Spironolactone is generally prescribed as an “off label” acne treatment for women. This drug, though intended to help people with heart problems not zit problems, reduces the production of the hormone androgen. Androgen promotes excess facial oil secretion.

Less oil secretion limits the possibility of having clogged pores and acne flare-ups.

Spironolactone works as an androgen receptor blocker. This drug decreases androgen production in the ovaries and adrenal glands.
Side effects from spironolactone can include breast tenderness and menstrual irregularity.

For this reason, doctors usually add oral contraceptives like Ortho Tri-Cyclen and Estrostephave to compliment acne treatments and ease potential spironolactone side effects. Ironically though, spironolactone is recommended for women who are not candidates for oral contraceptives.

So should a woman over 35 with acne go with spironolactone? According to the American College of Physicians, the answer is “No”.

In the 2004 May/June edition of the American College of Physicians (ACP) published a medical review of studies that tested the effectiveness of spironolactone for controlling hirsutism, acne, or both in fertile or postmenopausal women. The ACP review found insufficient evidence to recommend spironolactone as an acne treatment.

Nevertheless, Dr. Diane Thiboutot of Pennsylvania State University, Hershey uses spironolactone for female patients with acne accompanied by a suspected endocrine disorder.

For example, when a woman experiences a sudden onset of severe acne or acne that is linked with excessive facial hair growth, irregular menstrual periods, increased libido, dark patches of skin, deepening of the voice, insulin resistance and hair loss, spironolactone may be helpful.

Dr. Thiboutot noted that spironolactone “seems to control quite well those cystic-type nodules that they [women] get on their lower face and chin.”

Yet Dr. Julie C Harper Dr. Harper of the department of dermatology at the University of Alabama, Birmingham doesn’t recommend spironolactone so easily. Only if neither topical retinoids nor antibiotics have not worked for a woman’s case of acne would Dr. Harper then suggest using spironolactone for women over 35.

Author of “Acne Messages”, Naweko San-Joyz, says “A woman’s response to androgens is so varied that limiting herself to an androgen blockers like spironolactone certainly does not guarantee a cure, or even a quick treatment.”

San-Joyz adds that overproduction of androgens is just one step in a series of potential events that could lead to acne. Instead of hormonal manipulation with drugs, San-Joyz suggests women with acne regulate this conditional using food, stress control and greater awareness of potential acne triggers like environmental estrogens.

Women with acne have numerous treatments options. If a woman does decide to go with spironolactone, it’s best to get her prescription filled with her gynecologist rather that her general practitioner.

It’s most likely that the gynecologist will be more aware of how a patient may respond to hormonal treatments like spironolactone and oral contraceptives, thus making recovery faster.