25-28 SEP 2024

Spironolactone: a place in the algorithm of adult female acne

Presentation ID D4T04.1B

Session type: Updates
Room: Auditorium
Date: Saturday, 28 Sep, 08:50 – 09:10 CEST

Part of Session: Acne

Prof. Brigitte Dréno

(Nantes, France)

Acne in adult females is mainly triggered by hormones. Doxycycline is considered a reference treatment in acne. Spironolactone at low doses is an anti-androgen which targets the androgen receptor of sebaceous glands. It is prescribed off-label for female adult acne for more than 40 years in some countries as the USA. However, until now, the “evidence-based medicine” proofs of the clinical efficacy of spironolactone in acne remain low, which explains why it is not included in the official acne recommendations.

In this context, a multicenter, controlled, randomized, double-blind prospective and parallel study assessed the efficacy of spironolactone compared with doxycycline in adult female acne. A total of 133 women with moderate acne were randomized to receive treatment with either doxycycline and benzoyl peroxide for 3 months followed by a 3-month treatment with its placebo and benzoyl peroxide, or spironolactone and benzoyl peroxide for 6 months. Successfully treated patients continued with benzoyl peroxide or spironolactone alone for a further 6 months. Primary endpoints were treatment success at month 4 and month 6 with the AFAST score (Adult Female Acne Scoring Tool: JEADV 2016; 30: 824–828), an easy-to-use tool for scoring acne in adult females.

This trial demonstrated that Spironolactone performed better at month 4 and showed a statistically significant better treatment success after 6 months than doxycycline (p = 0.007).  Spironolactone was 1.37-times and 2.87-times more successful compared with doxycycline at respective 4 and 6 months. In addition, patients’ quality of life was better with spironolactone at month 4 and month 6. This is the first study to show that, in female adults with moderate acne, treatment with spironolactone is significantly more successful than doxycycline and very well tolerated.

Explore the extensive Congress programme featuring the latest scientific advances and research in dermatology & venereology.

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