For those of us who experience frequent breakouts, navigating the path to clearer skin can be an emotionally charged journey. It can be especially confusing to figure out which treatment options are the real deal, particularly when it comes to fighting acne. 

The good news is there are some research-backed and proven treatments available for acne—one of which is topical spironolactone.

Topical spironolactone is different from oral spironolactone, and it minimizes the side effects that are typically associated with oral spironolactone while still effectively combating acne.¹ This relatively new acne treatment is generally considered safe for both women and men and may have fewer side effects than other acne treatments. So what exactly is it?

Here we’ll explain what topical spironolactone is and help you determine if it may be a good treatment option to help you clear your acne. 

What is topical spironolactone?

Spironolactone is a synthetic aldosterone receptor antagonist.² Which is quite a mouthful—so in simpler terms, what you need to know is that it's a drug that reduces your testosterone levels and blocks specific receptors that testosterone acts on. Dermatologists use spironolactone to diminish the effects of testosterone on your skin and hair, specifically conditions like female pattern hair loss (FPHL), acne, and hirsutism—especially in female patients.³ It can be taken orally or topically. 

In terms of treating hair loss, the topical version has an advantage. It’s shown to have fewer side effects and is suitable for both men and women.⁴

What are the benefits of topical spironolactone for acne?

For acne, topical spironolactone can help reduce comedones—the non-inflammatory acne lesions commonly known as black and whiteheads. This may be because it controls the processes that cause their formation, including sebum production.⁵

It also has a positive impact on inflammatory lesions. In one study, it outperformed the popular treatment clindamycin in reducing pustules, which are pus-filled bumps. Best of all, it’s generally considered safe and usually doesn’t cause significant side effects.⁶

Topical spironolactone in controlling sebum production

Topical spironolactone can help reduce hormonal acne by potentially managing sebum production. 

One hormone that can lead to acne is androgens. These hormones increase oil production in your skin, which may lead to acne across the face or body.⁷ Spironolactone’s mechanism helps by blocking androgen receptors, potentially reducing acne. 

In one study, participants applied 5% spironolactone to their faces twice daily for eight weeks. The results: Many saw a decrease in their acne—as observed in both men and women.⁸ The cream also caused no significant side effects, marking it a safe treatment option. 

Though the cream helped decrease acne, it didn’t majorly change other skin aspects, like hydration or the presence of acne-causing bacteria. Overall, 5% spironolactone cream appears to be a promising and safe treatment for acne for both men and women.⁹

Treat acne with fewer side effects

Spironolactone, when applied as a skin cream, shows promise as an acne treatment. It seems to also work effectively when it’s taken in pill form, but the topical has an advantage: fewer side effects. In tests, people who used the topical cream had fewer pimples and other acne symptoms. And when compared to some other common acne treatments, spironolactone cream showed better results and caused fewer unwanted reactions!¹⁰ Still, more extensive studies are needed before it’s declared the top choice for treating acne.

How safe is it?

If you’re thinking about using spironolactone for acne, here’s what you should know. 

While this drug isn’t primarily made for acne treatment, studies have shown it can be effective, especially for women.

Research shows there are little to no side effects following the use of a topical 5% spironolactone cream in the treatment of acne vulgaris.¹¹

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P.S. We did the homework so you don’t have to:

1. Ayatollahi, A., et al. Efficacy and safety of topical spironolactone 5% cream in the treatment of acne: A pilot study. Health Sci Rep. (2021, July 1).

2. Patibandla, S., et al. Spironolactone. StatPearls. (2023, July 4).

3. Wang, C., et al. The Efficacy and Safety of Oral and Topical Spironolactone in Androgenetic Alopecia Treatment: A Systematic Review. Clin Cosmet Investig Dermatol. (2023, March 9).

4. Wang, C., et al. The Efficacy and Safety of Oral and Topical Spironolactone in Androgenetic Alopecia Treatment: A Systematic Review. Clin Cosmet Investig Dermatol. Ibid.

5. Noaimi, A. and Al-Saadi, S.R. Treatment of Acne Vulgaris by Topical Spironolactone Solution Compared With Clindamycin Solution. Cureus. (2021, August 31).

6. Noaimi, A. and Al-Saadi, S.R. Treatment of Acne Vulgaris by Topical Spironolactone Solution Compared With Clindamycin Solution. Cureus. Ibid.

7. Elsaie, M.L. Hormonal treatment of acne vulgaris: an update. Clin Cosmet Investig Dermatol. (2016, September 2).

8. Ayatollahi, A., et al. Efficacy and safety of topical spironolactone 5% cream in the treatment of acne: A pilot study. Health Sci Rep. Ibid.

9. Ayatollahi, A., et al. Efficacy and safety of topical spironolactone 5% cream in the treatment of acne: A pilot study. Health Sci Rep. Ibid.

10. Rehan, S.T., et al. Role of topical spironolactone in the treatment of acne: A systematic review of clinical trials—Does this therapy open a path towards favorable outcomes? The Journal of Dermatology. (2022, November 22).

11. Ayatollahi, A., et al. Efficacy and safety of topical spironolactone 5% cream in the treatment of acne: A pilot study. Health Sci Rep. Ibid.

12. Noaimi, A. and Al-Saadi, S.R. Treatment of Acne Vulgaris by Topical Spironolactone Solution Compared With Clindamycin Solution. Cureus. Ibid.

13. Noaimi, A. and Al-Saadi, S.R. Treatment of Acne Vulgaris by Topical Spironolactone Solution Compared With Clindamycin Solution. Cureus. Ibid.

14. Ayatollahi, A., et al. Efficacy and safety of topical spironolactone 5% cream in the treatment of acne: A pilot study. Health Sci Rep. Ibid.

15. Elsaie, M.L. Hormonal treatment of acne vulgaris: an update. Clin Cosmet Investig Dermatol. Ibid.

16. Ayatollahi, A., et al. Efficacy and safety of topical spironolactone 5% cream in the treatment of acne: A pilot study. Health Sci Rep. Ibid.

17. Patibandla, S., et al. Spironolactone. StatPearls. Ibid.

18. Ayatollahi, A., et al. Efficacy and safety of topical spironolactone 5% cream in the treatment of acne: A pilot study. Health Sci Rep. Ibid.

Kristen Jokela is a certified Family Nurse Practitioner at Curology. She obtained her Master of Science in Nursing at the University of South Florida in Tampa, FL.

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Written by

Curology Team

Medically reviewed by

Kristen Jokela, NP-C