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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 acne. 

Hormonal acne 101

Before we can dive into spironolactone, we need to talk about hormonal acne. One of the leading contributing factors 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. 

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. Hormonal acne usually appears around the cheeks and jawline (though it can appear just about anywhere you get breakouts). Treating hormonal acne may require changes in diet or lifestyle, alongside topical or oral medications (like spironolactone) to address breakouts. 

What is spironolactone?

Spironolactone, available also under brand names like Aldactone, is a prescription-only 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.(2) 

How spironolactone works to clear acne

Both men and women create androgens (that’s hormones like testosterone). Androgens stimulate oil production, which can worsen acne. Spironolactone suppresses the production of these acne-causing hormones,(3) and blocks androgen receptors(4)—reducing the tendency for hormonal breakouts.

Spironolactone prescriptions come in both oral and topical forms. Oral spironolactone can be safe for use in women.(5) While men cannot safely take oral spironolactone, topical spironolactone may be a safer option.(6) We’re looking forward to more studies! 

Oral spironolactone 

• Oral spironolactone is a diuretic commonly used to treat heart failure, high blood pressure, and fluid retention. It is also often prescribed to treat hormonal acne.

• It inhibits the production and decreases the effects of acne-causing androgens like testosterone. 

• It can be safe for use in women. 

• Oral spironolactone can have adverse side effects in men. 

Topical spironolactone 

• Topical spironolactone may treat hormonal acne when applied directly to the skin. 

• Emerging evidence suggests it’s generally safe for use in men and women.

• More research is needed to prove its effectiveness. 

How much spironolactone should I take for acne?

Oral spironolactone prescribed for acne can vary. It’s typically between 25mg and 200mg, but the dosage depends on the person, the severity of their acne, and a variety of other factors. The prescribing medical provider will determine the most effective dose!

How long does spironolactone take to work?

Individual results vary. Many people start to see a decrease in oil production and fewer breakouts within a few weeks.(7)

The skin benefits of spironolactone 

• It helps treat the hormonal component of acne—including acne on the face, chest, and back.(8)

• No purging! Acne does not tend to get worse before it gets better. 

• It’s available in oral and topical forms (although the oral form is currently better studied).

• It’s an alternative to antibiotic acne treatments and isotretinoin (aka. Accutane). 

Potential side effects of spironolactone

Potential side effects include by are not limited to:

• Enlargement of breast tissue in men and women.(9)

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

• Risk of increased potassium (hyperkalemia).(10) When potassium levels are too high, this can lead to heart damage.(11)

• Nausea/vomiting/diarrhea

• Drowsiness

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 baby.(12) Based on data from animal studies, oral spironolactone may interfere with the development of primary sex characteristics in male fetuses.(13)

Does spironolactone get rid of acne forever?

Spironolactone is not a cure-all treatment, so it won't get rid of your acne forever. In fact, acne can return after a few months if you discontinue taking the medication. Spironolactone 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,(14) which can be found in foods like:  

• Coconut water

• Avocados

• Bananas

• Beans and lentils 

• Broccoli 

• Oranges

• 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 about proper storage of ​​​​spironolactone. In general, oral spironolactone should be stored in a closed container at room temperature.(15) 

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 include:

• Oral antibiotics

• Benzoyl peroxide

• Retinoids 

• Clindamycin (topical antibiotic)

• Isotretinoin

Your Curology provider can work with you to figure out which of these medications are the best ones for you.

How to get spironolactone 

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

At Curology we limit our spironolactone prescription strength to 100mg/day. An in-person medical provider may be your best bet for obtaining higher doses of spironolactone. Those taking higher doses of spironolactone may require close monitoring which may include blood tests 

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P.S.

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

1. American Academy of Dermatology. Stubborn acne? Hormonal therapy may help. 

2. Patibandla, S., et al. Spironolactone. StatPearls. (2021).

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

4. Patibandla, S., et al. Spironolactone. Ibid.

5. Zaenglein, A. L., e. al. Guidelines of care for the management of acne vulgaris. Ibid.

6. Ayatollahi, A., et al. Efficacy and safety of topical spironolactone 5% cream in the treatment of acne: A pilot study. Health science reports. (2021).

7. American Academy of Dermatology. Stubborn acne? Hormonal therapy may help.

8. Charny, J. W., et al. Spironolactone for the treatment of acne in women, a retrospective study of 110 patients. International journal of women's dermatology. (2017).

9. Patibandla, S., et al. Spironolactone. Ibid.

10. Patibandla, S., et al. Spironolactone. Ibid.

11. Cleveland Clinic. Hyperkalemia (High Potassium).

12. Awan, S. Z., & Lu, J. Management of severe acne during pregnancy: A case report and review of the literature. International journal of women's dermatology. (2017).

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

14. MedlinePlus. Spironolactone. 

15. MedlinePlus. Spironolactone. 

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Medically reviewed by

Nicole Hangsterfer, PA-C