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New Findings Support The Rising Popularity Of Spironolactone For Adult Acne
Even though acne is usually at its worst when we're in our teens and twenties, it's one of the most common skin conditions in adults, too. As many as one in three women have facial acne in their thirties, and an estimated one in seven continue to struggle with facial blemishes into their fifties. Many experts recommend considering systemic therapies if topical medications aren't working or if the acne is causing scars. But that usually means antibiotics, which can be less than ideal for a few reasons. "Not only is antibiotic resistance a problem, but antibiotics can affect the gut microbiome with unwanted consequences," says Abigail Waldman, MD , the clinical director of the Mohs and Dermatologic Surgery Center at Brigham and Women's Hospital and a dermatologist at Mass General Brigham, both in Boston. For women with a certain type of acne , one alternative has been an inexpensive drug used to treat high blood pressure called spironolactone. Used "off-label" for the skin condition, the drug blocks certain hormones that can cause acne. Men aren't prescribed spironolactone for acne because of the side effects; men have developed breasts while taking the drug, according to the American Academy of Dermatology . Largest Randomized Controlled Trial to Look at Spironolactone for Acne Now results from the first large-scale clinical trial to look at the effectiveness of spironolactone in treating acne, published on May 16 in the British Medical Journal , add support for the inexpensive generic drug. "Spironolactone has been gaining popularity [as a treatment for acne], and I think this randomized controlled trial with over 400 participants will help. The previous randomized controlled trials were with fewer than 40 women," says Dr. Waldman, who was not involved in this study. "Because spironolactone has been generic for many years, there is less financial incentive to conduct large, multicenter placebo-controlled trials in acne patients," says Lindsay Strowd, MD , an associate professor of dermatology at Wake Forest University School of Medicine and a dermatologist at Atrium Health Wake Forest Baptist, both in Winston-Salem, North Carolina. Dr. Strowd was not involved in the new research. After 3 Months of Treatment, Women Saw Significant Improvement in Their Acne The UK study included 410 women older than 18, with an average age of 29, who had acne that had persisted for more than six months, and for whom oral antibiotics would have normally been the next treatment. Half were randomly selected to take spironolactone, while the other half were given a placebo. For the first six weeks, the spironolactone group took 50 milligrams (mg) a day, and then the dose was increased to 100 mg per day until week 24. The women were asked to complete questionnaires on their acne and quality of life relating to the condition at the start of the trial and then at 12 and 24 weeks into their treatment. "The results showed that the women taking spironolactone saw a significant improvement in their acne after 12 and 24 weeks compared to those on the placebo," said the lead author, Miriam Santer, PhD , a professor of primary care research at the University of Southampton in England, in a press release . Spironolactone Could Offer an Alternative to Antibiotics for Many Women "A significantly higher proportion of people also reported that they felt satisfied that their skin had been helped compared with those receiving placebo, and any side effects were uncommon and very minor. These results show that spironolactone could offer an alternative to antibiotics for many women with persistent acne to use alongside topical acne treatments," she said. "The findings also showed a significant objective reduction in acne at 24 weeks. This was a well-designed study, and I think it was reassuring that few side effects were noted, with headache being higher in the treatment group," says Waldman. "One important finding from this study that I discuss with my patients is the relative slowness of the acne to respond to spironolactone. It can often take three to five months to see the full effect of the medication, and more rapid improvement can be seen by pairing the medication with a topical acne agent such as a topical retinoid ," says Strowd. What Kind of Acne Responds to Spironolactone? Spironolactone is used for a very specific type of acne caused by hormonal imbalance in women, says Waldman. "This acne presents on the jawline, neck, and chest," she says. Usually, spironolactone is a second- or third-line treatment after topical medications such as benzoyl peroxide, topical retinoids, and oral antibiotics, says Waldman. "Often it is prescribed with an oral contraceptive, which increases its potency and prevents pregnancy complications while on the medication," she says. Spironolactone shouldn't be used during pregnancy or if you're trying to get pregnant because of its effect on hormones, and so women must be willing to use contraceptives while on the medication, she adds. Antibiotic Resistance Is One of the Biggest Threats to Global Health Spironolactone use for acne in the United States is very common, and its popularity has risen as dermatologists have become more conscious of antibiotic resistance. There has also been a push to minimize long-term use of oral antibiotics for acne treatment, says Strowd. Antibiotic resistance happens when germs like bacteria or fungi no longer respond to the drugs designed to kill them, according to the World Health Organization (WHO) . Antibiotic resistance is one of the biggest threats to global health, food security, and development today, per the organization. Although there are many health situations where antibiotics must be used, it's important to avoid using them unnecessarily, because it can contribute to antimicrobial resistance.Spironolactone Safe And Effective For Treating Acne In Women, Research Confirms
Spironolactone is a cheap, safe and effective for treating women with acne that can also be used in the longer term, a large UK study has shown.
The randomised controlled trial of 410 women over the age of 18 years with mild, moderate and severe acne found a significant difference in both in quality of life and self-reported acne improvement compared with placebo.
Reporting the results in the BMJ, researchers from the University of Southampton said the NIHR-funded trial was the first to provide clinical evidence that spironolactone was effective for the skin condition.
Differences were seen by 12 weeks but were more marked and statistically significant by 24 weeks, they said.
By this time, the number needed to treat for participants to report improvement in the condition of their skin was five.
There did not seem to be a difference in effectiveness between women who had PCOS and those who did not, the researchers noted.
It could mean a change in the way the condition is treated including a reduction in the number of antibiotics prescribed, as currently recommended in UK guidelines when topical treatments have not worked, they concluded.
More frequent headaches was the only difference in adverse effects between the two groups who were started on 50 mg spironolactone or matched placebo, increasing to two tablets daily at six weeks if tolerated, which was the case for more than 95% of participants.
Two other trials underway are looking at higher starting doses of the treatment.
Questions relative effectiveness in comparison with other treatments, use in younger age groups and which subgroups benefit would be answered in other studies, the team added.
A linked editorial said the women in the study had already heard about spironolactone as a possible treatment on social media and were keen to try it.
Study author Professor Miriam Santer, a GP and professor of primary care research at the University of Southampton, said spironolactone could provide a 'fantastic alternative' to oral antibiotics in women where topical treatments had not worked.
'We hope the publication of these results will mean more GPs and dermatologists feel confident to prescribe spironolactone as a treatment for acne,' she said. 'The drug is already included in treatment guidelines for persistent acne in the US and Europe, and we hope this trial will lead to a change in the UK guidelines.'
Professor Alison Layton from Harrogate and District NHS Foundation Trust and the Skin Research Centre at the University of York, who also worked on the study, said dermatologists had been prescribing the drug for severe acne for some time.
'This is a cheap medication which has been used for decades in the treatment of high blood pressure. The drug also reduces the main hormone that leads to the development of acne.
'However, previous studies of spironolactone for acne have been very small and there was no definitive proof that it actually worked.'
Professor Andrew Farmer, director of NIHR's Health Technology Assessment programme, said: 'The findings from this important trial provide compelling evidence which could help thousands of women affected by persistent acne.
'The treatment provides a valuable alternative to antibiotics and ensures clinicians can also better avoid the harms that can arise from antimicrobial resistance.'
A version of this story was originally published by our sister publication Pulse.
Dytor Plus Tab (5mg/50mg) (Spironolactone) Drug Price And Information
Dytor Plus Tab (5mg/50mg) Tablet Generic : Spironolactone ₹ 79.05 5mg/50mg 15 Tablets Price Updated on Apr 19, 2023 Drug information on Dytor Plus Tab (5mg/50mg) (Spironolactone) from Cipla LimitedAdvertisement
Adult- PO- The recommended dose range is 50 to 400mg/day for 3 to 4 weeks.
Gastrointestinal : Gastric bleeding, ulceration, stomach inflammation, diarrhea, cramping, nausea and vomiting.
Genitourinary : Breast enlargement in male, absence of menstrual period, painful erection, irregular periods, breast cancer, kidney impairment and postmenopausal bleeding.
Blood : Decrease in blood counts.
Hypersensitivity : Fever, hives, shock, inflammation of veins and skin lesions.
Metabolic : Elevated blood potassium level.
Central Nervous system : Mental confusion, incoordination, headache, drowsiness and lethargy.
Liver : Liver damage.
It comes as a tablet to take by mouth, with food.
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Contraindicated in patients with anuria (absence of urination), and significant impairment of kidney function.
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Caution should be exercised in patients with history of changes in blood minerals, kidney, liver, or heart disease, diabetes or high level of urea or nitrogen in blood, any allergy, who are taking other medications, elderly, children, during pregnancy and breastfeeding.
It may cause dizziness or drowsiness, do not drive a car or operate machinery while taking this medication.
Store it at room temperature (25°C).
Schedule : H Prescription drugs - Drugs to be sold only under the prescription of a Registered Medical Practitioner. Q: When is the best time of day to take Dytor Plus Tab (5mg/50mg)?A: Dytor Plus Tab (5mg/50mg) belongs to the class of potassium-sparing diuretics (water pills). It helps remove excess fluids from the body, which can lead to frequent urination. Therefore, it is advisable to take this medication during the day to avoid waking up frequently at night to urinate (1✔ ✔Trusted SourceSpironolactone
Go to source).
Q: Is Dytor Plus Tab (5mg/50mg) harmful to the kidneys?A: Dytor Plus Tab (5mg/50mg) can lead to acute kidney failure, especially in patients with impaired kidney function. As a result, it is important to let your doctor know if you have kidney-related problems because you may require a different dosage (2✔ ✔Trusted SourceLong-Term Effects of Spironolactone on Kidney Function and Hyperkalemia-Associated Hospitalization in Patients with Chronic Kidney Disease
Go to source).
Q: Does Dytor Plus Tab (5mg/50mg) raise cholesterol levels?A: Over a short course of treatment, Dytor Plus Tab (5mg/50mg) might have adverse effects on serum lipoprotein levels by increasing low-density lipoprotein (LDL) and decreasing high-density lipoprotein (HDL) (3✔ ✔Trusted SourceShort term effects of spironolactone on blood lipid profile: a 3-month study on a cohort of young women with hirsutism
Go to source).
Q: Does Dytor Plus Tab (5mg/50mg) cause breast enlargement?A: Dytor Plus Tab (5mg/50mg) is an anti-androgenic hormone that can inhibit the function of testosterone and male sex hormones. It has estrogen-like effects that lead to breast enlargement in males (4✔ ✔Trusted SourceSpironolactone-Induced Unilateral Gynecomastia
Go to source).
Q: Can Dytor Plus Tab (5mg/50mg) help treat PCOD?A: Dytor Plus Tab (5mg/50mg) can prevent or lessen PCOD symptoms in young females. It works by blocking the action of testosterone and thereby preventing coarse hair growth on the face, chest, and stomach (5✔ ✔Trusted SourceSpironolactone as a single agent for long-term therapy of hirsute patients
Go to source).
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