Oral spironolactone has been used for over two decades in the dermatological setting. Although it is not generally considered a primary option in the management of female patients with acne vulgaris, the increase in office visits by post-teenage women with acne vulgaris has recently placed a spotlight on the use of this agent in this subgroup of patients. This article reviews the literature focusing on the use of oral spironolactone in this subset of women with acne vulgaris, including discussions of the recommended starting dose, expected response time, adjustments in therapy, potential adverse effects, and patient monitoring.
Acne vulgaris (AV) is usually perceived as a disorder that affects primarily teenagers; however, preteens and postadolescents are commonly affected. Outpatient visits by patients 25 years of age or older has increased over the past 10 years.1 AV can have a significant impact on the emotional and psychological wellbeing of affected individuals and has been compared to other major disease states in terms of adverse impact on quality of life (QoL).2 While many individuals experience AV that regresses soon after they complete their teenage years, there is a subset of patients that notes persistence throughout later adulthood, with some noting the onset of AV in their adult life, the latter especially in women. Adults may be more conscious of their acne because it is considered a “disease of teenagers,” experiencing more social anxiety as they are wondering why they are still having acne breakouts or are first developing acne lesions when their teenage years have passed. Women seem to make up the majority of patients with adult AV.1 It has also been shown that postadolescent patients fail conventional treatment for AV in 79 to 82 percent of cases.1 Oral isotretinoin treatment failure has also been reported to occur in 16 to 32 percent of this subgroup of patients.1 The recognition that postadolescent women with AV respond to antiandrogenic hormonal therapies has prompted a sustained interest in oral spironolactone.Full Article