Lower-Dose Spironolactone Effective for Hidradenitis Suppurativa With Tolerability Issues

Hidradenitis Suppurativa
Hidradenitis Suppurativa
Lower doses of spironolactone seem to be effective and may be an appropriate option for those patients with tolerability issues.

The management of hidradenitis suppurativa (HS) with the antiandrogen therapy spironolactone has been shown to reduce lesion counts, scores on the HS Physician Global Assessment, and pain among those affected, according to the results of a single-center, retrospective chart review of female patients with HS. Findings were published in the Journal of the American Academy of Dermatology.

The investigators sought to examine whether spironolactone treatment is associated with improvements in HS disease severity and patient-reported pain. Female patients with HS who were treated with spironolactone between 2000 and 2017 were evaluated. The primary study measurements included the HS Physician Global Assessment, inflammatory lesion count, fistula count, Hurley staging, and a numeric rating scale for pain.

A total of 46 women with HS were included in the study. The average age at initial presentation of the 46 participants with ≥1 follow-up was 35.1±10.3 years. The mean patient age was 21.4±10.1 years at disease onset and 31.1±9.4 years at diagnosis. The most common comorbidities included psychiatric disease, acne, and polycystic ovarian syndrome. Overall, 6 patients had a family history of HS.

On average, participants were exposed to spironolactone 75 mg daily during a 7.1-month follow-up period. Patients attained significant disease improvement in terms of pain (P =.01), inflammatory lesions (P =.02), and HS Physician Global Assessment (P <.001). No significant change was reported with respect to Hurley stage (P =.32) or fistulas (P =.73). No difference in improvement was observed between participants who were treated with <75 mg per day (n=25; average of 45 mg/day) and those who received >100 mg per day (n=21; average of 112 mg/day).

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Major limitations of the study include its retrospective nature, limited sample size, and variations in severity measures that were documented.

The investigators concluded that lower doses of spironolactone seem to be effective and may be an appropriate option for those patients with tolerability issues. Additional studies are warranted to better characterize those patients who are most likely to be responders to antiandrogen therapy, to identify optimal spironolactone dosing, and to explore the effects of treatment over longer durations.


Golbari NM, Porter ML, Kimball AB. Antiandrogen therapy with spironolactone for the treatment of hidradenitis suppurativa [published online July 9, 2018]. J Am Acad Dermatol. doi: 10.1016/j.jaad.2018.06.063