Spironolactone Acne Treatment

Spironolactone through its anti-androgen properties reduces the impact of hormonal acne.

Reduces inflammation, oily skin and clogged pores to restore healthier looking skin.

hormonal acne on jawline
Hormonal acne on lower face and neck

what Is Spironolactone Acne Treatment?

Spironolactone acne treatment works by blocking the effects of androgens, which are male hormones present in both men and women. Androgens can stimulate the sebaceous glands in the skin to produce excess oil, leading to clogged pores and acne breakouts. By inhibiting the action of androgens, spironolactone helps to reduce sebum production, which can effectively prevent and treat acne.

This medication is typically prescribed for women with hormonal acne, particularly those who experience acne flare-ups around the time of their menstrual cycle or have other signs of hormonal imbalances, such as hirsutism (excessive hair growth) or irregular periods.


spironolactone acne treatment

Spironolactone acne treatment represents a valuable therapeutic option for individuals grappling with persistent or hormonally-driven acne, offering a tailored solution to regain control over their skin health. As an anti-androgen medication, spironolactone works by blocking the effects of androgens, hormones that can contribute to the development of acne. This approach targets the root cause of hormonal acne, helping to reduce sebum production, minimize inflammation, and prevent the formation of acne lesions.

When do you use Spironolactone?

Acne affects more than 85% of adolescent and can persists into adulthood for many women. Acne varies in severity, from mild to severe cystic variants.  Although oral antibiotics are commonly prescribed for acne, they are associated with side effects, antibiotic resistance and acne recurrence. On the other hand, oral isotretinoin is reserved for acne that is not responding to standard treatments or for nodulo-cystic acne.

Many women may not be comfortable taking oral isotretinoin due to the side effects,  poor candidates for it or who may have relapsed following a course of therapy. Oral spironolactone is a treatment alternative available for women with long standing acne.

How Does Spironolactone Acne Treatment work?

Oral spironolactone works to improve acne through its anti-androgen properties. It reduces testosterone production and stops testosterone and dihydrotestosterone (DHT) binding to androgen receptors on your skin. This reduces sebum production and hyperkeratinisation in acne associated hair follicles.

Oral spironolactone is a diuretic and has traditionally been in use in medical conditions such as heart failure, hypetension and swelling associated with liver disease. However, over the decades, there has been off-label use of oral spironolactone for several dermatological conditions such as acne, female pattern hair loss and hidradenitis suppurativa.

clear skin after acne is treated successfully
Hormonal acne is a treatable condition.

is oral spironolactone for women with acne effective?

From studies, it has been shown that most of individuals treated with oral spironolactone noticed an improvement in their acne appearance from the 12th week. Improvement in acne clearance increased over time with the peak effect taking place between the 4th to 6th month. 

In addition, women with co-existing chest or back acne had good clearance while on treatment.

Average effective dose is 50-100mg oral spironolactone daily.

Who is suitable for oral spironolactone?

Spironolactone should be considered in women with acne with the following:

  • Women more than 25 years of age with signs hyperandrogenism (E.g. Polycystic ovarian syndrome)
  • Perimenstrual flare
  • Neck and/or lower face acne
  • Comedomal acne associated with excessively oily skin
  • Acne resistant to conventional therapies such as antibiotics
  • Alternative to oral isotretinoin therapy

Can spironolactone acne treatment be combined with other modalities?

The most successful acne treatment takes on a combination approach, to tackle the various factors implicated in acne formation. While spironolactone reduces androgen levels, treatments that clears comedomes, inflammation and bacteria are essential.

Dr. Ng often tailors a multiple-modal approach that gives you the best results according to your skin type. In conjunction with oral spironolactone, the following treatments will help restore and maintain your skin:

  • Advatx Laser
  • Topical retinoids
  • Hydra Plus Facial
  • Carbon Peel Laser

Frequently Asked Questions About Spironolactone

Oral spironolactone acne treatment is generally well-tolerated in most women, however most of its side effects are dose related. 

Common side effects (15-30%) include menstrual irregularities. This can be managed with an oral contraceptive or a intra-uterine device if necessary.

Less common side effects (<5%) include breast tenderness, headache, nausea, dizziness, increased frequency of urination and high blood potassium levels.

Oral spironolactone treatment is contraindicated in individuals who have a history of high serum potassium levels, or those at risk of hyperkalaemia. It is also contraindicated with individuals with kidney failure, inability of the kidneys to produce urine and those with significant impairment of kidney function.

It is generally not prescribed for women who are pregnant, who intend to get pregnant and who are breastfeeding.

Drugs that can potentially increase blood potassium levels should not be taken together with oral spironolactone. Some of these include anti-hypertensive medicaltion such as ACE inhibitors, potassium sparing diuretics and anti-inflammatory medicines such as NSAIDS.

Avoid food or supplements rich in potassium, including salt substitutes.

Spironolactone is often used in combination with other acne treatments, such as topical retinoids or oral contraceptives, for more comprehensive acne management. However, the specific combination of treatments should be determined by a healthcare professional.

Spironolactone is not recommended for pregnant women or women planning to become pregnant due to potential risks to the fetus. It may also not be suitable for individuals with certain medical conditions, such as kidney disease or hyperkalemia.

Spironolactone can be used long-term for acne management in individuals who continue to benefit from treatment and tolerate it well. However, regular monitoring by a healthcare professional is important to assess effectiveness and monitor for potential side effects.

schedule a consultation for Spironolactone Acne treatment in singapore

We treat a range of acne and acne scars at both our clinics in Woodlands and Kovan. Oral spironolactone is an effective hormonal acne treatment for many women. Dr. Ng makes it his mission to match each patient to the most effective acne treatment according to your lifestyle, skin condition and budget. Schedule a consultation with us today, so you can find out more.

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Or give us a call at +65 6769 6007 | WhatsApp us +65 9855 3022

Dr Moses Ng dermatologist

spironolactone for acne

With its proven efficacy in managing acne in adult women, spironolactone offers a unique benefit for those who have not responded adequately to conventional acne treatments. Through personalized consultation and careful consideration of individual medical history and hormonal profile, spironolactone in appropriate doses to optimize efficacy and minimize potential side effects. By addressing the underlying hormonal imbalances driving acne, spironolactone treatment not only improves skin clarity and texture but also restores confidence and enhances overall quality of life.

  1. Roberts EE, Nowsheen S, Davis MD, McEvoy MT, Newman CC, Sartori Valinotti JC, Sciallis GF, Torgerson RR, Wetter DA. Treatment of acne with spironolactone: a retrospective review of 395 adult patients at Mayo Clinic, 2007–2017. Journal of the European Academy of Dermatology and Venereology. 2020 Sep;34(9):2106-10.
  2. Garg V, Choi JK, James WD, Barbieri JS. Long-term use of spironolactone for acne in women: A case series of 403 patients. Journal of the American Academy of Dermatology. 2021 May 1;84(5):1348-55. 
  3. Han JJ, Faletsky A, Barbieri JS, Mostaghimi A. New acne therapies and updates on use of spironolactone and isotretinoin: a narrative review. Dermatology and Therapy. 2021 Feb;11(1):79-91.
  4. Santer M, Lawrence M, Renz S, Eminton Z, Stuart B, Sach TH, Pyne S, Ridd MJ, Francis N, Soulsby I, Thomas K. Effectiveness of spironolactone for women with acne vulgaris (SAFA) in England and Wales: pragmatic, multicentre, phase 3, double blind, randomised controlled trial. bmj. 2023 May 16;381.