Topical spironolactone: Benefits, side effects and FAQs

Learn more about the benefits and side-effects of topical spironolactone and get answers to common questions about using topical spironolactone for hormonal acne.

Medically reviewed by:
Dr. Carolina Fernandez Quiroga
Dermatologist

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The information presented in this article is based on scientific research and the professional advice of our Content Medical Reviewers, who are experts in the field of Dermatology. How we write our content →

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.

Using topical spironolactone for acne

Topical spironolactone, like oral spironolactone are 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 .

Benefits of topical spironolactone

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.

Request a topical spironolactone prescription for hormonal acne!

Topical spironolactone side effects

The most common side effects of topical spironolactone are very mild and often include:

Redness
Itching
Swelling
Irritation
Burning
Scaling⁷

Oral spironolactone vs topical spironolactone for acne

There are several differences between oral and topical spironolactone, despite the fact that they both treat hormonal acne.

Does topical spironolactone work for acne?

Some studies show that spironolactone topical cream works well for acne ⁸ ⁹ . However, since it is not approved by the FDA, it is not widely available.

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

Yes, spironolactone cream needs a doctor’s prescription.

How to get topical spironolactone?

You can request one by starting a photo consultation with an online dermatology provider. This only costs $59 and you will get an answer together with your prescription for topical spironolactone or Winlevi in 1-2 days.

Where to buy topical spironolactone?

Spironolactone topical gels and creams can only be bought by compounding pharmacies (pharmacies that can make customized medications).

However, if you have a hard time finding it, your doctor can prescribe Winlevi^® instead. It works in a very similar way to topical spironolactone and it is approved by the FDA for the treatment of acne. This medication is also a topical antiandrogen used in the treatment of acne and can be bought at any local or online pharmacy with a medical prescription.

Is there a “new topical spironolactone”?

Winlevi has been called the “new topical spironolactone” by patients because it is a very similar topical medication. You can read more about the differences and similarities of Winlevi vs 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, for women with persistent acne taking oral spironolactone alongside topical treatment is beneficial and can reduce long term 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.

What is hormonal acne?

Hormonal acne, also known as adult acne, are acne breakouts related to hormone fluctuations.

Androgens (male sex hormones such as testosterone and dihydrotestosterone) play a significant role in the development of acne in both males and females.

Increased sebum production: androgens stimulate the sebaceous glands in the skin to produce more sebum, leading to clogged pores.

Keratinocyte proliferation: androgens can promote the growth of keratinocytes, which can lead to an abnormal shedding of skin cells, contributing to the formation of acne breakouts.

Inflammation: androgens may also contribute to the inflammatory response in acne, which can lead to redness, swelling, and inflammation around the hair follicle and sebaceous gland¹⁴.

Although these breakouts are typically associated with hormone fluctuations during puberty, hormonal acne can affect women between the ages of 20 to 50.

Women often experience fluctuating hormones during these periods:

Menstruation
Pregnancy and miscarriage
Peri-menopause and menopause
After starting or discontinuing birth control pills¹⁵

In difficult-to-treat female hormonal acne, healthcare providers may consider treatment with birth control pills or Spironolactone which counter the effects of androgens¹⁶ ¹⁷.

Testimonial: Kelly’s Story

Kelly struggled with skin issues for as long as she can remember. For years, she relied on birth control pills to manage her hormonal acne, but eventually, she had to stop.

Other contributors to hormonal acne

Family history: Research suggests that some people may have a genetic predisposition for acne.
Stress: Research shows there is a close relationship between stress and acne breakouts. However stress is not a proven cause of acne, but may worsen existing acne, and when stress intensifies, the severity of acne increases. When a person is stressed, the body produces androgen hormones, which stimulate oil glands and hair follicles in the skin, which may lead to acne breakouts.
Stress can trigger the release of hormones like cortisol. These hormones can stimulate the sebaceous glands in the skin to produce more oil, which can clog the pores and contribute to the development of acne.

Certain cosmetics and hairstyling products can cause acne: Ensure you buy oil-free, non-comedogenic products that won’t clog pores.
Side effects of some medications: Acne is a side effect of some medicines. If you suspect that a medicine is causing your acne breakouts, talk to your healthcare provider¹⁸.

Request a spironolactone prescription for hormonal acne!

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#