High-Dose Spironolactone for Acne in Patients with Polycystic Ovarian Syndrome: A Single-Institution Retrospective Study

    Pallavi Basu, Scott A. Elman, Boya Abudu, Ashley Beckles, Prerna Salian, Daniel Yanes, Martina L. Porter, Rachel V. Reynolds
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    TLDR Higher doses of spironolactone may improve acne in PCOS patients, but side effects are a concern.
    The retrospective study analyzed the effectiveness of high-dose spironolactone for treating acne in 59 patients with polycystic ovarian syndrome (PCOS) at a multidisciplinary clinic. The study found that 41% of patients experienced physician-assessed acne improvement, with those showing improvement taking a significantly higher mean dose of spironolactone (166.1 mg/day) compared to those who did not improve (130.7 mg/day). The mean treatment duration was 408.9 days, and over 85% of patients were also using oral contraceptives and topical treatments. Patients on combination therapy with oral antibiotics had more severe acne at baseline and at the last recorded visit. Adverse effects led to discontinuation in 15.3% of patients. The study suggests that higher doses of spironolactone than typically used may be required for acne improvement in PCOS patients, but it acknowledges limitations such as small size, single-center design, and potential selection bias.
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