Spironolactone for Acne: Practical Strategies for Optimal Clinical Outcomes

Spironolactone is an effective systemic treatment for acne in women and likely is an underutilized alternative to oral antibiotics. It is used off label for all types of acne and has shown effectiveness for both facial and truncal acne. We recommend a starting dose of 100 mg/d, as most patients can tolerate it and it has superior effectiveness to lower doses. The most common adverse effects of spironolactone are lightheadedness; headache; and menstrual irregularities, which tend to be dose dependent and can be prevented or treated using combined oral contraceptives. Potassium monitoring is of low usefulness in young healthy women, and studies have not identified an association between spironolactone use and increased risk for cancer. This article provides an overview of spironolactone for the treatment of acne, including recent clinical trials and practical strategies for patient selection, dosing, adverse effect management, and monitoring.