Nov 16, 2017

What is Spironolactone?: Female Hair Loss & Hormonal Acne Treatment

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By Kyle T. Amber, MD

Spironolactone is a medication taken by mouth that is traditionally used to treat patients with severe congestive heart failure. In early studies, it was found that while the medication was not a particularly impressive diuretic, it did lead to a reduction in adult acne and female pattern hair loss. While it is not FDA-approved for the treatment of acne or hair-loss, it is a commonly used treatment for both conditions [1].

Spironolactone works by inhibiting the enzyme 5 alpha-reductase, the enzyme that activates testosterone. Several observational studies have shown significant improvement in female patients taking the medication [2, 3]. It can be safely and effectively combined with oral contraceptive pills or topical retinoids[4, 5]. For women with thinning hair (androgenetic alopecia, female pattern hair-loss) spironolactone can also increase hair growth [6, 7]. Like other solutions for increasing hair-growth, it only lasts while taking the medication.

While spironolactone is overall a well-tolerated medication, there are several side effects that should be noted. Spironolactone can result in severe birth defects if taken while during pregnancy, thus oftentimes a concomitant oral contraceptive is recommended. High potassium has been a concern, though a recent large study demonstrated that in young healthy women, there is no clinical significance to having slightly elevated potassium with spironolactone [8]. Other side effects include irregular menstrual cycles, headache and low blood pressure. For male-pattern hair loss, it is not a good treatment, as it can result in gynecomastia (the development of breasts in men).

Overall, spironolactone is a very helpful and generally well-tolerated medication for improving hormonal acne (around the mouth, chin-strap lines, flares near menses) as well as for female-pattern hair loss. I’ve had many patients with quite stubborn acne that benefited from it.

1.    Hassoun LA, Chahal DS, Sivamani RK, Larsen LN. The use of hormonal agents in the treatment of acne. Semin Cutan Med Surg. 2016; 35: 68-73.
2.    Sato K, Matsumoto D, Iizuka F, et al. Anti-androgenic therapy using oral spironolactone for acne vulgaris in Asians. Aesthetic Plast Surg. 2006; 30: 689-94.
3.    Yemisci A, Gorgulu A, Piskin S. Effects and side-effects of spironolactone therapy in women with acne. J Eur Acad Dermatol Venereol. 2005; 19: 163-6.
4.    Krunic A, Ciurea A, Scheman A. Efficacy and tolerance of acne treatment using both spironolactone and a combined contraceptive containing drospirenone. J Am Acad Dermatol. 2008; 58: 60-2.
5.    Lessner E, Fisher S, Kobraei K, et al. Spironolactone and topical retinoids in adult female cyclical acne. J Drugs Dermatol. 2014; 13: 126-9.
6.    Adamopoulos DA, Karamertzanis M, Nicopoulou S, Gregoriou A. Beneficial effect of spironolactone on androgenic alopecia. Clin Endocrinol (Oxf). 1997; 47: 759-60.
7.    Famenini S, Slaught C, Duan L, Goh C. Demographics of women with female pattern hair loss and the effectiveness of spironolactone therapy. J Am Acad Dermatol. 2015; 73: 705-6.
8.    Plovanich M, Weng QY, Mostaghimi A. Low Usefulness of Potassium Monitoring Among Healthy Young Women Taking Spironolactone for Acne. JAMA Dermatol. 2015; 151: 941-4.

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