Spironolactone shows long-term efficacy for acne in women

More than 90% of women treated with spironolactone for acne demonstrated complete clearance at 2 years’ follow-up, according to a study.

“There are limited data regarding the long-term outcomes of spironolactone use for women with acne and its effect on truncal acne,” Vaibhav Garg, BS, of the department of dermatology and cutaneous biology at the Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, and colleagues wrote.

In the retrospective case series, the researchers aimed to describe short- and long-term outcomes in 403 adult women treated at a single academic medical center between 2008 and 2019.

The researchers assessed a number of objective and subjective parameters, including Comprehensive Acne Severity Scale, acne clearance, treatment discontinuation, changes in dosing and drug survival, according to the findings.

Adverse event analyses targeted incidence of menstrual events and combined oral contraceptive use.

Using the Comprehensive Acne Severity Scale endpoint, 75.5% of participants demonstrated a reduction or complete clearance of facial acne at the first follow-up visit. Other first follow-up visit data showed that 84% of patients reached this endpoint for chest acne clearance, while 80.2% showed reduction or complete clearance of back acne.

The findings showed a mean drug survival of 470.7 days.

Women using combined oral contraception experienced fewer menstrual adverse events than women not using oral contraception (OR = 0.23; 95% CI, 0.11-0.50).

Looking closer at efficacy data, 20% of the cohort showed complete clearance at 3 to 5.9 months of follow-up, while 40% were completely clear at 6 to 8.9 months. By 9 to 11.9 months of follow-up, 53% of patients demonstrated complete acne clearance.

At 2 years, 96% of participants were clear of acne.

The most common starting dose was 100 mg per day. Patients showing insufficient response increased to 150 mg per day or 200 mg per day, while others decreased as low as 25 mg per day.

Acne clearance was the most commonly reported reason patients gave for drug discontinuation, at 44%. Conversely, 23% discontinued due to adverse events. Six of those 21 events were menstrual.

“Spironolactone improves clinical outcomes and is well tolerated for many adult women with acne using it for an extended duration,” the researchers wrote.