Off-Label Spironolactone Can Fight Acne of Face, Chest and Back in Women Interview with:
John S. Barbieri MD MBA
University of Pennsylvania
Philadelphia, PA 19104  What is the background for this study?

Response: Spironolactone is used off-label for the treatment of acne in women. However, data on its effectiveness is limited to small trials and retrospective studies that often use subjective, qualitative outcomes. As a result, we sought to characterize the effectiveness of spironolactone for acne in routine clinical practice, using objective, quantitative outcomes such as the Comprehensive Acne Severity Scale. We also evaluated acne both on the face and also on the chest and back. What are the main findings?

Response: We found that spironolactone is effective for both acne on the face as well as for acne on the chest and back. Similar to prior studies, we found that spironolactone can take a few months to reach peak effectiveness, so patience is importance when starting treatment with spironolactone. We found that doses 100mg/day or higher tended to be better than lower doses. What should readers take away from your report?

Response: Spironolactone can be an effective treatment for women with acne, including acne on the face and on the body. Given the importance of limiting antibiotic overuse in the treatment of acne, spironolactone is a great option to consider for women with moderate to severe acne. What recommendations do you have for future research as a result of this work?

Response: There is a need for randomized controlled trials to establish the efficacy of spironolactone for acne in women. In particular, trials comparing spironolactone to other common treatments such as oral antibiotics are important to guide clinical decision making. While it seems clear that spironolactone works, it would be valuable to know if it works better than oral antibiotics, which are prescribed 5-7x more often for women with acne.

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Long-term Use of Spironolactone for Acne in Women: A Case Series of 403 patients
Vaibhav Garg, BS,, Juliana K. Choi, MD, PhD, William D. James, MD, John S. Barbieri, MD, MBA

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