What do we know about prescribing spironolactone for acne?

Recurrent acne can have a negative psychosocial impact in adolescence, which can persist into adulthood. Topical treatments are recommended as first line by guidelines, but many people with acne are treated with extended courses of antibiotics, which should be prescribed alongside topical treatments, although are often prescribed on their own. Spironolactone may be a useful alternative to oral antibiotics for women with persistent acne.Our experiences of prescribing spironolactone for acne differ. Alison, a dermatologist, has prescribed it successfully for acne over the past 20 years on the basis of clinical experience, case series, and very small trials.1 Miriam, a GP, has never prescribed spironolactone for acne, but has often prescribed it for cardiovascular conditions. Following evidence from this trial (https://www.bmj.com/content/381/bmj-2022-074349), Miriam will prescribe it for persistent acne in women too, as may other GPs. However, GPs are likely to have questions regarding prescribing spironolactone for women with acne.One question is,…
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