Off-label spironolactone for acne?

Would you please comment on the off-label use of spironolactone as a treatment for acne vulgaris in women?
—Daniel L. Regan, MD, Barrington, R.I.

Spironolactone has been used for more than 25 years as an antiandrogen in the treatment of acne and hirsutism.

The drug has had success in treating adult women with acne, but side effects are common at the doses reported in published studies. One study assessed the therapeutic effect and tolerance of low-dose spironolactone used alone or as an adjunct in the treatment of acne in adult women (J Am Acad Dermatol. 2000;43:498-502). The author reviewed the records of 85 women whose acne was treated with spironolactone 50-100 mg/day, administered either as single-drug therapy or as an adjunct to standard therapies. The maximum length of treatment was 24 months. Acne clearing occurred in 33% of patients treated with low doses of spironolactone; 33% had marked improvement, 27.4% showed partial improvement, and 7% showed no improvement. The treatment regimen was well tolerated, with 57.5% of patients noting no adverse effects. The author concluded that spironolactone can be used in low doses as a monotherapy or as an adjunct to other acne treatments in women with adult acne.
—Jeffrey M. Weinberg, MD (104-12)

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