Spironolactone and Acne: What to Know

You’ve bought every elixir, face wash and spot treatment made, but still struggle with acne. You’re not alone. 

And whether your dermatologist is your best friend or if you’ve never seen a professional about your complexion in your life, it’s not unusual to fight pimples long after puberty has passed. 

There are a ton of treatment options available for acne — topical products, pills, supplements and professional skin treatments galore. 

Spironolactone is one acne treatment to add to that long list. 

But it’s definitely not made for everyone. We’ll break down what you need to know about this prescription acne solution so you can make an informed decision on whether to give it a shot. 

TL;DR: The Basics about Spironolactone and Acne 

• Spironolactone is a diuretic drug FDA-approved to treat edema (fluid retention), heart failure, high blood pressure and over-abundance of the hormone aldosterone.

• Spironolactone is often prescribed “off-label” for the treatment of hormonal acne and increased hair growth on the face or body in women.

• Spironolactone is not typically prescribed for the treatment of acne in men, due to side effects.

What Is Spironolactone? 

Spironolactone is a prescription drug approved by the U.S. Food and Drug Administration to treat high blood pressure, heart failure, edema, and hyperaldosteronism (too much of the hormone aldosterone).

It’s known as an aldosterone antagonist because it lowers the concentration and/or effects of the hormone aldosterone.

Spironolactone is commonly used “off-label” in the treatment of acne and abnormal hair growth (hirsutism) in adult women.

Some people shouldn’t take spironolactone. Tell your healthcare provider about all prescription and over-the-counter medications you’re on, and any diagnoses you have. 

Drinking alcohol with spironolactone can cause dizziness and fainting, so it’s probably wise to abstain from drinking while on it.

A Bit About Acne 

Acne vulgaris is the most common skin problem in the U.S., according to the American Academy of Dermatology.

It occurs when your pores get clogged by dead skin cells, oil and bacteria. It isn’t exactly clear what causes acne in some people but not others, but hormones do play a role.

Keeping your skin clean and using skin care products labeled non comedogenic can help. Likewise, over-the-counter and prescription medications may lessen the severity and frequency of acne breakouts.

In some people, particularly women, spironolactone may be effective.

Evidence of Spironolactone Effectiveness on Acne

The off-label use of spironolactone in the treatment of acne is because of its antiandrogenic effects.

By blocking the effects of hormones called androgens, it’s believed spironolactone decreases  sebaceous gland activity (i.e., less production of oil by the skin).

These effects were first discovered when the drug was used to treat high blood pressure in women with polycystic ovarian syndrome (PCOS). 

Because of this discovery and the research that followed, spironolactone is largely used to treat hormonal acne in women. In fact, some research has shown spironolactone to reduce acne by 50 percent to 100 percent in women, according to the American Academy of Dermatology.

That said, a 2017 review of available scientific literature concluded the quality and volume of research on spironolactone in the treatment of acne in women was lacking. This doesn’t mean it’s not a worthwhile treatment, but that more research is needed.

For men, however, spironolactone is not recommended for acne treatment. The same antiandrogenic effects that help reduce acne in women can cause significantly disruptive side effects in men.

By inhibiting male sex hormones, spironolactone can cause feminizing effects such as breast growth and erection troubles. 

To put things in perspective, one spironolactone acne study conducted in Japan included men and women, but the study was discontinued on the men’s side because of significant complications with gynecomastia (enlargement of breast tissue in males).

Spironolactone Side Effects 

In addition to the androgen disruption caused by spironolactone, it may cause other side effects.

 These include irregular periods, vomiting, diarrhea, stomach cramping, drowsiness, tiredness, and restlessness. 

Other possible side effects of spironolactone can be a sign of a serious reaction. 

Call your healthcare provider immediately if you experience: trouble breathing or swallowing, signs of dehydration, muscle pain or cramping, pain or numbness in your extremities, confusion, fainting, unusual bleeding or bruising, hives, rash or blood in your stool or vomit.

To learn more about how to get spironolactone, you can read our guide on how much spironolactone costs and how to safely stop taking spironolactone for acne.