Most of the postadolescent women with acne in a retrospective review of 400 patients treated over a 4-year period improved with spironolactone treatment, with a low rate of side effects, according to the authors.

“The vast majority of our patients improved on spironolactone, despite many previously failing other acne treatments,” wrote Radhika Grandhi, MD, and Ali Alikhan, MD, of the department of dermatology, University of Cincinnati. They conducted a review of 400 postadolescent female patients treated with spironolactone from July 2012 through February 2016, representing 292 patient years of experience.

Of the 400 patients, 345 improved, 27 were unchanged, 11 became worse, and 17 had an indeterminate response. Most (220 of 253 or 87%) of previously treated patients improved with spironolactone as did most (137 of 147 or 93%) of previously untreated patients.

About half of patients were on a combination of spironolactone, at least one topical agent, and an oral treatment; almost 90% of these patients improved with spironolactone. Of the remainder, 81% of those on spironolactone plus an oral medication improved, and 95% of those on spironolactone plus a topical agent improved. Of the 41 patients on spironolactone monotherapy, 35 (85%) improved.

The most common adverse effect reported was hyperkalemia in six patients, followed by facial/perioral xerosis, erythema, irritation, and pruritus in four, and one report each of severe headaches, feeling sick, heavy menstrual cycles, back pain, abdominal fullness, and breast tenderness.

These data suggest that spironolactone, a second-line acne treatment, “is a useful drug, and the results further support that spironolactone is a safe medication with tolerable side effects,” the authors noted. ‘It may be speculated that an increased use of spironolactone may decrease our dependence on oral antibiotics in acne management, which is paramount in this age of antibiotic stewardship.”

For the full study, go to ( Dermatology doi: 10.1159/000471799 ).