Spironolactone can be prescribed off label to treat hormonal acne in adult women, according to Emmy Graber M.D., M.B.A., a dermatologist based in Boston, Mass. She is assistant professor in dermatology at the Boston University School of Medicine in Boston, Mass.
"There is no FDA indication for spironolactone [to treat acne]," Dr. Graber says. "However, a lot of practicing dermatologists have found that it works quite well for certain types of acne. I think [spironolactone] is very misunderstood, and it's an incredibly effective medicine, particularly for adult women with hormonal acne."
Because of the absence of an FDA indication for acne, Dr. Graber says, physicians and physician extenders are hesitant to prescribe spironolactone, an aldosterone antagonist that is indicated to treat sodium retention associated with congestive heart failure, essential hypertension, and hypokalemia.
"It is an anti-androgen, so it can't be used in men, but it can be used in women of any age. Women who have adult acne that is primarily located in the lower half of the face and on the neck, and women who have flares [of acne] just before or after their menstrual period, find it particularly useful," Dr. Graber explains.
In those patients, androgens appear to have a strong impact on sebaceous gland activity, and the spironolactone blocks the effect of those androgens, Dr. Graber says.
Dr. Graber says that oral contraceptives "can mitigate some of the side effects of spironolactone," such as irregular menses or breast tenderness that can present while patients are taking spironolactone.