Spironolactone and Topical Retinoids in Adult Female Cyclical Acne
February 2014 | Volume 13 | Issue 2 | Original Article | 126 | Copyright © February 2014
Erin Lessner MD,a Samantha Fisher MD,b Katherina Kobraei MD,b Michael Osleber MD,b Rebecca Lessner BS,c Lauren Elliott MD,d and Stanton Wesson MDb
aDepartment of Ophthalmology, University of South Carolina, Columbia, SC
bDepartment of Dermatology, University of Florida, Gainesville, FL
cLincoln Memorial University, DeBusk School of Medicine, Harrogate, TN
dDepartment of Emergency Medicine, University of California San Diego, San Diego, CA
This study illustrates the significant benefits of using spironolactone
and topical retinoids in female adult patients with
cyclical acne. Many of the women in this study had been on
chronic oral antibiotics for years with minimal improvement
in their acne. Our experience shows spironolactone and topical
retinoids provide an alternative and superior treatment
strategy for the women in this cohort other than chronic oral
antibiotics. Patients may be started on a 50mg po daily dose
of spironolactone with nightly application of tretinoin 0.025%
or adapalene and followed up within 3 months. If at this time
there is minimal improvement, the dose can be increased to
75mg po daily and subsequently 100mg po daily if improvement
is not seen over the course of 6-9 months time. We
recommend follow up visits every 3 months for the first 9-12
months to establish a baseline dose and monitor for adverse
effects. We establish prior to initiating therapy with spironolactone
that there is no history of renal disease, concurrent
potassium supplementation, or potassium sparing diuretic
use. We did not routinely monitor potassium levels in this
study or suggest dietary modification, as the data in the literature
suggests minimal risk of hyperkalemia in low doses of
spironolactone administered to young healthy patients with
normal renal function. However, we recommend monitoring
of baseline renal function and potassium levels every three
months in patients with a history of cardiac disease or renal
insufficiency, patients taking concurrent oral contraceptives
with drospirenone and other potassium sparing diuretics, potassium
supplementation, and ACE inhibitors. In addition, it
may be prudent to monitor potassium levels in patients on
higher dosages of spironolactone (150mg-200mg) every 3
months. To help clarify the risks of spironolactone, we encourage
studies with larger sample sizes, longer length of follow
up, and carefully conducted medical histories concerning
newly diagnosed malignancies in patients on spironolactone.
Our experience shows spironolactone is a safe and important
drug in treating women with adult cyclical acne along with
None of the authors have any relevant conflicts to disclose.
- Spironolactone package insert.
- Sica DA. Pharmacokinetics and pharmacodynamics of mineralocorticoid
blocking agents and their effects on potassium homeostasis. Heart Fail Rev. 2005; 10:23-29.
- Hardman J, Limbird L, Gilman A. Goodman & Gilman's The Pharmacological
Basis of Therapeutics, 10th ed. McGraw-Hill, 2001: 780.
- Schohn DC, Jahn HA, Pelletier. Dose-related cardiovascular effects of spironolactone. Am J Cardiol. 1993; 71:40A-45A.
- Shaw JC. Spironolactone in dermatologic therapy. J Am Acad Dermatol. 1991; 24:236-43.
- Farquhar C, Lee O, Toomath R, Jepson R. Spironolactone vs placebo or in
combination with steroids for hirsutism and/or acne. Cochrane Database
Syst Rev. 2003;(4):CD000194.
- Saha L, Kaur S, Saha PK. Pharmacotherapy of polycystic ovary syndrome - an
update. Fundam Clin Pharmacol. 2012; 26(1):54-62.
- Goulden V, Clark SM, Cunliffe WJ. Post-adolescent acne: Review of clinical
features. Br J Dermatol. 1997; 136(1):66–70.
- Thiboutot D, Chen W. Update and future of hormonal therapy in acne. Dermatol. 2003; 206(1):57–67.
- Goodfellow A, Alaghband-Zadeh J, Carter G, et al. Oral spironolactone improves
acne vulgaris and reduces sebum excretion. Br J Dermatol. 1984; 111(2):209-14.
- Westberg L, Baghaei F, Rosmond R et al. Polymorphisms of the androgen
receptor gene and the estrogen receptor beta gene are associated with androgen
levels in women. J Clin Endocrinol Metabol. 2001;86:2562–68.
- Sawaya ME, Shalita AR. Androgen receptor polymorphisms (CAG repeat
lengths) in androgenetic alopecia, hirsutism, and acne. J Cutan Med
Surg. 1998; 3(1):9-15.
- Muhlemann MF, Carter GD, Cream JJ, et al: Oral spironolactone: An effective
treatment for acne vulgaris in women. Br J Dermatol. 1986; 115:227-232.
- Burke BM, Cunliffe WJ. Oral spironolactone therapy for female patients with acne,
hirsutism or androgenic alopecia [letter]. Br J Dermatol. 1985; 112:124-125.
- Hatwal A, Bhatt RP, Agrawal JK, et al. Spironolactone and cimetidine in treatment
of acne. Acta Derm Venereol. 1988; 68(1):84-87.
- Shaw JC. Low dose adjunctive spironolactone in the treatment of acne in
women: A retrospective analysis of 85 consecutively treated patients. J Am
Acad Dermatol. 2000; 43(3):498–502.
- Saint-Jean M, Ballanger F, Nguyen J, et al. Importance of spironolactone
in the treatment of acne in adult women. J Eur Acad Dermatol Venereol. 2011; 25(12):1480-1.
- Faure M, Drapier-Faure E. L’ acné Les traitements hormonaux. Ann Dermatol
Venereol. 2003; 130:142–147.
- Shaw JC, White LE. Long-term safety of spironolactone in acne: results of a
8-year follow-up study. J Cutan Med Surg. 2002; 6(6):541-5.
- Krunic A, Ciurea A, Scheman A. Efficacy and tolerance of acne treatment
using both spironolactone and a combined contraceptive containing drospirenone. J Am Acad Dermatol. 2008; 58(1):60-2.
- Lowenstein EJ. Diagnosis and management of the dermatologic manifestations
of the polycystic ovary syndrome. Dermatol Ther. 2006; 19(4):210-223.
- George R, Clarke S, Thiboutot D. Hormonal therapy for acne. Semin Cutan
Med Surg. 2008; 27(3):188-196.
- Thai KE, Sinclair RD. Spironolactone-induced hepatitis. Australas J Dermatol. 2001; 42(3):180-2.
- Ghislain PD, Bodarwe AD, Vanderdonckt O, et al. Drug-induced eosinophilia
and multisystemic failure with positive patch-test reaction to spironolactone:
DRESS syndrome. Acta Derm Venereol. 2004; 84(1): 65-8.
- Sato K, Matsumoto D, Iizuka F, et al. Anti-androgenic therapy using oral spironolactone
for acne vulgaris in Asians. Aesthetic Plast Surg. 2006; 30(6):689-94.
- Wolverton, SE. Comprehensive Dermatologic Drug Therapy 2nd Ed. Elsevier
- Shaw JC. Acne: effect of hormones on pathogenesis and management. Am
J Clin Dermatol. 2002; 3(8):571-78.
- Ghanem CI, Gómez PC, Arana MC, et al. Induction of rat intestinal P-glycoprotein
by spironolactone and its effect on absorption of orally administered
digoxin. J Pharmacol Exp Ther. 2006; 318(3):1146-52.
- Levesque H, Verdier S, Cailleux N, Elie Legrand MC, et al. Low molecular
weight heparins and hypoaldosteronism. BMJ. 1990; 300:1437-8.
- Muhlemann MF, Carter GD, Cream JJ, Wise P. Oral spironolactone: an effective
treatment for acne vulgaris in women. Br J Dermatol. 1986; 115: 227-232.
- Krattenmacher R. Drospirenone: pharmacology and pharmacokinetics of a
unique progestogen. Contraception. 2000; 62(1):29-38.
- Yemisci A, Gorgulu A, Piskin S. Effects and side-effects of spironolactone
therapy in women with acne. J Eur Acad Dermatol Venereol. 2005;