Some women may benefit from combined oral contraceptive pills or spironolactone, which reduces the effect of androgens in the sebaceous glands. Spironolactone has been used for years to treat acne in women, although its original license was for heart disease, blood pressure, and fluid retention.
The British SAFA trial provided important randomized evidence of its effectiveness. The trial included 342 adult women with persistent acne and compared spironolactone to a placebo, in addition to usual topical treatment.
The results showed greater improvement in the spironolactone group, with the difference being more pronounced after 24 weeks than after 12 weeks, indicating that hormone therapy needs time before reaching its maximum effect. The researchers said the drug could represent a useful alternative to oral antibiotics for women.
Spironolactone is not usually used to treat acne in men because of its potential hormonal effects.
Isotretinoin remains the most effective medication for achieving long-term relief in severe cases. It reduces the size of sebaceous glands and sebum production, and limits clogged pores, bacterial activity, and inflammation.
The guidelines strongly recommend it when there is severe acne or scarring, significant psychological burden, or failure of topical treatments and appropriate antibiotics.
