Oral and topical spironolactone in acne treatment: A meta-analysis of effectiveness and safety

Acne vulgaris (AV) is a common chronic inflammatory skin disorder that commonly lasts from adolescence to adulthood and has serious social and psychological consequences. Current treatments typically use antibacterial drugs, which contributes to the rise in antibacterial drug resistance. Spironolactone, a potassium-sparing diuretic with anti-androgen effects, has been used off-label to treat acne by lowering sebum production. This systematic review and meta-analysis aims to assess the safety and efficacy of oral and topical spironolactone in acne treatment. Following PRISMA guidelines, a complete search of five databases yielded seven eligible studies (643 individuals) that compared spironolactone to placebo in randomized controlled trials. The total lesion count (TLC), comedones and papule counts, acne severity index (ASI), and adverse events (AEs) were all measured. RevMan was used for statistical analysis, and effect estimates were presented as mean differences (MD) and relative risk (RR), as appropriate. The study found that spironolactone significantly reduced ASI (MD =  - 6.53, 95% CI: [- 10.83 to - 2.22], p = 0.003) and had a satisfactory safety profile, particularly in terms of menstruation symptoms. There were no statistically significant variations in TLC, comedone, or papule counts between the 4, 8, and 12-week intervals. Adverse events, including menstrual abnormalities, were similar across groups. Spironolactone, both oral and topical, demonstrated promise in lowering acne severity, particularly in female patients. While larger, long-term trials are required to demonstrate its efficacy and safety, spironolactone is a beneficial option to antibacterial drug therapies for dermatological and cardiovascular issues.