Pharmacology: Spironolactone Use for Women With Acne or Hirsutism
Glen S. Blair
Nicole D. Allie

Journal of the Dermatology Nurses' Association
December 2011 
Volume 3  Number 6
Pages 374 - 376
  PDF Version Available!

Spironolactone is a potassium-sparing diuretic and selective aldosterone blocker used off-label in dermatology for treatment of acne and hirsutism in women.Spironolactone received initial approval by the Food and Drug Administration (FDA) in 1960s. The effects of circulating androgens on the skin and hair are well known and studied (Choudhry, Hodgins, Van der Kwast, Brinkmann, & Boersma, 1992; Stewart, Downing, Cook, Hansen, & Strauss, 1992; Thiboutot, Gilliland, Light, & Lookingbill, 1999). It was first investigated as a treatment for acne because of its antiandrogen properties in a study published in the British Journal of Dermatology in 1984 (Goodfellow et al., 1984). Subsequent studies have supported its effectiveness in the treatment of acne and hirsutism, but not for hair loss (Burke & Cunliffe, 1985; Moghetti et al., 2000; Muhlemann, Carter, Cream, & Wise, 1986). Androgen hormones are produced in the adrenal glands and the gonads, but more potent forms of androgen are produced in the peripheral tissues from steroid precursors.When used for the treatment of acne and hirsutism, the mechanism of action of spironolactone is not completely understood. Spironolactone seems to affect androgen receptors in the sebaceous glands causing reduced sebum production and thereby causing an improvement in acne symptoms. Spironolactone also blocks the conversion of weaker androgens to more potent androgens in the peripheral tissues, which may also explain its benefit when treating hirsutism (George, Clarke, & Thiboutot, 2008).Aldactone is the original branded preparation and is FDA approved for the management of primary aldosteronism, edematous conditions (e.g., congestive heart failure, cirrhosis, etc.), hypertension, and hypokalemia (Pfizer, 2008).Aldactone is made by Pfizer (New York, NY). However, this medication is available generically via multiple manufacturers and is very inexpensive for all patients with and without insurance (Pfizer, 2008).Potassium-sparing diuretic

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