In his article on acne published recently in the New England Journal of Medicine James (1) mentions that androgen antagonist spironolacton is often useful in women with hyperandrogenism. However, it would be important to point out, that the effectiveness of this treatment cannot be determined due to the small sample populations involved in the trials, as has been shown in recent metaanalysis. (2) It should be also emphasized that although the long-term use of spironolactone in the treatment of acne in women appears to be safe, its side-effects seem to be high. (3) On the other hand, it is worth mentioning that spironolactone in addition to its antiandrogenic effects might also have antiinflammatory potential. (4) This emphasizes the need for further properly designed trials with relevant outcomes to provide robust estimates of the size and mechanism of any treatment effects. Because of its long half-life spironolactone should be given once daily and not in divided doses as recommended by James. This might increase the compliance which is important in prolonged therapy to achieve maximal benefits. (5)
1. James WD. Clinical practice. Acne. N Engl J Med 2005;352:1463-72.
2. Farquhar C, Lee O, Toomath R, Jepson R. Spironolactone versus placebo or in combination with steroids for hirsutism and/or acne. Cochrane Database Syst Rev 2003;(4):CD000194.
3. Shaw JC, White LE. Long-term safety of spironolactone in acne: results of an 8-year followup study. J Cutan Med Surg 2002;6:541-5.
4. Hansen PR, Rieneck K, Bendtzen K. Spironolactone inhibits production of proinflammatory cytokines by human mononuclear cells. Immunol Lett 2004;91:87-91.
5. McEvoy B, Nydegger R, Williams G. Factors related to patient compliance in the treatment of acne vulgaris. Int J Dermatol 2003;42:274-80.
About the author:
Dr. Michal R. Pijak is a consultant in rheumatology, allergy and clinical immunology at the University Hospital in Bratislava, Slovakia.
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