Spironolactone | Everything you need to know
Created: 09.01.2025
Updated 09.01.2025
Approved by: Consultant Dermatologist, Dr James Denny
Choosing to start spironolactone can feel daunting since it can be used to treat other non-skin-related conditions and there is not a lot of easily accessed information available to you on the internet.
How does spironolactone work and what are the benefits?
Spironolactone is an oral medication that helps clear hormonally driven acne and is largely used for women in their 20’s and 30’s as well those in a perimenopausal and menopausal stage of their life.
Spironolactone helps fight hormonal acne but also treats cystic acne as well as comedonal acne, and in some can make skin less greasy. Hormonal acne can occur if hair follicles are overly sensitive to androgens (mainly testosterone and dihydrotestosterone), even when androgen levels are normal. Androgens are hormones that contribute to growth and reproduction in both men and women. Androgens are usually thought of as male hormones, but the female body naturally produces a small amount of androgens too.
Hormonal acne can also occur if androgen levels are raised for example in conditions like polycystic ovarian syndrome (PCOS). It is also useful in those whose acne is caused by a sensitivity to progesterone. Spironolactone works by blocking the effects of androgens and progesterone on the skin. It cannot be used to treat acne in males.
From our experience, spironolactone helps control acne in about 70% of women however there are several studies that have shown improvement rates between 71-93%.
Spironolactone has other uses including acne caused by HRT or testosterone (as part of HRT), female pattern hair loss and excessive body hair e.g., hirsutism.
Important considerations
Spironolactone does not work for everyone, and it is not possible to predict who may benefit and who may not.
Some women’s acne may clear completely whereas in others it may simply reduce the severity of acne. This means you may still need other acne treatments while taking Spironolactone.
It is effective for treating the face, chest and back.
It can take up to six months to see its full effect.
It only works while you are taking it. This means your acne may come back if you stop. Some women have safely been on treatment for several years.
If you stop treatment there is an approximately 40% chance your skin will remain clear of acne, 40% chance you will experience a mild relapse and a 20% chance your acne will relapse and you will require an additional course of treatment.
Follow up appointments are required every 2-3 months.
Risks & Side-effects
Spironolactone can cause side effects. About 5% of women may need to reduce their dose or come off spironolactone because of it. Below is a non-exhaustive list of the main side effects:
Common side effects
Needing to urinate more frequently ~30%. Spironolactone is a diuretic, but the body gets used to it and this settles within a month.
Menstrual irregularities – either heavy menstrual cycles, irregularity in cycles, spotting, discomfort or amenorrhoea (when the periods stop all together) ~20%. Sometimes it is necessary to add the combined oral contraceptive pill to help these side effects.
Breast tenderness and/or swelling ~15%
Acne flare ~5%
Bloating and/or feeling sick
Headaches and tiredness
Skin dryness
Reduced libido
Uncommon side effects, important, and potentially serious
Elevated potassium levels in the blood 0.75% for those under 45 years of age but up to 16% in those over 46 years of age.
Reduced kidney function and/or reduced sodium levels in the blood.
You must not get pregnant while on spironolactone as it can cause feminisation of baby boys.
You must not breastfeed while taking spironolactone as it is found in breastmilk.
Caution should be taken when taking spironolactone with any of the following medication: angiotensin-converting enzyme (ACE) inhibitors, angiotensin receptor blockers (ARBs), non- steroidal anti-inflammatory drugs (NSAIDs), trimethoprim, low molecular weight heparin (LMWH) and/or digoxin.
General advice
Spironolactone can be used with topical therapy; just be aware that it can dry the skin so use retinoids with caution.
Spironolactone can be used with hormonal contraception.
Although spironolactone is cautioned against in pregnancy, it is less teratogenic than some types of antibiotics called tetracyclines. We suggest no special restriction beyond knowing to use contraception.
Avoid foods and supplements that are high in dietary potassium, such as low-sodium processed foods and coconut water. A good resource can be found here.
