Aldactone (Spironolactone) for Hormonal Acne is a potassium-sparing diuretic, and a potent aldosterone blocker used off-label in dermatology to treat acne and hirsutism in women.
I promised myself two years ago while waiting in a new dermatologist’s office that this would be the last doctor I’d ever see for my acne. I was fed up with the disappointment — and the cost.
My most extreme breakouts happened during the formative years of middle school and college, but I was still struggling with hormonal acne at 30.
I felt a tinge of shame and self-loathing every time I looked in the mirror and saw a fresh cluster of swollen pimples on my face or back.
After waking up to yet another round of severe cystic acne, I wanted to crawl back under the covers as I did in college. However, I was now an editor at a magazine in downtown Manhattan.
It’s not that I didn’t make an effort to get rid of my moderate-to-severe acne. During my childhood, I’d seen many dermatologists who recommended everything from topical retinoids and acids to regular doses of oral antibiotics.
These medications, however, failed to alleviate my monthly barrage of red, painful bumps, even after months of use. Drugs also resulted in peeling skin and less money in my pocket to spend on concealer.
I wanted the dermatologist to frown at my “backne,” or back acne, and prescribe another round of doxycycline or a bottle of benzoyl peroxide when he entered the room and checked my records.
Instead, he inquired as to whether I had heard of spironolactone. I hadn’t, but I was willing to give it a shot.
He sent me a prescription for spironolactone after a short explanation about how it works and its possible side effects.
Why have you never heard of Aldactone spironolactone as a treatment for acne?
Even though dermatologists are gradually scraping “spironolactone” onto their Rx pads, many acne sufferers haven’t heard of it despite typing “acne” and “help!” into Google’s search bar.
Although doctors have known about its skin-clearing properties for decades, the drug is only now an effective treatment for hormonal acne in women.
The fact that spironolactone to treat high blood pressure and heart disease is probably why acne sufferers haven’t heard of it.
Though I’d been taking the birth control pill since I was a teenager to prevent period-related breakouts, spironolactone is more offensive. It inhibits the development of androgens (aka male sex hormones).
The drug decreases oil production and reduces the frequency of clogged pores by inhibiting the production of these hormones, such as testosterone.
Furthermore, the therapy isn’t limited to people who experience acne flare-ups during their menstrual periods. Spironolactone can also benefit postmenopausal women who have developed a sudden rash.
Females of any age who have high hormone levels and acne can benefit from the medication. Spironolactone is seldom administered to men for acne because it induces feminization, including a loss of libido and the growth of breast tissue, trusted Source.
So, how did it go for you?
Spironolactone, like most acne drugs, does not function right away. After six weeks, I found a decrease in the number and size of spots I had, but I still got some during my stay.
I went to my local drugstore about the three-month mark to replenish my blemish concealer in preparation for my monthly cycle breakout. However, it turned out to be a waste of money because I only had two slots that week instead of the expected 20.
My acne had cleared up three months after beginning spironolactone. There were left just a few scars.
My upper back and shoulders had been my most significant breakout region since I was in my mid-20s, and they had cleared up in three months.
But, after four months on spironolactone, I didn’t have to worry about pimples appearing on my chin and cheeks every month when the cramps hit.
My skin was smoother, less sticky, and free of the blackheads that had always adorned the pores on my nose.
I still triumphantly stashed my charcoal and mud masks under the bathroom sink because my skin was no longer red or blotchy when I woke up.
For the first time in my adult life, I had clear skin, which drastically changed my self-perception. While walking down the lane, I stopped dwelling on my shortcomings and lifted my head slightly higher.
Since my back was no longer inflamed, I began to wear clothes that I had previously avoided, such as backless dresses and tank tops.
I’d had acne for so long that I’d forgotten how much time I’d spent feeling ashamed and angry about it, let alone how many hours I’d spent trying to manage and conceal it.
Although everybody, with or without clear skin, can aspire for this level of self-confidence and acceptance, spironolactone helped me come to grips with all those years of being embarrassed about my acne — as though it were my fault — and finally move on.
Advantages and Disadvantages of Aldactone Spironolactone usage:
Given its ability to treat acne, spironolactone is not without the risk of side effects.
New users can experience dizziness, headaches, nausea, and vomiting, according to a 2017 research study trusted Source.
The medication has been know to cause potassium levels to spike on rare occasions. Since it’s administered at such a low dose for acne, it’s unlikely that users would need to avoid bananas or other potassium-rich foods.
Nonetheless, since high potassium levels can cause fatigue, heart palpitations, and even death, I have a blood test once a year to be sure.
On a less harmful note, spironolactone has been relating to breast tenderness and enlargement in some women. My breasts had blown up by almost a full cup size two months after starting spironolactone.
Although I celebrated this side effect with a mirror dance party, the downside is that my breasts are now sore and swollen around my time.
Spironolactone has also been linked to reducing the amount and thickness of body hair, especially on the face. Inversely, it raises the thickness of hair on the head, as though it were mindful of many women’s beauty goals.
My body hair is slight, and my hair was still unruly enough to clog any shower drain I’ve ever experienced, so I didn’t see any side effects.
Transgender women, on the other hand, have long praised the medication for its ability to minimize or remove facial hair growth. Female has also handled pattern hair loss with it, according to doctors’ Trusted Source.
For the past two years, I’ve been taking spironolactone.
To be clear, it’s not a miracle cure for acne: I still get small breakouts now and then, mostly in response to stressful situations. However, the most significant factor is that my acne is under control.
Although things could still change — if I get pregnant, I’ll have to stop taking the drug — spironolactone has helped me improve my self-esteem and accept my skin, scars, and all.
While trying various acne remedies, do you still have acne on your lower lip, jawline, and neck? Have you ever tried an antibiotic to cure your acne and been let down by the results? Are you still having trouble clearing acne on your chest or back?
If you replied yes to all of these questions, you might want to consider hormonal acne treatment.
What exactly is acne hormonal therapy?
Hormonal therapy refers to any drug that affects our hormones. The following are two hormonal treatments that can effectively clear acne in women:
- Oral contraceptive pills (also known as birth control pills or “the pill”) are oral contraceptives.
- Spironolactone is a type of spironolactone (spy-ren-no-lac-tone)
Is hormonal therapy effective, and is it safe?
Many studies have looked at how effective oral contraceptive pills are at preventing acne. Blackheads, whiteheads, pimples, acne nodules, and cysts have all been found to react well to the medication.
The pill has proven to be so successful that the US Food and Drug Administration (FDA) has approved certain oral contraceptives for acne treatment.
The pill is commonly thought to be healthy for females. Some women, on the other hand, should avoid it. If the medication is a safe and effective treatment choice for you, your dermatologist will tell you.
Spironolactone is a drug that doctors use to treat high blood pressure. It’s also used to treat people who have too much fluid in their bodies.
For several years, dermatologists have prescribed it to treat acne and excessive hair growth in women. It can successfully treat deep-seated, tender acne on the lower face, jawline, or neck where other acne remedies have failed.
Because of its side effects, spironolactone is not recommended for treating acne in men. When taking this acne drug, men have grown breasts.
For healthy women, spironolactone is usually considered secure.
Taking spironolactone and the pill together will help you be more successful. There’s another benefit of this mix. When taking spironolactone, it’s important to use birth control. If you become pregnant while on spironolactone, your child can be born with severe birth defects.
Spironolactone can also be given without the use of a pill. If you’re 35 or older, the medication may not be an option for you, and you’ll be given spironolactone instead. If you have a medical condition that makes taking the pill unhealthy, such as a blood clot or stroke, taking spironolactone without the medication is also advised.
Spironolactone can be very beneficial when taken alone. Researchers looked at the medical records of 85 people who took spironolactone and discovered that 1/3 of them had fully cleared acne and the other third had noticeably less acne. Just 7% of people saw no change.
Spironolactone has also been shown to be successful in studies. Acne reduction ranges from 50 percent to 100 percent.
It’s important to understand that spironolactone is a diuretic, which means you’ll need to urinate more often. If you think this could be a concern, talk to your dermatologist.
POTASSIUM AND SPIRONOLACTONE:
Too much potassium can be harmful when taking spironolactone. Coconut water and potassium supplements should be avoided.
What would taking hormone treatment for acne entail?
A doctor must write a prescription for these drugs. Each pill is something you’d take regularly.
Make an appointment with a dermatologist if you’re curious if hormone treatment will help you clear up your acne. This doctor will tell you whether hormone treatment is an option after testing your acne and collecting the relevant details about your health.
It is helpful to plan for your appointment with a dermatologist before you go. You should be able to tell your dermatologist the following information:
- You have (or had) medical problems such as high blood pressure, heart disease, blood clots, migraines, or cancer.
- Medications that you use.
- You take vitamins and other natural things.
- Surgical procedures you’ve undergone.
- Near relatives’ medical problems, such as cancer, kidney failure, or heart disease.
If you decide to take the pill, your blood pressure will be measured to rule out high blood pressure. A dermatologist does not need to conduct a Pap smear or a pelvic exam before administering the pill to treat acne.
You’ll need some blood tests before your dermatologist prescribes spironolactone.
If you start hormone therapy, you’ll need to see your dermatologist regularly. When you first start taking spironolactone, you’ll need to see your dermatologist every 4 to 6 weeks to progressively raise the dose.
How long do you think it would take for you to see results?
It takes time to see results, much like other acne remedies. Girls, on average, note the following improvements:
- The Pill: 2 or 3 months.
- Spironolactone: After just a few weeks, you’ll note a drop in breakouts and oiliness.
How long do the majority of patients stay on hormone therapy?
A patient can remain on hormone therapy for a long time if it helps to clear up acne. Some acne therapies, such as antibiotics and topical medications, are often discontinued. To avoid new breakouts, hormonal treatment may be used alone.
Long-term hormone therapy tends to be effective.
ARE YOU ON SPIRONOLACTONE?
According to studies, taking spironolactone at the same time per day produces the best results.
What are the potential negative consequences?
Dermatologists carefully test their patients before administering hormone therapy to reduce the possibility of severe side effects. The following are some of the potential side effects.
It’s the pill. Taking medicine increases your odds of:
- Clots in the blood
- Angina pectoris
- Blood pressure that is too high
Although these side effects do not seem to be worth the risk, most healthy women do not experience them. The risk of blood clots is higher during pregnancy and immediately after childbirth than when using the pill.
It’s also important to remember that today’s drugs carry a more negligible risk of severe side effects than in the past. The pill now has less estrogen in it.
Melasma, or dark spots on the skin, is a pill’s side effect for certain women. Avoiding the sun on your face will help prevent these spots.
Another potential side effect is bleeding through the skin. Taking the pill at the same time every day will help avoid this.
THE PILL AND ACNE:
Staying healthy, drinking plenty of water, and not smoking will help you avoid blood clots if you’re on the pill.
Spironolactone: The following are the most common side effects when taking spironolactone without a birth control pill:
- Cramps and painful periods
- Unusual periods
- tenderness in the breasts
- Enlargement of the breasts
When women take the pill, these side effects can be reduced.
Fatigue, headache, and dizziness are some of the other possible side effects of spironolactone use. It is unusual for a woman to avoid taking her medicine as a result of these.
The information that comes with the drug can also include a breast cancer alert. After giving animals highly high doses of spironolactone, this alert was added. Breast cancer originated in some of the animals.
The possibility that this drug raises a woman’s risk of breast cancer is still a contention point.
We don’t have any proof that taking spironolactone makes you more likely to get breast cancer. In one study, 1,475 spironolactone patients were followed for 3 to 7 years. Nine cases of breast cancer were reported during that period. It’s estimated that about 8 of these patients would have developed breast cancer during that period if they hadn’t taken spironolactone. Similar findings have been found in other research.
What factors help in achieving the best results?
It is beneficial to take hormone treatment for acne to:
- Allow time for the drug to take effect.
- Every day, take your prescription at the same time.
- All on the acne care plan should be included.
- Keep all of the dermatologist’s follow-up appointments.
- If you find signs of a severe side effect, such as cramping in your leg or arm, contact your dermatologist right away.
Hormonal treatment is a viable choice for many women suffering from stubborn acne, but it isn’t always the only one. A dermatologist will advise you on how to get rid of acne.
What do you do on the first visit with a patient who is about to start taking spironolactone?
Some women would inquire about spironolactone for acne, so it’s crucial to classify possible antihormonal therapy candidates:
- Acne flare-ups in women who have menstrual cycles
- Also, in the absence of clinical or laboratory symptoms of hyperandrogenism, women with adult-onset acne or persistent-recurrent acne past their teenage years are at risk.
- Women on oral contraceptives (OCs) who have moderate to severe acne, particularly if they have a clinically significant hormonal pattern
- Women who haven’t responded to traditional therapy and don’t want to use or aren’t candidates for oral isotretinoin
Polycystic ovary syndrome and congenital adrenal hyperplasia are the two most common causes of hyperandrogenism, so these people with acne will need to be evaluated for hormonal imbalance. In conjunction with dysmenorrhea or amenorrhea, the appearance of alopecia, hirsutism, acanthosis nigricans, or other signs of androgen overload may indicate that the patient has an underlying medical condition that needs to be treated. Testosterone tests, dehydroepiandrosterone, follicle-stimulating hormone, and luteinizing hormone will be acceptable screening tests and should be conducted during the menstrual cycle or the week before; the patient should not be on an OC or have been on one during the previous 6 weeks.
Before beginning spironolactone treatment, make sure the patient has no history of renal failure, that he or she is not taking potassium supplements, other potassium-sparing diuretics.
(e.g., amiloride, triamterene), Angiotensin-converting enzyme inhibitors, or angiotensin-converting enzyme inhibitors, and that the patient is not taking angiotensin-converting enzyme inhibitors or angiotensin-converting enzyme inhibitors.
It’s worth noting that the patient shouldn’t be trying to get pregnant right now or soon. Despite its category C ranking, there is a significant theoretical risk of teratogenicity, especially in male fetuses (i.e., the feminization of a male fetus). There have been no reports linking spironolactone to human congenital defects, and there have been no well-controlled, prospective studies testing spironolactone exposure in pregnant women.
What does the patient know before the first visit?
Since patients can reach Dr. Internet via their smartphones and tablets in seconds, I review several points with them as a semi-preemptive attack.
While the US Food and Drug Administration has not approved spironolactone for acne treatment, it has been used for decades to treat acne and much longer to treat high blood pressure (since 1957!). Patients must be careful not to take too much of a good thing because it is a potassium-sparing diuretic (i.e., potassium). I advise patients on potassium intake from various sources, including diet (e.g., fruits and fruit drinks), coconut water (currently popular), and over-the-counter nutritional supplements.
Spironolactone is given in various doses (25–200 mg daily) depending on the situation, but it’s essential to start with a low amount and gradually increase it as required, depending on how the patient is doing. I typically inform the patient that at least one dose increase (around 50 mg twice daily) is needed to see noticeable results; however, patients frequently see some change even at the lowest dose of 25 mg twice daily within four weeks of starting treatment, which is when I make them come back for reevaluation.
Acne on the face, back, and chest may be treated with spironolactone.
The majority of spironolactone side effects are dose-dependent; low-dose treatment (25–50 mg daily) is usually well-tolerated, and even 100 mg daily is rarely problematic.
Frequent urination, menstrual disturbances, breast tenderness and/or enlargement, low blood pressure, hyperkalemia, and decreased libido are all dose-dependent side effects. A recent study (Plovanich et al.) discovered that the frequency of hyperkalemia in healthy young women taking spironolactone for acne is comparable to the baseline rate of hyperkalemia in this population. As a result, for healthy women taking spironolactone for acne, regular potassium testing is unnecessary. I typically don’t monitor potassium in these patients unless they’re on higher doses or have female pattern alopecia, which also necessitates higher dosing.
Spironolactone has enough evidence to indicate that long-term usage is generally healthy. One long-term research included patients who obtained spironolactone to treat acne vulgaris for up to 8 years (Shaw and White).
Spironolactone can be safely used alone or in conjunction with OCs. In reality, prescribing spironolactone with OCs can kill three birds with one stone in terms of efficacy (the synergy between the two also allows for lower spironolactone dosing without sacrificing impact), contraceptive, and dysmenorrhea prevention. I do include OCs to patients who are beginning spironolactone for the first time. Spironolactone can be used safely in conjunction with oral antibiotics in most cases, but oral antibiotic use should be limited to prevent antimicrobial resistance from spreading. When spironolactone is mixed with trimethoprim-sulfamethoxazole, there is a chance of hyperkalemia, so it should be avoided in this situation.