For women with acne, spironolactone may be as effective as oral tetracycline-class antibiotics, according to results published in the Journal of Drugs in Dermatology.

The study included women with acne who were started on either spironolactone (n=6684) or an oral tetracycline-class antibiotic (n=31,614) between 2010 and 2016. The researchers conducted a retrospective analysis of the frequency of switching to a different systemic agent within the first year of therapy.

Among participants who were started on spironolactone, 14.4% switched to a different systemic agent within 1 year compared with 13.4% of participants who started on an oral tetracycline-class antibiotic.

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After they adjusted for age, topical retinoid, and oral contraceptive use, the researchers found that the odds ratio for being prescribed a different systemic agent within 1 year was 1.07 (95% CI, 0.99-1.16) for women prescribed spironolactone compared with oral tetracycline-class antibiotics, and the risk difference was 0.007 (95% CI, −0.002 to 0.017).

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The researchers noted that although their results provide support for spironolactone as an effective acne treatment, larger clinical trials are needed to determine the optimal management strategy for these patients.

“Increased utilization of spironolactone is a potential opportunity to improve antibiotic stewardship and reduce complications associated with antibiotic use,” the researchers concluded.


Barbieri JS, Choi JK, Mitra N, Margolis DJ. Frequency of treatment switching for spironolactone compared to oral tetracycline-class antibiotics for women with acne: a retrospective cohort study 2010-2016. J Drugs Dermatol. 2018;17(6):632-638.