Spironolactone in adolescent acne vulgaris

Acne vulgaris (AV) is the most common skin condition affecting adolescents, most likely due to elevated androgen levels during puberty. Androgens stimulate and enlarge the sebaceous glands and keratinocytes, resulting in increased production of sebum and abnormal hyperproliferation of keratinocytes which lead to the formation of acne lesions. Current standard of care for AV includes topical therapies for mild cases and antibiotics or oral retinoids for severe cases. In recent years, spironolactone, an aldosterone antagonist and diuretic, has been applied to the treatment of AV due to its anti-androgen effects. Spironolactone is currently recommended in women who use oral contraceptives, are refractory to or contraindicated for standard treatment, show clinical signs of hyperandrogenism, or present with late-onset or persistent-recurrent AV past the teenage years. It is not prescribed to adolescents due to potential side effects; however, current data studying adults indicate that most side effects are mild, and that potential associations with hyperkalemia and increased risk of cancer are not sufficiently supported. Hence, we believe that spironolactone may be a safe and effective therapy for adolescent AV.