Use of Spironolactone in Dermatology: Acne, Hidradenitis Suppurativa, Female Pattern Hair Loss, and Hirsutism

The document from October 2020 reviews the use of spironolactone in dermatology for conditions such as acne, hidradenitis suppurativa, female pattern hair loss (FAGA), and hirsutism. It presents evidence that spironolactone, a potassium-sparing diuretic with antiandrogenic effects, is effective in treating these conditions. For acne, it can reduce the need for antibiotics and isotretinoin, with one trial showing a 75% reduction in inflammatory lesions compared to 20% with placebo among 29 patients. Observational studies, including one with 38,298 women, suggest similar effectiveness to tetracyclines. For FAGA, studies indicate spironolactone can lead to hair regrowth or prevent progression, with Sinclair et al. reporting 44% of women showing regrowth and another 44% having no progression after 12 months. In hirsutism, it is as effective as flutamide and finasteride and more effective than placebo. The document concludes that spironolactone is underused in dermatology and should be more commonly used in clinical practice, despite the need for more controlled clinical trials to establish its effectiveness.