Spironolactone, a diuretic commonly used to treat fluid build-up, high blood pressure, and low potassium, improved acne in adult women enrolled in the phase III Spironolactone for Adult Female Acne (SAFA) trial, which recruited participants in England and Wales. These results were published by Santer et al in The BMJ. In the trial, 410 women with a median age of 29.2 years—most of whom had mild or moderate acne—were randomly assigned 1:1 to either receive spironolactone at 50 mg once daily or placebo for 6 weeks; those assigned to the intervention arm were then increased to 100 mg/d of spironolactone or placebo until week 24. The primary endpoint was improvement on the Acne-Specific Quality of Life (Acne-QoL) symptom subscale at week 12. Although there was little difference seen between the intervention and control groups at week 12, at week 24, more patients in the spironolactone group reported acne improvement (82%) than in the placebo group (63%). Adverse events were slightly more common in the spironolactone cohort than in the placebo cohort, but no serious adverse events were reported. The study authors concluded, “Spironolactone is a useful alternative to oral antibiotics for women with acne.”
In a companion press release on the findings issued by the University of Southampton, first study author Miriam Santer, MD, Professor of Primary Care Research at the University of Southampton, commented, “We hope the publication of these results will mean more [general practitioners] and dermatologists feel confident to prescribe spironolactone as a treatment for acne…. The drug is already included in treatment guidelines for persistent acne in the U.S. and Europe.”