The Exchange

Commentary and Observations from
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Spironolactone Use in Adult Female Acne

Spironolactone Use in Adult Female Acne

Acne is an inflammatory skin condition that is usually seen in adolescence. However, it is becoming more common past the teenage years, often affecting those aged 20 years or older; women are affected at higher rates than men in all age groups. One study found that 85% of females and 15% of males have adult-onset acne.

Females are likely to get adult acne due to fluctuating hormone levels and stress, but other factors include a positive family history, medication side effects, and underlying medical conditions. The most common time for adult females to develop acne is while they are going through menopause or during a switch of oral contraceptive agents. Adult female acne has a negative impact on quality of life, often causing anxiety and depression.

Though labeled as an aldosterone antagonist, spironolactone also has anti-androgenic properties and has demonstrated efficacy in the treatment of adult females with acne vulgaris. Due to the increased sensitivity of the sebaceous glands to androgenic hormones, as well as an increase in the number of the receptors to circulating androgenic hormones located on sebocytes and keratinocytes, the androgen receptor-blocking effects of spironolactone are able to offer patients an opportunity for long-term acne control. Doses of 100 mg daily are safe and rarely associated with side effects; routine potassium monitoring is unnecessary for healthy women taking spironolactone for acne.

  • Bagatin E, de Freitas THP, Machado MCR, et al. Adult female acne: a guide to clinical practice. An Bras Dermatol. 2019;94:62-75.
  • Collier CN, Harper JC, Cafardi JA, et al. The prevalence of acne in adults 20 years and older. J Am Acad Dermatol. 2008;58:56-59.
  • Otto MA. Don't fear spironolactone, isotretinoin, OCs for acne. Accessed July 28, 2020.
  • Skroza N, Tolino E, Mambrin A, et al. Adult acne versus adolescent acne: A retrospective study of 1,167 patients. J Clin Aesthet Dermatol. 2018;11:21-25.

Filed under: Dermatology

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