Spironolactone vs antibiotics for acne

A study looking at almost 40,000 women with moderate to severe acne has found a medication discovered in the 1950s may be as effective as a particular type of oral antibiotic in treating acne.

Spironolactone is primarily used to remove excess fluid and lower blood pressure but it can also be used to treat other conditions including hirsutism (excess body hair) and acne.

As antibiotic resistance is a key public health issue, alternatives to long-term antibiotic use for acne are of interest. The antibiotic class used in this study was oral tetracycline which includes minocycline and doxycycline.

The study investigated the frequency of switching to another treatment within one year among women with acne who were started on spironolactone (6,684) or an oral tetracycline antibiotic (31,614) between 2010 and 2016.

Switching to another therapy is often due to treatment failure such as ineffectiveness or side effects.

For women started on spironolactone, 14.4% were switched to another treatment within 12 months compared to 13.4% of women initially prescribed the antibiotic. Furthermore, the frequency of switching to isotretinoin was more common among women who started on antibiotics than those started on spironolactone.

Oral antibiotics may provide a more effective strategy for people looking for rapid improvement in their acne as hormonal therapies may take longer to work.

According to the study’s authors “compared to oral antibiotics, spironolactone represents an enticing therapeutic alternative for women with moderate to severe acne, with a favourable side effect profile”.

Large clinical trials are still needed to determine the optimal strategy for women with moderate to severe acne.

Ref: J Drugs Dermatol. 2018; 17(6)632-638