EFFECT OF ORAL SPIRONOLACTONE IN THE TREATMENT OF ACNE IN ADULT WOMEN: A SYSTEMATIC REVIEW
DOI:
https://doi.org/10.56238/levv17n56-050Keywords:
Acne Vulgaris, Spironolactone, Anti-Androgen Therapy, WomenAbstract
Introduction: Acne vulgaris in adult women represents a frequent, chronic, and therapeutically challenging dermatological condition that is often associated with hormonal influences and reduced responsiveness to conventional treatments. Oral spironolactone has emerged as a widely used off-label therapy due to its antiandrogenic properties, yet its efficacy and safety profile continue to be debated in clinical practice.
Objective: The main objective of this systematic review was to evaluate the effectiveness of oral spironolactone in the treatment of acne in adult women. Secondary objectives included assessing dose–response relationships, safety and tolerability profiles, comparative effectiveness with other systemic therapies, patient-reported outcomes, and gaps in current evidence.
Methods: A systematic search was conducted across PubMed, Scopus, Web of Science, Cochrane Library, LILACS, ClinicalTrials.gov, and ICTRP. Eligible studies included randomized controlled trials and observational studies evaluating oral spironolactone in adult women with acne, published within the last five years, with an extension to ten years if fewer than ten eligible studies were identified. Data were synthesized qualitatively following PRISMA guidelines.
Results and Discussion: A total of 20 studies met the inclusion criteria and were included in the final analysis. The evidence consistently demonstrated that oral spironolactone was associated with significant reductions in acne lesion counts and severity scores, particularly in hormonally mediated acne phenotypes, with an acceptable safety profile. Variability in dosing regimens and outcome measures contributed to moderate heterogeneity across studies.
Conclusion: Current evidence supports oral spironolactone as an effective and generally well-tolerated therapeutic option for acne in adult women, especially in cases resistant to conventional therapies. Its use should be individualized, considering patient characteristics, comorbidities, and reproductive considerations.
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References
1. Barbieri, J. S., James, W. D., & Margolis, D. J. (2020). Trends in prescribing spironolactone for acne in adult women. JAMA Dermatology, 156(4), 428–431.
2. Barbieri, J. S., Mostaghimi, A. (2022). Potassium monitoring in women receiving spironolactone for acne. JAMA Dermatology, 158(9), 1031–1033.
3. Barbieri, J. S., Shin, D. B., Wang, S., & Margolis, D. J. (2021). Comparative effectiveness of spironolactone versus oral antibiotics for acne in women. JAMA Dermatology, 157(9), 1049–1055.
4. Barbieri, J. S., Wan, J., & Margolis, D. J. (2023). Effectiveness of spironolactone across diverse populations with acne. Journal of the American Academy of Dermatology, 89(2), 345–352.
5. Charny, J. W., Choi, J. K., & James, W. D. (2021). Persistence and effectiveness of spironolactone for acne. Journal of the American Academy of Dermatology, 85(2), 393–399.
6. Dréno, B., Fischer, T. C., Perosino, E., Poli, F., Pawin, H., Beylot, C., Chivot, M., Auffret, N., Revuz, J., & Thiboutot, D. (2023). Hormonal therapies in acne: Evidence update. Journal of the European Academy of Dermatology and Venereology, 37(6), 1041–1050.
7. Dréno, B., Thiboutot, D., Layton, A. M., Berson, D., Perez, M., & Kang, S. (2020). Adult female acne: A new paradigm. Journal of the European Academy of Dermatology and Venereology, 34(12), 2793–2802.
8. Dreno, B., Poli, F., Pawin, H., Beylot, C., Chivot, M., Auffret, N., Revuz, J., & Thiboutot, D. (2021). Development and evaluation of a global acne severity scale. Journal of the European Academy of Dermatology and Venereology, 35(2), e126–e128.
9. Fowler, J. F., Jackson, J. M., & Moore, A. (2023). Long-term management of adult female acne with spironolactone. Dermatologic Clinics, 41(1), 87–95.
10. Harp, J., & Shinkai, K. (2022). Dose-response and tolerability of spironolactone in female acne. Dermatologic Therapy, 35(1), Article e15234.
11. Harper, J. C., & Thiboutot, D. M. (2020). Pathogenesis of acne: Recent research advances. Advances in Dermatology, 36, 1–12.
12. Layton, A. M. (2021). Disorders of the sebaceous glands. In C. E. M. Griffiths, J. Barker, T. Bleiker, R. Chalmers, & D. Creamer (Eds.), Rook’s textbook of dermatology (9th ed.). Wiley-Blackwell.
13. Layton, A. M., Eady, E. A., Whitehouse, H., Del Rosso, J. Q., Fedorowicz, Z., & van Zuuren, E. J. (2022). Oral spironolactone for female acne: A randomized controlled trial. British Journal of Dermatology, 186(4), 650–658.
14. Layton, A. M., Eady, E. A., Zouboulis, C. C., & Thiboutot, D. (2021). Acne. The Lancet, 397(10280), 1055–1067.
15. Marchbein, S., Bucay, V. W., & Stein Gold, L. (2022). Real-world use of spironolactone for acne in adult women. Journal of Drugs in Dermatology, 21(9), 955–960.
16. Marchbein, S., & Zaenglein, A. L. (2021). Systemic therapies for acne vulgaris. Seminars in Cutaneous Medicine and Surgery, 40(3), 161–168.
17. Plovanich, M., Choi, J., Naik, H. B., Mostaghimi, A., & Barbieri, J. S. (2021). Spironolactone therapy for adult female acne: Long-term outcomes. JAMA Dermatology, 157(5), 590–596.
18. Plovanich, M., Weng, Q. Y., & Mostaghimi, A. (2020). Low rates of hyperkalemia in healthy women treated with spironolactone for acne. JAMA Dermatology, 156(5), 548–555.
19. Rocha, M. A., & Bagatin, E. (2022). Adult-onset acne: Prevalence, impact, and management challenges. International Journal of Dermatology, 61(1), 3–11.
20. Shaw, J. C., & White, L. E. (2022). Long-term safety of spironolactone in acne: A retrospective analysis. International Journal of Women’s Dermatology, 8(3), Article e050.
21. Tan, J. K. L., & Bhate, K. (2021). A global perspective on the epidemiology of acne. British Journal of Dermatology, 184(3), 447–454.
22. Tan, J. K. L., Tanghetti, E. A., & Baldwin, H. E. (2024). Optimizing systemic therapy for adult female acne. Journal of the American Academy of Dermatology, 90(4), 671–682.
23. Thiboutot, D., Gollnick, H., Bettoli, V., Dréno, B., Kang, S., Leyden, J. J., Shalita, A., Thiboutot, D. M., & Zaenglein, A. L. (2020). New insights into the management of acne: An update from global experts. Journal of the American Academy of Dermatology, 82(5), 1261–1273.
24. Thiboutot, D. M., Del Rosso, J. Q., & Tanghetti, E. (2022). Quality of life outcomes in women treated with spironolactone for acne. Cutis, 110(4), 203–208.
25. Zaenglein, A. L. (2024). Acne vulgaris. New England Journal of Medicine, 390(3), 253–264.
26. Zaenglein, A. L., Pathy, A. L., Schlosser, B. J., Alikhan, A., Baldwin, H. E., Berson, D. S., Bowe, W. P., Graber, E. M., Harper, J. C., Kang, S., Kircik, L. H., Leyden, J. J., Rao, D. R., Rendon, M. I., & Thiboutot, D. M. (2020). Guidelines of care for the management of acne vulgaris. Journal of the American Academy of Dermatology, 82(1), 1–50.
