Spironolactone for the Treatment of Moderate to Severe Acne in Adult Women: A Systematic Review and Meta-Analysis of Randomised Controlled Trials

Australas J Dermatol. 2025 May;66(3):165-168. doi: 10.1111/ajd.14428. Epub 2025 Feb 6.

Abstract

This systematic review and meta-analysis aimed to assess the efficacy and safety of spironolactone for moderate to severe acne in adult women by synthesising data from randomised controlled trials (RCTs). The meta-analysis demonstrated that spironolactone significantly increased the odds of treatment success, with a pooled odds ratio (OR) of 2.51 compared to placebo or doxycycline. This analysis supports spironolactone as a highly effective treatment for moderate to severe acne in adult women, particularly in hormonally driven cases. Its efficacy, combined with its role as an alternative to long-term antibiotic therapy, makes it a valuable option for acne management in women population.

Keywords: acne; antibiotics; doxycycline; isotretinoin; spironolactone.

Publication types

  • Systematic Review
  • Meta-Analysis

MeSH terms

  • Acne Vulgaris* / drug therapy
  • Adult
  • Anti-Bacterial Agents / therapeutic use
  • Female
  • Humans
  • Mineralocorticoid Receptor Antagonists* / therapeutic use
  • Randomized Controlled Trials as Topic
  • Severity of Illness Index
  • Spironolactone* / adverse effects
  • Spironolactone* / therapeutic use

Substances

  • Spironolactone
  • Mineralocorticoid Receptor Antagonists
  • Anti-Bacterial Agents