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Acne in women: Spironolactone new alternative to antibiotics

Spironolactone, a diuretic medication used to treat conditions like high blood pressure and heart failure, may be an effective alternative to systemic antibiotics for the treatment of acne in women, according to a study published in the Journal of Drugs and Dermatology (2018 17(6):632-638).

Investigators observed 38,298 women and girls for the study. A total of 6,684 were prescribed spironolactone and 31,614 were given standard tetracycline-class antibiotics. Since the drug hinders the effects of male hormones, including androgen, it is not an option to treat acne in men.

Within one year, 14.4% of patients on spironolactone and 13.4% of patients on antibiotics had switched to different treatments. According to researchers, these results suggest that the two therapies have the same efficacy.

The anti-hormonal effects of spironolactone can help treat acne in women.

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"These numbers suggest dermatologists should consider spironolactone first instead of antibiotics when it comes to women with acne," said lead author Dr. John S. Barbieri, dermatology chief resident at the Perelman School of Medicine at the University of Pennsylvania in Philadelphia in a press release.

Oral antibiotics are the most common systemic treatment for acne and, according to the Centers for Disease Control in the U.S., dermatologists prescribe the highest levels of antibiotics among all medical specialties. Concerns regarding increased resistance to antibiotics due to long-term use are causing physicians to seek alternatives.

"This [study] indicates spironolactone may have a better safety profile than oral antibiotics," said Dr. Barbieri. "It's clear that a safe alternative to oral antibiotics could have a huge benefit, and our data show spironolactone may be that alternative."

A randomized controlled trial confirming these findings must be conducted before the U.S. Food and Drug Administration can approve the drug for an acne indication.

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