BMJ 20 May 2023 Adapted from Effectiveness of spironolactone for women with acne vulgaris in England and Wales by Santer M et al.
Women over the age of 18 living in England and Wales whose acne was bad enough to merit antibiotic treatment, were randomised to use either Spironolactone or placebo. They were allowed to continue the topical treatments that they were already using for their acne. Their scores on their acne specific quality of life were assessed by themselves and a clinical assessor evaluated their acne.
200 women were recruited to each group. The findings showed a small but statistically significant improvement after 24 weeks of spironolactone use at 100mg a day. Their average age was 29 years.
One fifth of those taking Spironolactone reported headaches.
The assessors thought that 19% of the women had noticeable skin improvement compared to 6% of the placebo group. The women themselves reported a quality of life improvement of 17 points in the placebo group and 21 in the Spironolactone group.
The authors think that this improvement is good enough to be a useful alternative to long term antibiotics.
My comment: Having suffered from acne since the age of 11 I am pleased to see another treatment being offered for this condition. Almost all teenagers of both genders get acne. In boys it tends to be more severe than in girls but it tends to resolve completely. For some women it never resolves and they have it persistently throughout their lives. If a woman still has it by the age of 24 the acne is likely the persistent type. Acne, even with the best treatment is very slow to respond, and at best will improve at 10% a month. This is for Roaccutane. I wonder what the effects would be over a longer length of time for the other women in the study. The results, though promising are not stunning, and diligent use of topical treatments and consideration of using anti-biotics and Roaccutane will also need to be considered to resolve symptoms.
Spironolactone is a diuretic that can be also used to control facial hair growth in women. It is sometimes used if someone has high blood pressure that does not respond to other drugs.