Is spironolactone an effective treatment for adult women with acne?

TY - JOUR

T1 - Is spironolactone an effective treatment for adult women with acne?

AU - Reddy, Haarika

AU - Truss, Annie

AU - Mischell, Stephanie

AU - Amico, Jennifer

N1 - Funding Information: A 2017 systematic review of 31 studies (N=3,710), consisting of 10 randomized controlled trials (RCTs), 18 case series, and three clinical reports with no clinical outcomes, evaluated the efficacy of spironolactone for acne. Patients were mostly females (proportion not reported in some studies) aged 18 years old and older. All the studies evaluated “improvement of acne” (eg, lesion counts vs acne scores based on different grading systems) as the primary outcome. The RCTs (n=415) compared different types of treatments: spironolactone versus placebo (3 trials), spironolactone versus other antiandrogens, with an oral contraceptive pills (OCPs) in both groups (4 trials), and spironolactone versus ketoconazole with tetracycline (1 trial). Spironolactone treatment varied from 50 to 200 mg daily or divided twice per day for 2 to 12 months compared with placebo (5 trials), cimetidine (3 trials), finasteride (1 trial), ketoconazole (1 trial), tetracycline (1 trial), and flutamide (1 trial; 1 trial had 3 comparators). Four trials included a combined hormonal contraceptive for patients in both the spironolactone and the control groups. In one trial, the spironolactone group was more likely to show at least 50% improvement in number of lesions compared with placebo (18/21 vs 5/21, relative risk [RR] 3.6; 95% CI, 1.64–7.89); the other RCTs comparing spironolactone with placebo did not provide statistical data. Of the trials comparing spironolactone with a combined hormonal contraception to a combined hormonal contraceptive alone, only one trial provided statistical data, showing no difference in acne scores (n=142; RR 1.06; 95% CI, 0.80–1.40). In the trial comparing spironolactone with tetracycline or ketoconazole, spironolactone did not show improvement in acne lesion count compared with tetracycline (n=140; RR 1.21; 95% CI, 0.92–1.60) or ketoconazole (n=140; RR 0.99; 95% CI, 0.90–1.08). This review also used 21 case series (N=728) and three clinical reports (N=2,290) to serve as supplementary efficacy data; when the pooled data from the case series was dichotomized, 77.6% (427/550 women) of the intention-to-treat population and 94.1% (10 trials, 427/454 women; risk ratio [RR] 1.22; 95% CI, 1.13–1.32) of the per-protocol population had any improvement of acne (measured as a physician-assessed 4- or 5-point Likert scale or recorded as improved/not improved) when using spironolactone at any dose. The most common side effect reported in both the case series and the RCTs was menstrual irregularities, 13.4% in the RCTs, and 33.4% in the case series or clinical reports. The incidence of menstrual irregularities appeared significantly lower when spironolactone was used concomitantly with a combined oral contraceptive (10 trials, N=258; RR 0.24; 95% CI, 0.11–0.56). All the studies included were deemed to have “high risk” of bias and had “low” or “very low quality” of evidence for all outcomes. Although the systematic review was not funded, only one trial affirmed that they did not receive financial support from a pharmaceutical company and only two trials provided declarations that stated no conflicts of interest; six trials did not disclose sources of funding though two received treatment medication from a spironolactone manufacturer, and one trial was funded by a company producing spironolactone.

PY - 2022/6/1

Y1 - 2022/6/1

UR - http://www.scopus.com/inward/record.url?scp=85132517136&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85132517136&partnerID=8YFLogxK

U2 - 10.1097/EBP.0000000000001563

DO - 10.1097/EBP.0000000000001563

M3 - Short survey

SN - 1095-4120

VL - 25

SP - 28

EP - 29

JO - Evidence-Based Practice

JF - Evidence-Based Practice

IS - 6

ER -