Topical spironolactone: Dermatologist Guide

Table of Content:
What is topical spironolactone? | Is it used for acne? | Do you need a prescription? | How to get it? | Benefits | Side-effects | Oral vs topical spironolactone | FAQ

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What is topical spironolactone?

Topical spironolactone is a localized treatment option derived from oral spironolactone due to its anti-androgenic properties. Androgens are hormones that play a role in conditions such as acne and hair loss¹. 

By using topical spironolactone it is possible to target specific areas to mitigate the effects of androgens in the skin without the systemic effects often associated with taking spironolactone orally.

Is topical spironolactone used for acne?

Topical spironolactone is used off-label treatments to treat acne and other skin conditions, primarily for its anti-androgenic properties since it helps regulate hormonal causes of acne at the skin level. 

Some studies show that topical spironolactone could be an effective acne treatment for both men and women, however, this drug is not yet approved by the FDA for the treatment of acne ^2 3 .

Do you need a doctor’s prescription to buy topical spironolactone?

Yes, you need a prescription to buy topical spironolactone cream, as it is not available over the counter.

How to get a prescription for topical spironolactone?

You can request a customized formula via Miiskin with a board-certified dermatologist that includes topical spironolactone + tretinoin or topical spironolactone + niacinamide. The price for the consultation is $59 and price for a medication refill consultation is $39.

Where to buy topical spironolactone then?

Once your online dermatologist has sent your prescription, you can buy your customized topical spironolactone formula via Skin Medicinals. 

What are the benefits of using topical spironolactone for acne?

Reduced sebum production 

Spironolactone can help decrease the production of sebum (skin oil), which is a contributing factor to the development of acne. By reducing sebum, it can help prevent clogged pores and the formation of acne lesions⁴.

Anti-inflammatory effects

In addition to its impact on sebum production, spironolactone has anti-inflammatory properties. This can help decrease redness, swelling, and overall inflammation associated with acne lesions⁵.

Targeted treatment

Topical spironolactone is applied directly to affected skin areas, allowing for localized treatment only where acne is problematic.

Mild side effects

Topical spironolactone has usually very mild side effects⁶ compared to oral spironolactone.

Very effective as acne treatment when used as combination therapy

It can be used in combination with other acne treatments, such as topical retinoids or benzoyl peroxide, to enhance overall acne management.

Does topical spironolactone has severe side effects?

Not, not at all. The side effects of topical spironolactone are usually mild and temporary. The most common side effects often include:

• Redness
• Itching
• Swelling
• Irritation
• Burning 
• Scaling⁷ 

FAQ about topical spironolactone

Does topical spironolactone cause purging?

Although it is rare for topical spironolactone to trigger an initial outbreak of acne, an acne flare-up may affect very few patients when they first start using spironolactone.

How long does topical spironolactone take to work?

With topical spironolactone 5%, studies show that you should start seeing improvements after 4 to 8 weeks¹⁰. 

How effective is topical spironolactone?

Research shows that both male and female patients appear to respond well to the topical 5% spironolactone cream as an acne vulgaris treatment ^{11 12} .

It is important to consult with a dermatologist to initiate the acne treatment that best suits your skin, as well as evaluating therapeutic response during follow-up and adjusting the treatment.

Can spironolactone be used orally and topically at the same time?

Research suggests  that taking oral spironolactone alongside topical treatment is beneficial for women with persistent acne and can reduce oral antibiotic prescribing^13.

Who cannot use topical spironolactone for acne?

Topical spironolactone is antiandrogenic and these medications are not  recommended for use during pregnancy or breastfeeding as it is not safe for the baby. 

Article References:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3763909/
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8483163/
https://pubmed.ncbi.nlm.nih.gov/36412248/#
https://www.ncbi.nlm.nih.gov/books/NBK554421/
https://www.sciencedirect.com/science/article/pii/S1110116416300333
https://www.dovepress.com/the-efficacy-and-safety-of-oral-and-topical-spironolactone-in-androgen-peer-reviewed-fulltext-article-CCID
https://pubmed.ncbi.nlm.nih.gov/34250269/
https://www.bmj.com/content/381/bmj.p1114#