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 topical retinoids.
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None of the authors have any relevant conflicts to disclose.


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