Spironolactone Therapy

What is Recalcitrant Acne?

Recalcitrant acne is the condition where your acne does not respond to any of the common treatments. Acne is what we call a pimple, is painful, forms pus,  bleeds on picking, and leaves behind scars upon scratching. Acne is caused due to the overproduction of oil (sebum). This sebum is produced by androgens, one of the hormones secreted by the ovaries, which increases the hair follicle production.

The circulation of androgens is in excess in the acne areas. The use of hormonal therapy is effective in the treatment of acne. These androgens exchange sodium and potassium in the distal convoluted tubes in the kidney.

Because of hyperandrogenism, women exhibit recalcitrant acne, truncal obesity, hair loss, infertility, polycystic ovaries (PCOs), irregularities in the menstrual cycle. Recalcitrant acne is treated with hormonal preparations such as estrogen, oral contraceptive pills, and low-dose glucocorticoids. Steroids are the major ingredients in these hormones. These hormones possess anti-androgenic characteristics and help in decreasing the production of androgen.


Spironolactone has been widely used for over 50 years to treat fluid retention, high blood pressure, and a few rare hormonal problems. It was subsequently found to be highly effective in the treatment of certain hormonally-related conditions in women, including adult acne, unwanted facial or body hair, and pattern hair loss of the scalp. Spironolactone is used for the treatment of acne in female patients who are resistant to any other treatment. This lowers the production and circulation of androgens which in turn reduces the follicle and sebum production. Spironolactone acts as an anti-androgen, where the androgen receptor is blocked and inhibits 5α-reductase enzyme activity in the androgens. 400mg of this is taken orally twice daily for 3 to 4 weeks.Spironolactone is taken regularly for 4 months, if the result is effective, then it can be continued for 6 to 12 months. Sodium and water are excreted and potassium is retained by the kidneys. It can be given by itself or in combination with any other drug acting on kidney tubules. It should not be used with drugs called angiotensin-converting enzyme (ACE) inhibitors.

This drug is not to be used by men as it can cause feminization and is not used by pregnant women. Also, it is not prescribed for any patients with kidney-related disorders. Potassium and salt content in food, whole-grain cereals, chickpeas, potatoes, and bananas should be avoided.

In women, this treatment will cause irregularity in the menstrual cycle. Hence, spironolactone + OrthoTricyclin or OrthoCyclen is an excellent combination treatment for androgenic acne.

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