How to get a spironolactone topical prescription for acne?

Table of Content:
Why is spironolactone topical used for acne? | Availability | Spironolactone prescription | Where to purchase? | Is it effective? | Brand names | Results | Pregnancy

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Why is spironolactone topical used for acne?

Dr. Amit Om, board-certified dermatologist, says that spironolactone in its topical formulation is often used off-label in the treatment of hormonal acne, particularly in women because it helps reduce oil production and inflammation by blocking androgen (androgen is produced in males and females  but more in males) activity in the skin. Androgens, such as testosterone, stimulate sebaceous (oil) glands, leading to increased oil production and clogged pores, which contribute to acne¹.

By applying spironolactone directly to the skin, you get its anti-androgen effects without the systemic side effects that can come with oral spironolactone, such as dizziness, changes in blood pressure, or potassium imbalances. Spironolactone topical is particularly beneficial for hormonal acne, which often appears on the jawline, chin, and lower face in adult women².

Dermatologists typically prescribe it to women who prefer not to take oral spironolactone for their acne and men (since they cannot take oral spironolactone due to its antiandrogenetic effects).

Why is spironolactone topical cream not sold at most pharmacies?

Spironolactone cream is not sold at most pharmacies because it is not FDA-approved in a topical form for acne treatment, meaning major pharmaceutical companies do not mass-produce it. Instead, it is typically sold by specialty pharmacies and compounded based on a dermatologist’s prescription.

Is topical spironolactone only sold as a compounded medication for acne?

Yes, topical spironolactone is only sold as a compounded medication for acne (or hair loss), which means you cannot buy it as a stand-alone medication. 

However, dermatologists using the Miiskin platform can prescribe it to their patients through a local compounding pharmacy or via Skin Medicinals where a customized formulation is made to fit the patient’s needs. 

In the case of acne, spironolactone topical is usually compounded with tretinoin for added benefits and this customized formula may sometimes include an additional ingredient.

How do I get an online prescription for spironolactone topical?

To get a prescription for spironolactone cream, you can have a photo-based consultation with an independent board-certified dermatologist, if they consider that it is medically adequate for you, they will issue a prescription.

Where can I purchase spironolactone topical?

Once you get a prescription from your online dermatologist, you can choose to buy it at a local compounding pharmacy or you can buy it online via the Skin Medicinals platform, and it will be delivered to your doorstep. Read more in our article Where to buy topical spironolactone?

Is topical spironolactone effective?

Dr. Om says that research indicates that topical spironolactone can be an effective and well-tolerated treatment for acne, in both men and women. Studies and anecdotal reports suggest that it helps reduce oil production and inflammation by blocking androgens in the skin³. Unlike oral spironolactone, which works systemically, the topical version targets the affected area directly, minimizing potential side effects. While more research is needed to confirm its long-term effectiveness, many dermatologists prescribe it as an off-label treatment for patients who can’t or don’t want to take oral spironolactone.

Does topical spironolactone have a brand name?

Topical spironolactone is not approved by the FDA, therefore it does not have a commercial name and is not available as a mass-produced medication. When prescribed to a patient, it is typically compounded by specialty pharmacies based on a dermatologist’s prescription.

How long does topical spironolactone take to work?

Dr. Om says that the time it takes for topical spironolactone to work varies from case to case, but most patients notice improvements within 6 to 12 weeks of consistent use twice a day. Since it helps reduce oil production and inflammation, its effects may take time to become noticeable. Like other acne treatments, results depend on factors such as skin type, acne severity, and adherence to a skincare routine. Compounding it with other acne-fighting ingredients such as tretinoin or niacinamide, may enhance its effectiveness.

Can topical spironolactone be used during pregnancy?

Dr. Om says that it is not advisable to use topical spironolactone during pregnancy. Spironolactone is classified as a pregnancy category C drug⁴, meaning it has shown potential risks in animal studies, and its safety in human pregnancy is not well established. Because spironolactone has anti-androgenic properties that could affect fetal development, particularly in male fetuses, most dermatologists advise against its use during pregnancy. Women who are pregnant or trying to conceive should discuss alternative acne treatments with their online dermatologist. Read more about spironolactone and pregnancy.

Does topical spironolactone affect hormones?

Dr. Om says that it is believed that topical spironolactone has a localized effect on the skin rather than a significant impact on systemic hormone levels. Unlike the oral form, which can affect the entire body and cause side effects such as menstrual irregularities or breast tenderness, the topical version is designed to work directly at the application site. However, more studies are needed to fully understand whether any amount is absorbed into the bloodstream and if it could influence hormone levels.

Does topical spironolactone help with facial hair?

Dr. Om says that if you apply topical spironolactone to your face, every day, twice a day it may help reduce mild cases of unwanted facial hair (hirsutism) in women. This “side effect” is because it blocks androgen activity in the skin. Androgens, such as testosterone, contribute to excess hair growth, particularly in conditions like polycystic ovary syndrome (PCOS). While oral spironolactone is commonly used for hirsutism, the topical version may provide localized benefits without systemic side effects. However, its effectiveness for facial hair is less studied, and if this is your goal, you should probably opt for prescription creams such as eflornithine (Vaniqa) or laser hair removal as they will be more effective.

Is topical spironolactone safe?

Dr. Om says that spironolactone creams are generally considered safe when used as prescribed. It is also well-tolerated by most people, with side effects typically limited to mild skin irritation, redness, or dryness. Unlike oral spironolactone, the topical version is much less likely to cause systemic side effects such as dizziness, potassium imbalances, or menstrual irregularities. However, its long-term safety has not been extensively studied, and it is not recommended for use during pregnancy due to potential risks to fetal development.

Can I buy a compounded formula of spironolactone and clindamycin topical?

Yes, you can buy a compounded formula of spironolactone and clindamycin topical, but only with a prescription from a dermatologist. Since topical spironolactone is not commercially available, it must be custom-made by a compounding pharmacy. Some dermatologists may prescribe a combination of spironolactone and clindamycin to enhance acne treatment, as spironolactone reduces oil production while clindamycin fights acne-causing bacteria. If you’re interested in this combination, you need to consult an online dermatologist to determine if it’s appropriate for your skin.

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References:
¹ https://www.bmj.com/content/381/bmj-2022-074349
² https://www.bmj.com/content/381/bmj-2022-074349
³ https://pubmed.ncbi.nlm.nih.gov/36412248/
⁴ https://www.researchgate.net/figure/Spironolactone-as-a-therapeutic-drug-in-pregnancy_tbl1_265134621