Spironolactone for Acne: What You Need to Know Before Use

While hormonal acne is often thought to be just for teens, it's perfectly normal (and extremely common) to experience hormonal acne as an adult. Whether you’ve tried tweaking your diet or have seen a dermatologist about prescription acne medications like tretinoin, sometimes these small adjustments just aren't enough to clear tough breakouts.

Typically, when topical ingredients aren't cutting it, your dermatologist might recommend a medication called Spironolactone—an oral blood pressure medication that can be prescribed off-label to treat hormonal acne. And when used as directed, it's actually quite effective (in fact, one study found that 86% of patients saw their acne improve on spironolactone therapy, and most saw results after three to six months of use).

Physicians say Spironolactone works by regulating oil production, blocking acne-causing androgen receptors, and reducing the intensity and lifespan of hormonal breakouts.

So, who is a candidate for using Spironolactone for acne, and how does it work? Ahead, dermatologists share everything you need to know.

What Is Spironolactone?

Spironolactone is an oral form of medication that was initially developed to treat mild blood pressure irregularities and water retention. However, women with combination skin taking the drug for those aforementioned reasons soon found that one of the side effects was improved skin—in particular, fewer spots and breakouts. Soon after this discovery (and plenty of clinical studies), dermatologists began prescribing Spironolactone off-label to treat difficult hormonal acne cases in women.

Board-certified dermatologist Dr. Justine Kluk clarifies what is meant by "off-label" use: “It’s not actually specifically licensed for treating acne in absence of a syndrome like PCOS, but 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."

How Does It Work?

The impact Spironolactone has on hormones is what give it those acne-clearing superpowers. It works by blocking the effect that androgens (hormones like testosterone) have on the body. Increased androgens can increase sebum production, which leads to clogged pores and acne flare-ups. So essentially, Spironolactone gets to the root of the cause by blocking the hormones at the core of the problem, which means the acne glands and hair follicles won’t get overloaded, thus reducing the likelihood of developing pimples.

And like most skincare products, topical or oral, you have to give Spironolactone some time to work. Kluk says it takes around three months to see results.

What Do the Studies Say?

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. Another study offered similar results, demonstrating that acne of all severity responded to 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. But Kluk says that many patients see improvement after just two "rounds" of treatment and find that they don't have to continue taking the medication.

Benefits of Spironolactone

• Effective at Clearing Stubborn Hormonal Acne: While topical ingredients can certainly be effective for many people dealing with hormonal acne, Spironolactone can prevent blemishes from developing in the first place by blocking the androgens that stimulate sebum production. Many women dealing with stubborn hormonal acne that's resistant to topical treatments find success in using Spironolactone.
• Can Treat 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.
• All-in-One Treatment: Because of the efficacy of Spironolactone, you may no longer need to use drying topicals to treat acne.

Who Can Take Spironolactone Safely?

Spironolactone is a prescription medication that should only be used under the direct supervision of a physician. Because the drug tampers with hormone levels and testosterone, it’s recommended for use by women only. 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. Dr. Colbert also notes that in some cases, Spironolactone "may alter blood potassium levels, therefore, people with kidney disease should not take it,"

Spironolactone Side Effects and Safety Considerations

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

Frequent Urination

Spironolactone is a diuretic, so it removes excess fluid from the body via urination. Colbert recommends that patients stay well-hydrated and carry a water bottle while taking Spironolactone to minimize dehydration from the diuretic effect.

Increased Cramping During Menstruation

Spironolactone can alter the body's electrolyte balance (think potassium, magnesium, and calcium)—thereby leading to low sodium. An imbalance of electrolytes can lead to muscle cramps, which can be particularly problematic during menstruation, when cramps are already an issue. If experiencing any form of cramps or dizziness, speak to a doctor.

Breakout Breakthrough

While the medication helps with breakouts, it also alters the hormonal balance. As many know from experiencing hormonal breakouts, acne can result.

Fatigue

Spironolactone blocks certain hormones and lowers blood pressure—both of which can cause fatigue. If you feel suddenly tired (and that's unusual) it's best to seek the advice of an expert before continuing the medication.