In May 2020, a retrospective study from the Journal of the American Academy of Dermatology examined the safety and effectiveness of long-term oral Spironolactone for the treatment of acne in women. Spironolactone is FDA approved as a diuretic for blood pressure control. However, it also has the added benefit of blocking testosterone receptors and dramatically reduces cystic acne in women.
The key take away points from the study are:

1. Spironolactone was well-tolerated with low rates of adverse effects. – side effects were mild and resolved upon discontinuation or lowering the dosage of medication. The most common side effects include frequent urination, headache and menstrual irregularities.

2. More than 75% of women show improvement in their acne: 20% women are clear at six months, 40% are clear at nine months, and more than 50% are clear within a year of taking spironolactone.

3. It takes 4 to 6 months to start seeing the peak effect of the medication.

4. A 3 mmHg drop in blood pressure was seen on average and was not clinically significant.

5. The average patient in the study took spironolactone for more than a year without long-term side effects.

6. The average starting dose of spironolactone was 100 mg.

Spironolactone is not an antibiotic or a hormone. Routine blood monitoring is unnecessary in women between the ages of 18 and 45 years of age who have no other health problems.