Spironolactone plus combined OC containing drospirenone shows acne promise
By Samantha Crofskey
11 January 2008
J Am Acad Dermatol 2008; 58: 60-62

MedWire News: The combination of low-dose spironolactone with a combined oral contraceptive (OC) containing drospirenone is well tolerated and may be an effective treatment for women with acne, suggests research published in the Journal of the American Academy of Dermatology.

"The recent development of [an] OC containing drospirenone, a progestogen with significant antiandrogenic and anti-mineralocorticoid activity, represents an advance over previous combinations," say Aleksandar Krunic and colleagues from the Northwestern University Feinberg School of Medicine in Chicago, Illinois, USA.

Although adding such an OC to spironolactone would be expected to augment anti-androgen activity, the combination could potentially increase adverse effects, such as elevations in serum potassium levels, they explain.

A total of 27 women with severe papular or nodulocystic acne received oral spironolactone 100 mg and a combined OC containing ethinyl estradiol 30 µg and drospirenone 3 mg (EE/DRSP) once daily, and were followed-up over a 6-month period.

The combination of spironolactone and EE/DRSP was well tolerated, with no significant elevation of serum potassium in any of the patients. Serum potassium levels ranged from 3.8 to 4.8 mmol/l, with a mean of 4.35 mmol/l at follow-up.

No patient experienced spotting, weight gain, menstrual cycle irregularities, or any other adverse effects severe enough to require cessation of treatment.

At the end of the study, three patients achieved complete clearance of their acne lesions. A further 20 patients demonstrated excellent improvement (≥ 75% clearance of acne lesions), two patients experienced mild improvement (≥ 25% clearance), and the remaining two patients showed no change in their acne lesions.

"The augmentation of the anti-androgenic effect of DRSP by spironolactone and the reduction of side effects makes the combination of spironolactone and EE/DRSP attractive for control of moderate to severe, hormonally influenced female acne," the researchers conclude.

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