Spironolactone Is Safe and Effective for Moderate-to-Severe Acne in Women

Guidelines support use of spironolactone for its antiandrogenic effects in women with moderate-to-severe acne vulgaris as an alternative to long-term systemic antibiotics (NEJM JW Gen Med Mar 15 2017 and J Am Acad Dermatol 2016; 74:945). However, spironolactone is not approved by the U.S. FDA for this indication, and randomized trial evidence supporting its efficacy is sparse.

Researchers identified 410 women (age, ≥18; mean age, 29) with facial acne for ≥6 months that warranted systemic therapy; participants were randomized to add spironolactone (50–100 mg daily) or placebo to their usual topical treatments for 24 weeks. At 12 weeks, patients assigned to spironolactone had a slightly but significantly greater mean improvement in quality of …