Spironolactone Video Transcript

Introduction (pictures of acne)

“Hello, Brent Goedjen here, Live Oak Dermatology. Today we are talking about one of my favorite medications for adult female hormonal acne, spironolactone.

First, what is adult female hormonal acne. As opposed to the acne we had when we were kids, favoring comedones, whiteheads, blackheads, favoring the forehead - this is an acne of a slightly different character. It tends to favor the lower face and jawline, cyclical, worse with periods, appearing to arise from underneath the surface. People can be experiencing this type of acne for the first time in adulthood, or they could have had acne their entire life, and it just changes in quality as they get older.

It’s a very frustrating type of acne to treat. If you’ve had it before, you know what I mean. Often times the traditional topical therapies for acne can fall short of our expectations, be underwhelming. So spironolactone is a very useful tool in that situation.”

Hormonal Acne Features (slide)

“For hormonal acne, birth control is a traditional treatment for acne and can be used. However, some people are not candidates. Perhaps due to the clotting risk or increased age and so spironolactone can be helpful to provide some of the same benefits, and more, without the same side effect profile.

So what is spironolactone? Spironolactone was developed as a diuretic, which is a type of blood pressure pill. But this medicine is also a potent androgen blocker. It is the androgens - a male hormone that females have too - that contributes to cystic hormonal acne”

Spironolactone info (slide)

“Like any medicine there are potential side effects. This one can cause electrolyte abnormalities. You are at greater risk for these if you have certain medical problems like kidney disease or hypertension on certain medications like ACE inhibitors. In those situations we would want to monitor K+ carefully or consider switching to an alternative.

Formerly, we would monitor K+ levels routinely in all patients. This is not done as commonly in young healthy patients because the incidence of abnormalities are low. However, we monitor in patients with risk factors such as kidney disease, HTN, or age >40.

Additionally, you can have side effects related to the hormonal effects of the medication such as menstrual irregularity, breast tenderness.”

Spironolactone Side effect (slide)

“You must not become pregnant while on this medicine. It’s not of the same severity as if you were on Accutane with the development of birth defects. However, it is an androgen blocker which could theoretically cause feminization of a male fetus. So you should not take this medication if you are pregnant or planning on become pregnant.”

Spironolactone Contraindications (slide)

“So how does the treatment work? What we usually do is start at a lower dose like 50mg twice a day. If you have side effects or risk factors, we may start even lower than that. It takes some time for this medication to work. It takes about 2-3 months before you start to see meaningful benefits.

The goal is to clear up the cystic breakouts. After 4-5 months of complete control, when things are going well, we will then consider slowly titrating down the medication to find the lowest effective dosage. Some people are able to titrate all the way down. Other people require low levels indefinitely to control their symptoms.

This medicine is considered safe for long term use. Their use to be some concern, as there is for birth control, that it could contribute to breast cancer risk. There have been multiple studies that do not show a clear causation. Nevertheless, if you have a personal breast cancer history we will defer to your oncologist as to your candidate for spironolactone.”

Spironolactone dosage (slide)

“Spironolactone is one of my favorite weapons against adult female hormonal acne. If you think you may be a good candidate, talk to your dermatologist.”