Is Spironolactone The Only Option For Women Over 35 With Acne?

Spironolactone is generally prescribed as an “off label” acnetreatment for women. This drug, though intended to help peoplewith heart problems not zit problems, reduces the production ofthe hormone androgen. Androgen promotes excess facial oilsecretion.Less oil secretion limits the possibility of having cloggedpores and acne flare-ups.Spironolactone works as an androgen receptor blocker. This drugdecreases androgen production in the ovaries and adrenal glands.Side effects from spironolactone can include breast tendernessand menstrual irregularity.For this reason, doctors usually add oral contraceptives likeOrtho Tri-Cyclen and Estrostephave to compliment acne treatmentsand ease potential spironolactone side effects. Ironicallythough, spironolactone is recommended for women who are notcandidates for oral contraceptives.So should a woman over 35 with acne go with spironolactone?According to the American College of Physicians, the answer is“No”.In the 2004 May/June edition of the American College ofPhysicians (ACP) published a medical review of studies thattested the effectiveness of spironolactone for controllinghirsutism, acne, or both in fertile or postmenopausal women. TheACP review found insufficient evidence to recommendspironolactone as an acne treatment.Nevertheless, Dr. Diane Thiboutot of Pennsylvania StateUniversity, Hershey uses spironolactone for female patients withacne accompanied by a suspected endocrine disorder.For example, when a woman experiences a sudden onset of severeacne or acne that is linked with excessive facial hair growth,irregular menstrual periods, increased libido, dark patches ofskin, deepening of the voice, insulin resistance and hair loss,spironolactone may be helpful.Dr. Thiboutot noted that spironolactone “seems to control quitewell those cystic-type nodules that they [women] get on theirlower face and chin.”Yet Dr. Julie C Harper Dr. Harper of the department ofdermatology at the University of Alabama, Birmingham doesn’trecommend spironolactone so easily. Only if neither topicalretinoids nor antibiotics have not worked for a woman’s case ofacne would Dr. Harper then suggest using spironolactone forwomen over 35.Author of “Acne Messages”, Naweko San-Joyz, says “A woman’sresponse to androgens is so varied that limiting herself to anandrogen blockers like spironolactone certainly does notguarantee a cure, or even a quick treatment.”San-Joyz adds that overproduction of androgens is just one stepin a series of potential events that could lead to acne.Instead of hormonal manipulation with drugs, San-Joyz suggestswomen with acne regulate this conditional using food, stresscontrol and greater awareness of potential acne triggers likeenvironmental estrogens.Women with acne have numerous treatments options. If a womandoes decide to go with spironolactone, it’s best to get herprescription filled with her gynecologist rather that hergeneral practitioner.It’s most likely that the gynecologist will be more aware of howa patient may respond to hormonal treatments like spironolactoneand oral contraceptives, thus making recovery faster.