there were increased benign and malignant tumours. This does not appear to be relevant for the doses used for acne.
Low potassium diet
You should not take any supplements that contain Potassium. It is also helpful to avoid large quantities of foods which are high in potassium, and to cook potatoes and vegetables in such a way so as to reduce their potassium content. There are a variety of resources on the Internet on low potassium diets.
A low potassium diet is more important if you are over 45 years of age or if you have any other conditions of the kidney or take medications that could affect potassium levels in your body.
It can be helpful to see a private registered dietitian.
How long is a course of Spironolactone?
You would require Spironolactone for as long as your acne is a problem. Most women will be on treatment for a year or two and some women may need treatment for several years. It is possible to reduce the dose and try without medication a year into treatment after the acne has been controlled fully.
How long does Spironolactone take to work?
Spironolactone is started at doses of 25-100mg per day and increased every 6 to 8 weeks until a dose that improves the acne is reached. There are many variations to this regime. Improvement in acne can take 3 to 6 months to be seen. The usual dose for skin concerns is 50-150mg per day.
Pregnancy and breast feeding
Pregnancy and breast feeding must be avoided while taking Spironolactone.
How many appointments are required?
You will require regular consultations and blood tests if you choose to go on Spironolactone. It is important to factor the costs of these in when considering a course of Spironolactone.
Consultation
On average, follow-up appointments are required every 6 to 8 weeks. A consultation may be required sooner and more frequently if you experience side effects. Please review the information on follow-up consultations at the Clinic.
Once your skin and medications are stable, consultations are required every four to six months.
Blood tests
Regular blood tests are required to monitor potassium levels and kidney function.
- A blood test will be required before starting and 6-7 weeks after starting treatment.
- A blood test is required after any change in dose.
- Once the dose is stabilised, blood tests are required every 3 to 6 months while you are in treatment
You are advised not to commence treatment if you cannot fulfil consultation and blood test requirements.
Spironolactone is not licensed for acne in the UK. What does this mean?
It is very important to understand that Spironolactone is an unlicensed medication for acne. For those patients receiving Spironolactone all monitoring blood tests, prescribing and follow up consultations will need to take place at our Clinic as NHS GPs are under no obligation to continue prescribing or monitoring unlicensed medications. This means that if you elect to go on Spironolactone you cannot continue this under the care of your GP. You should factor this in when considering the costs of private Spironolactone treatment.
Even though Spironolactone works for acne, it is not in the UK Guidelines for Acne Treatment. One of the reasons for this is because the quality of evidence to show benefits with Spironolactone alone compared to other established acne treatments is lacking. Low quality evidence, no matter how significant it is, means that such medications are not included in national guidelines.
Until larger and more statistically sophisticated studies are carried out, Spironolactone will remain unlicensed in the UK.
You can only receive a prescription from a doctor who has experience in using this medication for acne and who has assessed you to deem the benefits outweigh the risks. You must also take the time to read the information on unlicensed medications (such as this fact sheet) and agree that you feel the benefits outweigh the risks.
Many medications are used outside a license in the UK, especially in Dermatological practice. While we have a large number of patients on Spironolactone for acne, your Dermatologist may not suggest this treatment to you if they do not believe your situation fulfils the criteria for them to provide you with an unlicensed medication.
Appointments for Acne and Spironolactone
If you are interested in discussing Spironolactone as a treatment for acne, then please contact us on 0121 285 4540 to organise an appointment or click here to make an enquiry .
Medications are only prescribed during a consultation once your doctor has an adequate knowledge of your health and condition. A particular medication is only prescribed if the medication is suitable for a person in their current situation.
We ask that you do not assume that a particular medication will be prescribed at a consultation, as this will be down to the medical assessment made by your doctor. Further, we also do not necessarily continue prescriptions for medications you may have been prescribed elsewhere including from overseas or from online providers as the same criteria for prescribing are applied.
References
Author details
Author: Dr Sajjad Rajpar
Date last reviewed: 1 Oct 2021
Conflict of interest and disclaimer
This information is based on the views of a UK Consultant Dermatologist (a doctor who is on the specialist register for Dermatology, the equivalent of which is ‘Board certified’ in the USA) who has supervised many patients successfully on Spironolactone over almost 20 years of practice. This information is intended for patients of this Clinic and under our care only. No part of this document should be construed at medical advice to those not under the care of this Clinic and under our care. Practices vary nationally and internationally, and we do not wish to contravene advice you have been provided by your own Physician.
