Acne is a chronic dermatological condition which is characterized by spots or areas of scarring, blackheads, pimples or greasy skin.
Acne affects the parts of the body which have higher number of oil glands such as face, the upper part of the chest and the back. Acne in both sexes is brought about by increase in androgens specifically testosterone.
Features of acne
The typical features include increased oil secretion, comedones, papules, pustules, nodules and scarring. The appearance of acne mostly varies with the color. The transformation of skin appearance may lead to psychological and social problems.
How spironolactone helps acne?
Spironolactone is used in the treatment of wide range of disorders, mostly used in treatment of high blood pressure and fluid retention. However the drug is used extensively and prescribed as an off-label to treat hormonally acne breakout in women.
Spironolactone for acne is classified as anti-androgen. This class of drugs blocks androgen receptors in the body preventing the cells from absorbing androgen hormones. How it works? The spironolactone limits the fluctuations that can lead to the breakouts of acne.
Hormones especially the androgens are implicated in the development of acne. In women during the menstrual cycle and puberty, hormonal activity may lead to formation of acne. Androgen causes the follicular glands to become larger and increase the secretion of sebum.
Androgens such as testosterone, dehydroepiandrosterone sulfate, dihydrotestosterone, insulin – like growth factor 1 and growth hormone are responsible for the development of acne.
What is Aldactone?
This is spironolactone and marketed by the above brand name – Aldactone. This is a steroidal anti-mineralocorticoid antiandrogen which is synthetic. It is highly used to reduce unwanted and elevated levels of androgen. It is a component of the hormone replacement therapy and used extensively in the treatment of hyperandrogenism.
Due to reversion of the effects of acne and being a potent androgen receptor antagonist, spironolactone has seen it used widely as off-label to treat the acne condition since it helps alleviate acne. It is widely used to treat other skin conditions such as seborrhea and hirsutism in women.
Side effects
The administration of spironolactone 50 mg (Aldactone) has a wide range of side effects which include: urinary frequency which is the most observed side effect. Other effects include dry skin, ataxia, drowsiness and rashes. But it safe for acne. In males, due to reduction in androgen levels, spironolactone causes gynecomastia, physical feminization, breast tenderness, testicular atrophy.
There is reversible infertility, sexual dysfunction which leads to loss of libido and erectile dysfunction. In females, spironolactone causes menstrual irregularities enlargement and tenderness of the breast. Spironolactone also leads to hyperkalemia which is a life threatening condition.
It puts the patients at increased risk of gastrointestinal issues like diarrhea, vomiting, cramping , nausea and gastritis. Rarely, spironolactone may cause severe adverse effects such as renal failure, hepatotoxicity, agranulocytosis and toxic epidermal necrolysis.
Dosage for acne
When treating acne using spironolactone, usually dosage is from 50 to 100 mg per day. Some doctors prefer to start from 25 mg and work up the dosage for several weeks.