Efficacy and safety of spironolactone in moderate to severe acne in females


  • Madiha Sanai
  • Shehla Shaukat
  • Ayesha Ghias
  • Aneela Asghar
  • Muhammad Nadeem
  • Tahir Jamil Ahmad


Acne, Spironolactone, Acne Severity Index


Background Acne vulgaris is one of the commonest, chronic conditions of skin. Its estimated mean prevalence in Asian women is 30%. Androgens have a key role in the development of this disease so hormonal therapy like spironolactone is an innovative approach in the treatment of acne with successful results. Objective To determine the efficacy and safety of spironolactone in moderate to severe acne in females. Material and Methods In this longitudinal interventional study, 50 unmarried females of 18 to 45 years, suffering from moderate to severe acne according to Acne Grading Scale of American Academy of Dermatology, presenting to the outpatient of Dermatology Department Unit-II, KEMU/ Mayo Hospital, Lahore, with or without raised testosterone levels were enrolled. Pre-treatment, lesions were counted and Acne Severity Index (ASI) was also calculated. Oral spironolactone 100mg/ day was given for 3 months. Monthly follow-up was done during treatment and for another three months after treatment. Serum testosterone and serum potassium levels were done at baseline, 3rd month and at 6th month. During follow-up visits, ASI and blood pressure were recorded. Photographs were taken at baseline and at every follow-up visit. Percentage reduction of ASI was calculated at the end of therapy. Results 50 patients completed the study with mean age of 21 years. Spironolactone was well tolerated and proved efficacious in 94% of cases (p-value ≤ 0.001). ASI score at the end of study showed 73% improvement (p-value ≤ 0.001) with decrease in the severity of acne after treatment. Patients experienced different side effects during the treatment. Maximum number of patients who had menstrual irregularities was 12, postural hypotension in 4, hyperkalaemia in 2 patients, 2 had polyuria and 8 had other side effects such as headache, weakness and vertigo. All the side effects recovered significantly at the completion of study (p-value ˂ 0.001). Conclusion Spironolactone is effective and safe medication for females with moderate to severe acne. 


Tobechi LE, Emily LA, Diane B. Hormonal treatment of acne in women. J Clin Aesthet Dermatol 2009; 2(12): 16–22.

Zaenglein AL, Thiboutot DM. Acne Vulgaris. In: Bolognia JL, Jorizzo JL, Rapini RP, eds. Dermatology, 2nd edn. London, U.K.: Mosby 2008; 37: 495-508.

Vos T, Flaxman AD, Naghavi M, Lozano R, Michaud C, Ezzati M et al. Years lived with disability (YLDs) for 1160 sequelae of 289 diseases and injuries 1990–2010: a systematic analysis for the Global Burden of Disease Study 2010. The Lancet 2013; 380(9859): 2163-96.

Rahman MM, Khondker L, Hazra SC, Khan MSI. Association of serum testosterone with acne vulgaris in women-A case control study. J Pak Assoc Dermatol 2012; 22: 105-11.

Mufeed JE, Khawla AS, Kadhum JH. The correlation of some hormones with acne vulgaris. Int J Sci Nat 2011; 2(4): 713-7.

Zouboulis CC, Rabe T. Hormonal anti-androgens in acne treatment. J Dtsch Dermatol Ges 2010; 8: 60-74.

Katsambas A, Dessinioti C. Hormonal therapy for acne: why not as first line therapy? facts and controversies. Clin Dermatol 2010; 28(1): 17-23.

George R, Clarke S, Thiboutot D. Hormonal therapy for acne. Semin Cutan Med Surg 2008; 27(3): 188-96.

Spironolactone. [Internet] online Wikipedia, the free encyclopedia. Available from: URL: http://en.wikipedia.org/wiki/spironolactone

Grace KK, James DR. Oral spironolactone in post-teenage female patients with acne vulgaris. J Clin Aesthet Dermatol 2012; 5(3): 37–50.

Yemisci A, Gorgulu A, Piskin S. Effects and side effects of spironolactone therapy in women with acne. J Eur Acad Dermatol Venereol 2005; 19: 163–6.

Would my acne be considered mild, moderate or severe? Available from: http://customercare.proactive.com/app/answers/detail/a_id/16.

Faghihi G, Vali A, Asilian A, Mohammad Reza Radan, Esteki H, Elahidoost M et al. Comparative efficacy of filtered blue light (emitted from sunlight) and topical erythromycin solution in acne treatment: a randomized controlled clinical trial. J Pak Assoc Dermatol 2011; 21(3): 179-84.

Katsujiro S, Daisuke M, Fumiko L, Emiko A, Asami W, Hirotaka S et al. Anti-androgenic therapy using oral spironolactone for acne vulgaris in Asians. Aesth Plast Surg 2006; 30: 689-94.

Chiu A, Chon Y, Kimball B. Changes in the Severity of Acne Vulgaris as affected by Examination Stress. Arch Dermatol 2003; 139: 897-900.

Krunic A, Ciurea A, Scheman A. Efficacy and tolerance of acne treatment using both spironolactone and a combined contraceptive containing drospirenone. J Am Acad Dermatol 2008; 58(1): 60.

Shaw JC. Low-dose adjunctive spironolactone in the treatment of acne in women: a retrospective analysis of 85 consecutively treated patients. J Am Acad Dermatol 2000; 43(3): 498-502.

Shaw JC1, White LE. Long-term safety of spironolactone in acne: results of an 8-year followup study. J Cutan Med Surg 2002; 6(6): 541-5.




How to Cite

Sanai M, Shaukat S, Ghias A, Asghar A, Nadeem M, Ahmad TJ. Efficacy and safety of spironolactone in moderate to severe acne in females. J Pak Assoc Dermatol [Internet]. 2019Sep.1 [cited 2024Jul.13];29(1):101-9. Available from: https://www.jpad.com.pk/index.php/jpad/article/view/1411



Original Articles

Most read articles by the same author(s)

1 2 3 4 5 6 7 8 > >>