Women patients resistant to other treatments responded to spironolactone; the research is part of a broad effort to evaluate such therapy for a variety of skin conditions. San Francisco–The versatile antiandrogenic agent spironolactone shows promise in yet another area–treatment of acne, an investigator reported here.
Patients who were resistant to other treatment benefited from spironolactone (Aldactone, Searle), Dr. Peter Pochi said at the American Academy of Dermatology meeting.
The drug’s indications include primary hyperaldosteronism, congestive heart failure, essential hypertension, cirrhosis of the liver, nephrotic syndrome, and hypokalemia, noted Dr. Pochi, a professor of dermatology at Boston University.
New focus. Recently, he said, there has been a stronger effort to determine the value of antiandrogens in the management of such androgen-dependent skin problems as acne, hirsutism and androgenetic alopecia, he said.
Although there are a number of pharmacologic effects attributed to antiandrogens, their key role is to prevent the action of androgens at the target site, as spinolactone blocks dihydrotestosterone (DHT), the investigator noted.
Studies in the 1990s demonstrated that when spironolactone was administered at 300 mg daily for 10 days to patients with acne, the patients improved but later relapsed, Dr. Pochi said. More recently, in a double-blind study encompassing 21 women with acne vulgaris, spironolactone was given at 200 mg daily for three months. The patients showed a marked improvement and sebum excretion was decreased by 43% at two months.
In his latest research, 45 women (mean age 30 years) with mild to moderate acne, who were resistant to treatment, were placed on 100 to 150 mg of spironolactone daily for four to 53 months (mean 15 months).
Considering that these were refractory patients, results were quite satisfactory, Dr. Pochi said. Excellent to good improvement was seen in 60% of the women and the remainder had fair to poor improvement. Side effects included menstrual disturbances in 21 women, none of whom were on oral contraceptive drugs, as well as fatigue, nausea, and dizziness.