Spironolactone

In recent years, the rise in cases of adult acne has been likened to an epidemic. More and more adults are having to deal with teenage skin long after blowing out the candles on that 19th birthday cake. Whether you’ve tried tweaking your diet (have you tried giving up dairy yet?) or switching up your skincare routine, it’s a really tricky skin issue to fix because the causes and fixes vary so wildly from person to person. In short, when it comes to acne, we’re still after some miracle cure. So when we heard that highly-respected dermatologists recommended the same spot-fighting ingredient within weeks of each other, our ears perked up. 

TYPE OF INGREDIENT: Medication

MAIN BENEFITS: Regulates oil production, blocks androgen receptors, and reduces the length of hormonal breakouts.

WHO SHOULD USE IT: In general, women with hormonal acne or women who have been resistant to other acne treatments in the past. It is not recommended for men or for women who are looking to become pregnant.

HOW MUCH YOU SHOULD USE IT? Consult a dermatologist.

WORKS WELL WITH: Generally, it works well with all topical treatments.

DON'T USE WITH: Check for interactions with other medications.

What Is Spironolactone?

One of the reasons this ingredient has been lying low is because it can’t be applied topically. In fact, it’s an oral form of medication that was initially used to treat mild blood pressure and water retention. However, women with combination skin taking the drug for those aforementioned reasons soon found that one of the side effects was better skin—in particular, fewer spots and breakouts.

It’s been dished out in the United States for years to treat adult acne. Nick Lowe, MD, a consultant dermatologist and clinical professor, who practices out of the U.S. and England, says this is because prescribing spironolactone for acne is essentially “off-label,” meaning it wasn’t designed to treat hormonal acne, so it doesn’t sit neatly under that category.

Susan Raffy, a California-based cosmetic chemist and the president of Susan Raffy Consulting, says that those "off-label" prescriptions are typically reserved as a last resort. "If you do not suffer from Polycystic Ovarian Syndrome, Spironolactone is not prescribed for treating acne," says Raffy.

That being said, dermatologists, gynecologists, and endocrinologists have been using it for women suffering from PCOS for a while. “It’s not actually licensed for treating acne in absence of the full syndrome, but consultant dermatologists can prescribe the drug on an off-label basis for women who have a hormonal pattern to their spots and whose acne hasn’t responded to first-line therapies such as prescription creams, antibiotics, and even Accutane,” explains Justine Kluk, MD, dermatologist and acne specialist.

So, when women experiencing hormonal acne get wind of a treatment that works without any irritation to the skin or other nasty side effects (some lightheadedness can occur if you have low blood pressure), they might be quick to jump in. Which is why it’s now starting to gain traction as a treatment for women who have severe hormonal acne.

• Clears skin by blocking hormones: It’s the impact spironolactone has on the hormones that give it its superpowers. That’s because it blocks the effect that androgens (hormones like testosterone) have on the body. Increased androgens can increase sebum production. Once you stop that, the acne glands and hair follicles won’t get overloaded, thus reducing the likelihood of developing pimples.

• Treats high blood pressure: This is, of course, the primary reason spironolactone is prescribed—it's a potassium-sparing diuretic (i.e. a water pill) that prevents the body from absorbing too much salt.

• Treats hair loss in women: Due to its impact on hormone regulation, the drug has recently been prescribed for women experiencing hair loss. It hasn't been found to have the same impact on men, however.

The trouble with spironolactone, however, is that androgens are notoriously tricky to target, which is why it doesn’t perform very well as a topical treatment: “Studies show it’s the same concept as Roaccutane in that it works when ingested via the mouth, but not when applied as a gel,” Lowe says.

The good news? The more people are talking about it and the more studies that can prove its complexion clearing abilities, the more likely it will start to become a go-to for dermatologists and doctors—especially when cases of adult acne are on the rise.

As Raffy explains, the reason that spironolactone works on acne is two-fold. "Testosterone causes the sebaceous glands in our skin to produce more oil and make our skin thicker resulting in increased clogged pores," she says. "By blocking the actions of testosterone on our skin, the risk of clogged pores and subsequent acne is reduced." 

Side Effects of Spironolactone

Because the drug tampers with hormone levels and testosterone, it’s recommended for use by women only (it could potentially cause men to suffer from gynecomastia, enlarged breast tissue and tenderness). It also can’t be prescribed for those who are trying to get pregnant, so bear this in mind if you’re planning to conceive any time soon.

Otherwise, the negative side effects associated with taking oral doses of Spironolactone include "electrolyte imbalance, breast tenderness, irregular periods and increase in urination," says Raffy. 

Dr. David Colbert, MD, and founder of the New York Dermatology Group, also recommends that people taking spironolactone stay hydrated, as it is a diuretic. "Also, it can alter your blood potassium levels, therefore, people with kidney disease should not take it," he says.

How Does It Work?

Like most skincare products, topical or oral, you have to give it time to work. Kluk says it takes around three months to see results. And just how promising are those results? In one study, 85% of patients saw an improvement in their acne, and 55% were completely clear of acne after taking spironolactone. The good thing is that there’s no time limit to how long you can take the drug, unlike the antibiotics that are often prescribed for acne.

Having said that, some dermatologists advise taking antibiotics at the same time, including Lowe. “If someone keeps coming back for acne because other treatments aren’t working, I’ll prescribe a low-dose antibiotic along with spironolactone, but that will soon be withdrawn and then they can remain on the spironolactone for long-term periods,” he adds. If you do find yourself on antibiotics, consider trying to bolster your gut bacteria (it can be adversely affected by antibiotics) with a probiotic like Symprove.