Long-term use of spironolactone for acne in women: A case series of 403 patients

Abstract

Background: There are limited data regarding the long-term outcomes of spironolactone use for women with acne and its effect on truncal acne.

Objective: To comprehensively describe outcomes of patients treated with spironolactone in routine clinical practice, including long-term outcomes.

Methods: We performed a retrospective case series of 403 adult women treated for acne with spironolactone at an academic medical center between 2008 and 2019. Rates of objective, as assessed by Comprehensive Acne Severity Scale scores, and subjective acne clearance were evaluated, as well as rates of treatment discontinuation, dosage changes, and drug survival. Logistic regression was used to assess for association between incidence of menstrual adverse effects and combined oral contraceptive use.

Results: As evaluated by Comprehensive Acne Severity Scale scores, at the first follow-up, 75.5%, 84.0%, and 80.2% of patients with available data had reduction or complete clearance of acne on the face, chest, and back, respectively. The mean drug survival was 470.7 days. Menstrual adverse effects were less common among those using combined oral contraception (odds ratio, 0.23; 95% confidence interval, 0.11-0.50).

Limitations: This study was conducted at a single academic medical center.

Conclusions: Spironolactone improves clinical outcomes and is well tolerated for many adult women with acne using it for an extended duration.

Keywords: acne; acne vulgaris; birth control pill; combined oral contraceptive; comprehensive acne severity scale; oral antibiotics; outcomes; spironolactone.