Spironolactone

Also known as: Aldactone (brand), aldosterone antagonist, anti-androgen

Dermatology

In plain English

Spironolactone is a water pill that also blocks male-type hormones (androgens), which is why dermatologists use it off-label for hormonal acne and for hair thinning/excess facial hair in women. Taken as a daily tablet, it reduces oil and hormonal breakouts along the jawline over a few months. It is used in women; blood pressure and potassium are sometimes monitored.

The science

Spironolactone antagonizes the mineralocorticoid (aldosterone) receptor and also blocks androgen receptors and inhibits androgen synthesis, reducing sebaceous gland activity. Randomized and pragmatic trials, including the SAFA trial, and meta-analyses show meaningful improvement in acne in women versus placebo, positioning it as an alternative to long-term oral antibiotics; it is also used for female pattern hair loss and hirsutism.

References

• Santer M et al., spironolactone for acne in women (SAFA RCT), BMJ 2023
• Ghanem L et al., oral spironolactone for acne in women (systematic review/meta-analysis), J Cosmet Dermatol 2025