Topical Spironolactone Safe in Patients With Androgenetnic Alopecia

Spironolactone is a safe and effective treatment in androgenetic alopecia (AGA) and can improve efficacy when combined with minoxidil or other conventional treatments, according to study findings published in Clinical, Cosmetic and Investigational Dermatology.

Researchers conducted a systematic review and searched Web of Science, Cochrane Library, Embase, and PubMed databases through October 2022 for studies that assessed success and safety of spironolactone in AGA. They included 7 articles that comprised a total of 618 patients (89.5% women) with AGA, of whom 414 were treated with spironolactone.

Additional inclusion criteria included studies that enrolled at least 20 patients diagnosed with AGA and compared results with placebo or other treatment options. Risk for bias was evaluated using the Newcastle-Ottawa Scale or Cochrane Collaboration’s Risk of Bias Assessment tool; bias risk was determined to be low or questionable in at least 3 of the studies.

The 5 studies that investigated oral spironolactone included only women participants (n=295).

Alopecia recovery was efficacious with oral or topical treatment, but topical spironolactone produced significantly fewer adverse effects than oral spironolactone, with topical treatment appropriate for any sex. Of the 2 studies that examined topical spironolactone, 1 study reported 20% of patients experienced an adverse effect of contact dermatitis with no adverse effects on libido or sexual performance. The other study did not report on adverse effects.

Of the 5 studies that evaluated oral spironolactone, 2 did not report on adverse effects.  In the other 3 studies 73% of participants reported adverse effects. One study reported 41% of participants experienced menstrual disorder, 22% experienced scalp pruritus, 16% experienced increased scurf, and less than 14% experienced multiple side effects. Another study reported that 17% of participants experienced dizziness and less than 5% reported multiple other adverse effects. Adverse effects experienced by less than 5% of participants in the third study were postural hypotension, urticaria, facial hypertrichosis.

Topical spironolactone combined with oral or topical minoxidil showed better efficacy than monotherapy in the 3 studies that compared combination with minoxidil or spironolactone alone. In the 6 studies that reported on spironolactone combined therapies, 95% of participants were deemed to have effective combination therapy.

Limitations of the review include the nature of the systematic review study design and the relatively small number of included studies in the review.

“Spironolactone is an effective and safe treatment of androgenic alopecia which can enhance the efficacy when combined with other conventional treatments such as minoxidil,” the researchers conclude. “Topical spironolactone is safer than oral administration and is suitable for both [men and women] patients, and is expected to become a common drug for those who do not have a good response to minoxidil.”