Topical spironolactone effective for acne treatment with fewer adverse effects

The study found that topical spironolactone gives better results than other first-line acne treatments and exhibits fewer side effects. However, whether spironolactone can be used as the preferred treatment in acne's clinical management needs to be determined in further large-scale clinical trials.

Worldwide, acne vulgaris is the eighth most common disease and presents with noninflammatory and inflammatory skin lesions and other abnormalities. Oral spironolactone is used for acne treatment due to its antiandrogenic properties and inhibition of sebogenesis. Recent studies have shown that the topical form of spironolactone has similar efficacy as its oral form, with relatively lesser adverse events linked with its use.

Based on the above, Syeda Tayyaba Rehan, Dow University of Health Sciences, Karachi, Pakistan, and colleagues conducted a systematic review to investigate the safety and efficacy of topical spironolactone for treating acne vulgaris to establish an evidence-based understanding.

For this purpose, the research team comprehensively searched the online databases from the date of inception till March 18, 2022. It included all clinical trials experimenting with the role of topical spironolactone for acne treatment. The authors excluded articles that examined the effect of oral spironolactone or other topical agents. The Cochrane risk of bias assessment tool was used to assess the risk of bias in each study. The study findings have been reported in line with PRISMA 2020 guidelines.

The literature search provided 600 articles. Five clinical trials comprising 195 patients were included in the review.

The study revealed the following findings:

• Two of the five trials showed a high bias risk, while three had some concerns.
• Patients treated with topical spironolactone showed a significant decrease in closed comedones, papules, and lesions.
• Compared to the placebo, treatment with 5% spironolactone showed a significant decrease in total lesion count.
• In addition, 2% spironolactone showed efficacy over clindamycin and reduced the number of papules, comedones, and pustules, while the acne severity index was also considerably lowered.
• Spironolactone was not found to affect significant skin hydration, elasticity, sebum, redness, and melanin.

To conclude, topical spironolactone is an effective acne treatment. However, further large-scale clinical trials are required before spironolactone can be used as the preferred treatment for acne's clinical management.

Reference:

Rehan ST, Khan Z, Abbas S, Imran L, Munir S, Tahir MJ, Kheljee AZ, Eljack MMF, Ahmed A. Role of topical spironolactone in the treatment of acne: A systematic review of clinical trials-Does this therapy open a path towards favorable outcomes? J Dermatol. 2022 Nov 22. doi: 10.1111/1346-8138.16637. Epub ahead of print. PMID: 36412248.