Spironolactone
Also known as Aldactone
An antiandrogen used off-label for hormonal acne in women, and often more effective than another round of antibiotics.
Generic, typically $10–30/month.
How it works
A potassium-sparing diuretic that also blocks androgen receptors and reduces androgen-driven sebum production. Lower sebum means less substrate for the inflammatory acne cascade.
How it's used
Typically 50–200mg daily, prescribed for women with hormonally patterned acne along the jaw and chin. Requires a prescriber; potassium monitoring is used selectively depending on age and risk factors.
Trade-offs
In favour
- Targets the hormonal driver rather than the bacteria
- Avoids long-term antibiotic use
- Also helps hormonal hair thinning and hirsutism in women
- Can be used long term
Against
- Not appropriate for men at acne doses due to antiandrogenic effects
- Slow — three months before a fair assessment
- Diuretic effects, particularly early on
Risks and side effects
- Hyperkalaemia risk, particularly with kidney impairment or interacting drugs
- Menstrual irregularity and breast tenderness
- Must not be used in pregnancy
- Dizziness and increased urination
How good is the evidence?
Good observational and trial evidence for hormonal acne in women; widely used off-label and supported in dermatology guidance.
Sources
- Acne vulgaris management guidelinesAmerican Academy of Dermatology · 2024
- Spironolactone for acne in womenPubMed
Sources point to guideline bodies and literature searches rather than single papers, so they stay accurate as the evidence moves.