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Use of
Spironolactone In The Treatment of Acne
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by:
Michal R. Pijak
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In
his article on acne published recently in the New England Journal of
Medicine James (1) mentions that androgen antagonist spironolacton is
often useful in women with hyperandrogenism. However, it would be
important to point out, that the effectiveness of this treatment cannot
be determined due to the small sample populations involved in the
trials, as has been shown in recent metaanalysis. (2) It should be also
emphasized that although the long-term use of spironolactone in the
treatment of acne in women appears to be safe, its side-effects seem to
be high. (3) On the other hand, it is worth mentioning that
spironolactone in addition to its antiandrogenic effects might also
have antiinflammatory potential. (4) This emphasizes the need for
further properly designed trials with relevant outcomes to provide
robust estimates of the size and mechanism of any treatment effects.
Because of its long half-life spironolactone should be given once daily
and not in divided doses as recommended by James. This might increase
the compliance which is important in prolonged therapy to achieve
maximal benefits. (5)
1. James WD. Clinical practice. Acne. N Engl J Med 2005;352:1463-72.
2. Farquhar C, Lee O, Toomath R, Jepson R. Spironolactone versus
placebo or in combination with steroids for hirsutism and/or acne.
Cochrane Database Syst Rev 2003;(4):CD000194.
3. Shaw JC, White LE. Long-term safety of spironolactone in acne:
results of an 8-year followup study. J Cutan Med Surg 2002;6:541-5.
4. Hansen PR, Rieneck K, Bendtzen K. Spironolactone inhibits production
of proinflammatory cytokines by human mononuclear cells. Immunol Lett
2004;91:87-91.
5. McEvoy B, Nydegger R, Williams G. Factors related to patient
compliance in the treatment of acne vulgaris. Int J Dermatol
2003;42:274-80.
About the author:
Dr. Michal R. Pijak is a consultant in rheumatology, allergy and
clinical immunology at the University Hospital in Bratislava, Slovakia.
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