Oral spironolactone may hold edge in female acne

Topical treatment showed lesion reductions with minimal systemic exposure, but small, heterogeneous studies leave its clinical role uncertain.

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A narrative review found stronger evidence for oral than topical spironolactone in adult female acne.
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In the 410-participant SAFA trial, spironolactone improved acne-specific quality-of-life scores versus placebo at 12 and 24 weeks.
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At 12 weeks in SAFA, investigator-assessed treatment success was 19% with spironolactone and 6% with placebo, but the primary outcome difference did not reach the trial’s prespecified 2-point threshol
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Topical studies reported lesion reductions, but evidence was limited by small samples, short follow-up, varied formulations, and indirect applicability to adult women.
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Oral treatment was associated with menstrual irregularities and breast tenderness, whereas topical treatment showed minimal systemic exposure in available studies.

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