A study published in February, 2012, evaluated the efficacy of a commonly used oral acne medication for topical use. This medication, Spironolactone, has been used off-label for many years to treat acne by taking advantage of its androgen receptor blocking effect. Dr. Schweiger explains that, “Spironolactone is a type of medication called an androgen antagonist. It works by selectively binding to the androgen receptors, so that the androgenic influence is not as strong. Spironolactone is FDA-approved for management of hypertension, or high blood pressure, but is commonly used at lower doses to control hormonally influenced acne in women.”
Androgen hormones can over-stimulate the sebaceous glands to produce sebum. This excess sebum can clog the pore, which results in an ideal environment for the p. acnes bacteria that causes acne. By blocking some of the androgen hormones from binding, Spironolactone stops the excess sebum production that would otherwise occur. Spironolactone is an oral medication, meaning that it is taken by mouth. Most acne patients being treated with Spironolactone take a very low dose, but there are still potential side effects associated with this systemic medication. Spironolactone has a diuretic effect, meaning that it causes increased urination. Some patients notice that they feel dehydrated, dizzy or weak while taking Spironolactone.
The Journal of Dermatological Treatment published a study evaluating the efficacy of using Spironolactone in a topical formulation. This new acne cream was a 5% Spironolactone gel. Patients with mild to moderate acne saw a statistically significant decrease in total lesion count when compared to patients who used a placebo (the non-medicated cream.)
The possibility of a new acne cream is exciting and promising. Topical acne creams have long consisted of benzoyl peroxide, topical antibiotics such as Clindamycin, topical retinoids such as Tazorac and Retin-A, and salicylic acid. Topical dapsone, in the form of a medication called Aczone, was introduced recently; however, Aczone was the first new active ingredient for the treatment of acne in many years. Topical 5% Spironolactone could fill a void in the treatment of acne in women, allowing the treatment of hormonal acne without taking an oral medication.