What Is Spironolactone? Everything to Know About Taking It for Acne

What Is Spironolactone?

According to board-certified dermatologist Rachel Nazarian, MD, FAAD, spironolactone is “an oral medication that can be used to treat many medical conditions, including high blood pressure and heart failure—and increasingly popular for treating hormonal acne ‘off label.”’

Dr. Nazarian notes that it’s been around for many years and in general, “can be used safely with minimal side effects, and even used long term for women with persistent hormonal acne.”

How Does Spironolactone Work for Hormonal Acne?

According to Dr. Nazarian, hormonal acne is largely driven by androgens, which is basically the science-y word for sex hormones, namely testosterone, which both men and women have. 

“Androgens are the trigger for oil production and inflammation in the skin,” explains Dr. Nazarian. “By reducing these hormonal signals we can decrease excess oil and clogged pores, thereby decreasing hormonal acne.” 

Who Can Take Spironolactone for Acne?

While men can be prescribed spironolactone for certain cardiovascular issues, in general, it is not used to treat acne in cisgender males. 

The reason? It “can lead to unwanted side effects, and feminization: including increased breast tissue or decrease in libido,” says Dr. Nazarian. 

Dr. Nazarian notes that women should always discuss their full medication list with their physician when thinking about or deciding to take spironolactone, as “those with kidney problems, or people taking other blood pressure-lowering medications may not be able to take it.”

Is There a Topical Version of Spironolactone?

There is a topical version of spironolactone (also prescription-only) and, according to Dr. Nazarian, “it can be used topically to target local androgens and block testosterone’s effect on local oil glands on the skin without some of the same side effects that occur with oral spironolactone.” 

However, she says, there’s an important distinction. Spironolactone is “not as well-studied in the topical form, and I've personally found it to be less effective than the oral form, especially for more persistent cases of acne.”

For men or anyone who wants to avoid taking a pill for acne, Dr. Nazarian suggests using ingredients that are supported by the American Academy of Dermatology for acne relief. 

These include:

• Topical retinoids like adapalene. We love PROACTIV’s Adapalene Gel 0.1% for this, which you can try without a prescription. 

• Benzoyl peroxide is found in many acne-fighting cleansers. We are fans of the LA ROCHE POSAY Effaclar Acne Face Wash that has 4% benzoyl peroxide. 

• Salicylic acid: For a powerful over-the-counter concentration, we love THE ORDINARY’s Salicylic Acid 2% Solution. 

How Long Does Spironolactone Take to Work for Acne?

If you’re prescribed spironolactone for acne, don’t expect an overnight transformation. According to Dr. Nazarian, it can take up to six months to see changes, and you shouldn’t expect noticeable results before the 12-week mark.

Dosage can also vary from person to person. “I’ve also found that some people can clear with a very low dose, like 50 mg a day,” says Dr. Nazarian. When prescribing spironolactone for acne, she prefers to start slowly and adjust the dosage over time when needed. “Everyone is different. The appropriate regimen is determined by working as a team with your board-certified dermatologist,” she adds.

What Are the Side Effects of Spironolactone?

Like any prescription medication, spironolactone can come with potential side effects. “For many people, spironolactone can be taken orally safely, and without side effects,” says Dr. Nazarian. “For others, the drop in blood pressure can cause mild weakness, lightheadedness, or a feeling of being tired.”

Spironolactone also isn’t right for everyone. Dr. Nazarian notes that people with kidney problems or those taking certain blood pressure-lowering medications may not be able to take it. That’s why it’s important to discuss your medical history and complete medication list with your doctor before starting spironolactone.

Is Spironolactone Worth Considering for Hormonal Acne?

For some people dealing with persistent hormonal acne, spironolactone may be an option worth discussing with a board-certified dermatologist. But there’s no one-size-fits-all acne treatment—and what works for one person may not be appropriate for another.

Before starting spironolactone or adding any new acne treatment to your routine, talk to your dermatologist. They can consider your skin concerns, medical history, and any medications you’re already taking to determine whether spironolactone makes sense for you. If hormonal acne is bothering you, consider making an appointment to discuss your treatment options rather than trying to tackle it on your own.