What if there was a magic pill that could cure hormonal acne? Reality check: There isn’t. But there is spironolactone, a diuretic that can be used to treat the hormonal component of breakouts. Studies show that participants who took spironolactone to treat hormonal acne experienced a 50% to 100% reduction in acne.¹ Keep reading to learn everything you need to know about taking spironolactone for hormonal acne.

Hormonal acne 101

Before we can dive into spironolactone, we need to talk about hormonal acne. One contributing factor to acne is hormones. Hormonal acne can appear during periods of hormonal fluctuations, like puberty, menstruation, or menopause. Periods of hormonal fluctuation (especially testosterone changes) can cause an increase in our skin’s oil production, which creates an overproduction of sebum that can clog pores and lead to pimples.²

Wondering how to tell if hormones are causing your acne? One of the telltale signs of a hormonal breakout is its location on the face. To gain a deeper understanding of what your acne might be telling you, check out our Acne Face Mapping article. This insightful resource will help you decode the messages your skin is sending, particularly how different areas of facial acne can indicate various underlying causes, including hormonal imbalances. Hormonal acne usually appears around the cheeks and jawline (though it can appear just about anywhere you get breakouts).³

Treating hormonal acne may require changes in diet or lifestyle, alongside topical or oral medications (like spironolactone) to address breakouts.⁴

What is spironolactone?

Spironolactone, available also under brand names like Aldactone, is a prescription medication. Spironolactone belongs to a class of drugs known as potassium-sparing diuretics. It’s used to treat heart failure, high blood pressure, and fluid retention. Spironolactone is also used off-label to treat hormonal acne.⁵

How spironolactone works to clear acne

Both men and women create androgens (those are hormones like testosterone). Androgens stimulate oil production, which can worsen acne. Spironolactone suppresses the production of these acne-causing hormones,⁶ and blocks androgen receptors⁷—reducing the tendency for hormonal breakouts. Spironolactone prescriptions come in both oral and topical forms.

Oral spironolactone 

As we just mentioned, oral spironolactone is prescribed to treat hormonal acne. It inhibits the production and decreases the effects of acne-causing androgens like testosterone. 

Oral spironolactone can be safe for use in women.⁸ While men cannot safely take oral spironolactone, topical spironolactone may be considered.⁹ 

Topical spironolactone 

Topical spironolactone can treat hormonal acne when applied directly to the skin. The topical form decreases oiliness and helps prevent and treat clogged pores. It is safe for use for both men and women.

How much spironolactone should I take for acne?

The dose of oral spironolactone prescribed for acne can vary. It’s typically between 50mg and 200mg, but the dosage depends on the person, the severity of their acne, and a variety of other factors.¹⁰ The prescribing medical provider will determine the most appropriate dose!

How long does spironolactone take to work?

Individual results vary. Many people start to see initial improvement through a decrease in oil production and fewer breakouts within a few weeks.¹¹

According to a study involving female patients, about 80% saw their acne improve with spironolactone, usually at a dose of around 100mg daily.¹² For most people, the initial positive changes in acne begin to show up around 3 months after starting the treatment. The best results are often seen between 3 months and 5 months.¹³ 

You might need to take spironolactone for several months to fully experience its benefits, but it's generally safe and well-tolerated over the long term.¹⁴ This means you can keep using it without worrying too much about side effects, making it a good option for long-term acne management, especially if you’re looking for an alternative to antibiotics.¹⁵

The skin benefits of spironolactone

Let’s take a look at the many benefits of spironolactone, exploring how it can transform your skincare routine and possibly provide you with that long-sought-after relief from acne.

The potential benefits of spironolactone for your skin include:¹⁶

• Significant reduction in acne severity: Known for significantly diminishing acne severity, spironolactone shows impressive results in areas like the face, chest, and back. Many users report substantial improvements, with a significant number achieving total acne clearance.

• Generally well-received: Most users tolerate spironolactone well, despite some potential side effects.

• Available in various forms: Catering to different treatment needs, spironolactone comes in both oral and topical options.

• Targets hormonal acne: Particularly beneficial for women, it effectively addresses the hormonal component of acne.

Potential side effects of spironolactone

When you’re considering spironolactone for acne treatment (especially oral spironolactone), it’s important to be aware of possible side effects. While this medication can be highly effective for hormonal acne, like any medication, it comes with its own set of potential side effects, including:

• Enlargement of breast tissue in men and women.¹⁷

• Loss of electrolytes can occur due to its diuretic function.¹⁸

• Risk of increased potassium (hyperkalemia).¹⁹ When potassium levels are too high, this can lead to irregular heart rhythms and muscle weakness.²⁰

• Nausea/vomiting/diarrhea²¹

• Drowsiness²²

Knowing these potential side effects is key to making an informed decision about taking oral spironolactone. While these effects can be concerning, remember that not everyone experiences them, and your doctor will monitor your health closely while you’re on this treatment. Always communicate any concerns or symptoms with your healthcare provider to ensure your treatment plan is both safe and effective for your needs.

Can you take spironolactone while pregnant?

Spironolactone is pregnancy category C, which means that risks cannot be ruled out. It should not be taken by women who are pregnant, trying to become pregnant, or are sexually active and not using a reliable form of contraception. Spironolactone should not be taken while pregnant due to potential adverse effects on the developing fetus.²³ Based on data from animal studies, oral spironolactone may interfere with the development of primary sex characteristics in male fetuses.²⁴

Does spironolactone get rid of acne forever?

Spironolactone is not a cure-all treatment, so it won’t get rid of your acne forever. The good news is that the benefits can extend for months after discontinuation, but for some patients, your acne may return if you discontinue taking the medication.²⁵Spironolactone is prescribed to be taken daily and can be safely taken for many years, if necessary.

Are there dietary concerns when taking spironolactone?

The most important thing is to follow your prescribing medical provider’s instructions about diet. In general, people taking spironolactone should avoid excess potassium,²⁶ which can be found in foods like²⁷:  

• Apricots

• Squash

• Bananas

• Beans and lentils 

• Broccoli 

• Orange juice

• Prunes

You can speak with your medical provider about the amount of potassium-rich foods that you can eat.

How to properly store the medication

Talk to the prescribing medical provider or your pharmacist about the proper storage of ​​​​spironolactone. In general, oral spironolactone should be stored in a closed container at room temperature.²⁸

What are some alternatives to spironolactone?

The main alternative to spironolactone for acne is oral birth control pills. Both directly address the hormonal component of breakouts. 

Other treatments for acne can include²⁹:

• Oral antibiotics

• Benzoyl peroxide

• Retinoids 

• Clindamycin (topical antibiotic)

• Isotretinoin

Your dermatology provider can work with you to figure out which of these medications are the most appropriate options for you.

Clear your skin with Curology today

Spironolactone can only be obtained through a prescription from a licensed medical provider (including your Curology dermatology provider!). 

We also offer topical spironolactone in our personalized prescription formulas. 

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Get your personalized skincare routine with Curology

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

1. American Academy of Dermatology Association. Stubborn acne? Hormonal therapy may help. (n.d.).

2. American Academy of Dermatology Association. Adult Acne. (n.d.).

3. Bagatin, E., et al. Adult female acne: a guide to clinical practice. An Bras Dermatol.

   (January-February 2019).

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

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

6. Zaenglein, A.L., et al. Guidelines of care for the management of acne vulgaris. Journal of the American Academy of Dermatology. (May 2016).

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

8. Zaenglein, A.L., et al. Guidelines of care for the management of acne vulgaris. Journal of the American Academy of Dermatology. Ibid.

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

10. Zaenglein, A.L., et al. Guidelines of care for the management of acne vulgaris. Journal of the American Academy of Dermatology. Ibid.

11. American Academy of Dermatology Association. Stubborn acne? Hormonal therapy may help. Ibid.

12. Roberts, E.E., et al. Use of spironolactone to treat acne in adolescent females. Pediatr Dermatol. (January 2021).

13. Roberts, E.E., et al. Use of spironolactone to treat acne in adolescent females. Pediatr

    Dermatol. Ibid.

14. Roberts, E.E., et al. Use of spironolactone to treat acne in adolescent females. Pediatr Dermatol. Ibid.

15. Roberts, E.E., et al. Use of spironolactone to treat acne in adolescent females. Pediatr Dermatol. Ibid.

16. Charny, J.W., et al. Spironolactone for the treatment of acne in women, a retrospective study of 110 patients. Int J Womens Dermatol. (2017, March 13).

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

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

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

20. Simon, L.V., et al. Hyperkalemia. StatPearls. (2023, September 4).

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

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

23. Awan, S.Z. and Lu, J. Management of severe acne during pregnancy: A case report and review of the literature. International Journal of Women's Dermatology. (2017, July 13).

24. Liszewski, W. and Boull, C. Lack of evidence for feminization of males exposed to spironolactone in utero: A systematic review. Journal of the American Academy of Dermatology. (April 2019).

25. Charny, J.W., et al. Spironolactone for the treatment of acne in women, a retrospective study of 110 patients. Int J Womens Dermatol. Ibid.

26. MedlinePlus. Spironolactone. (2018, February 15).

27. Office of Dietary Supplements. Potassium. National Institutes of Health. (2022, June 2).

28. MedlinePlus. Spironolactone. Ibid.

29. Zaenglein, A.L., et al. Guidelines of care for the management of acne vulgaris. Journal of the American Academy of Dermatology. Ibid.

30. Han, J.J., et al. New Acne Therapies and Updates on Use of Spironolactone and Isotretinoin: A Narrative Review. Dermatol Ther (Heidelb). (February 2021).

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

32. Roberts, E.E., et al. Use of spironolactone to treat acne in adolescent females. Pediatr Dermatol. Ibid.

33. Roberts, E.E., et al. Use of spironolactone to treat acne in adolescent females. Pediatr Dermatol. Ibid.

34. DailyMed. Spironolactone. (October 2022).

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

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

37. Han, J.J., et al. New Acne Therapies and Updates on Use of Spironolactone and Isotretinoin: A Narrative Review. Dermatol Ther (Heidelb). Ibid.

Laura Phelan is a board-certified Family Nurse Practitioner at Curology. She earned her Masters of Science in Nursing at Benedictine University and went on to get her post-master’s certificate as a Family Nurse Practitioner at the University of Cincinnati.

*Restrictions apply. See website for full details and important safety information.

**Results may vary. Subject to consultation.

Written by

Curology Team

Medically reviewed by

Laura Phelan, NP-C