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What To Know About Topical Spironolactone

Vicky Davis, FNP

Medically reviewed by Vicky Davis, FNP

Written by Our Editorial Team

Last updated 1/19/2021

Spironolactone is a medication commonly used to treat high blood pressure. But it can also be prescribed off-label for the treatment of acne. Yup, really.

While oral spironolactone can be used for acne, there is also a topical form of it — and research suggests it’s effective at treating hormonal acne.

But, as with any mediation, before you start using it, you should have a basic understanding of topical spironolactone. Which is exactly what we’re here to help with! 

Understanding Hormonal Acne

When your body produces too much sebum, it can mingle with dead skin cells and bacteria to block your pores, causing acne. This production of sebum can be triggered by hormones.

Sebum is an oil-like substance that’s naturally created by your skin. Wondering why it would produce this substance? Sebum actually plays an important role in keeping your skin lubricated and protecting it from environmental factors. 

But if your skin produces too much, it can cause pores to become clogged.

Dead skin cells also play a role. Your skin naturally sheds these as part of its turnover process. But if there’s any left behind, they can mingle with sebum to contribute to blocked pores.

The biggest hormonal culprit behind acne is thought to be testosterone. Though it’s most commonly associated with men, women have it in our bodies, too. It’s an androgen hormone that, among other things, can encourage sebum production.

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Using Topical Spironolactone to Treat Acne

Both oral and topical spironolactone gel are available as an acne treatment. It’s used because there’s evidence that it has anti-androgenic effects. Essentially, it blocks androgen hormones and, in turn, is thought to decrease the activity of your sebaceous glands.

Taking oral spironolactone has been found to reduce acne by at least 50 percent in women in some studies. However, it’s not a medication used to treat acne in men. 

In fact, it’s been shown to have some pretty adverse complications for men — like breast growth

Like every prescription medication, spironolactone may cause side effects in some people. Common spironolactone side effects include vomiting, diarrhea, stomach pain, irregular periods and more.

Topical spironolactone generally has fewer side effects than oral spironolactone — and it’s been found to be effective, too. 

In one study, 5% topical spironolactone was used twice a day for eight weeks to treat patients with mild to moderate acne.

By the end of the eight weeks, female participants reported significantly less breakouts. It’s worth noting that this study was quite small and included only 15 people. 

Another study, which was slightly larger, found similar results. In it, 78 people with mild to moderate acne were either given 5% topical spironolactone or a placebo. 

Those given the topical reported a decrease in acne.

Other Topical Treatments to Consider

If you are interested in a topical treatment for acne, there are a number of others you can consider. 

Two of the most popular? Salicylic acid and benzoyl peroxide. Both work by removing dead skin cells while also addressing the bacteria that causes breakouts.

On top of this, salicylic acid may reduce swelling, which can help with the appearance of acne. 

Tretinoin is another option. Also requiring a prescription, this topical helps your skin shed dead skin cells to prevent breakouts.

Another one to consider is clindamycin. This prescription antibiotic prevents bacteria from multiplying. 

Hers offers an acne cream that requires a prescription. It contains clindamycin, tretinoin and azelaic acid — together, these things remove dead skin cells, help with bacteria and reduce inflammation. 

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Considering Topical Spironolactone

Acne in women is not uncommon. Luckily, there are a variety of ways to approach acne treatment. One unexpected way is to use spironolactone, a medication most commonly used for high blood pressure. 

Oral spironolactone is certainly available, but there is also a topical formulation. Many people like the topical option because it tends to have fewer side effects.

If you’re navigating a bad acne situation, the best thing to do is to consult with a medical professional. They will be able to determine the right course of treatment for you. 

13 Sources

Hims & Hers has strict sourcing guidelines to ensure our content is accurate and current. We rely on peer-reviewed studies, academic research institutions, and medical associations. We strive to use primary sources and refrain from using tertiary references.

  1. Spironolactone. Medline Plus. Retrieved from https://medlineplus.gov/druginfo/meds/a682627.html
  2. Pappas, A., Johnsen, S., Liu, J., Eisinger, M., (2009). Sebum analysis of individuals with and without acne. Dermato Endocrinology. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2835908/
  3. Hoover, E., Aslam, S. & Krishnamurthy, K. (2020, October 26). Physiology, Sebaceous Glands. StatPearls. Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK499819/
  4. Acne. (n.d.). Retrieved from https://www.americanskin.org/resource/acne.php
  5. Iftikhar, U., Choudhry, N., (2019). Serum levels of androgens in acne & their role in acne severity. Pakistan Journal of Medical Sciences. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6408631/
  6. Rathnayake, D., Sinclair, R., (2010). Use of spironolactone on dermatology. Skinmed. Retrieved from https://pubmed.ncbi.nlm.nih.gov/21413648/
  7. Stubborn Acne? Hormonal Therapy May Help. American Academy of Dermatology. Retrieved from https://www.aad.org/public/diseases/acne/derm-treat/hormonal-therapy
  8. Haynes, B., Mookadam, F., (2009). Male Gynecomastia. Mayo Clinic Proceedings. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2719518/
  9. Ayatollahi, A., Samadi, A., Bahmanjahromi, A., Robati, R., (2021). Efficacy and safety of topical spironolactone 5% cream in the treatment of acne: A pilot study. Health Sci Rep. Retrieved from https://pubmed.ncbi.nlm.nih.gov/34250269/
  10. Afzali, B., Yaghoobi, E., Yaghoobi, R., et al., (2012). Comparison of the efficacy of 5% topical spironolactone gel and placebo in the treatment of mild and moderate acne vulgaris: a randomized controlled trial. J Dermatolog Journ. Retrieved from https://pubmed.ncbi.nlm.nih.gov/20964565/
  11. Tretinoin Topical. (2019, March 15). Retrieved from https://medlineplus.gov/druginfo/meds/a682437.html
  12. Clindamycin Topical. (2016, October 15). Retrieved from https://medlineplus.gov/druginfo/meds/a609005.html
  13. Spironolactone. (n.d.). MedlinePlus. https://medlineplus.gov/druginfo/meds/a682627.html

This article is for informational purposes only and does not constitute medical advice. The information contained herein is not a substitute for and should never be relied upon for professional medical advice. Always talk to your doctor about the risks and benefits of any treatment.

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