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The Definitive Guide to Spironolactone

Spironolactone is a prescription-only medicine with many actions and uses. It was originally developed to treat high blood pressure and heart failure. However, it also blocks androgen hormones, which has made it a useful treatment for hormonal acne and androgenetic (pattern) hair loss. Spironolactone comes in two forms. The oral tablets are already licensed for heart and blood pressure conditions but used off-label for skin and hair. Spironolactone is also available in topical compounded formulas which you apply directly to the skin or scalp. These are unlicensed and formulated individually for each patient.


Regardless of form, you can only use spironolactone under the guidance of a registered doctor or medical prescriber. This guide explains how spironolactone works to treat acne and hair loss and the differences between the oral and topical forms. We will also review the side effects and how to get it safely in the UK if it is appropriate for you.

What is Spironolactone?

The main function of is as a potassium-sparing diuretic. It is an aldosterone (mineralocorticoid) receptor antagonist, meaning it blocks the hormone aldosterone in the kidneys. This helps the body clear excess water and salt whilst holding on to potassium. For this reason, spironolactone has been popular for decades to treat heart failure, resistant high blood pressure and a condition called primary hyperaldosteronism (where your body makes excess steroids).


also . This is the group of hormones, including testosterone and DHT, responsible for so-called "male" characteristics. Despite the name, both males and females have these hormones. Androgens drive oil in the skin and contribute to on the scalp. In some people this can lead to acne and hair loss. Interestingly, this is rarely due to an excess of androgens. Instead, some people’s skin and hair follicle cells are just more sensitive to androgen activity. By blocking androgen receptors and reducing the effect of these hormones, spironolactone can help reduce oil production and potentially reduce hormonal acne breakouts. It can also help reduce DHT-driven hair loss. Spironolactone is not licensed for use on the skin and hair. However, dermatologists have been using it for over 30 years as both oral tablets and topical forms.

What Does Spironolactone Treat?

Broadly speaking, OnabotulinumtoxinAAbobotulinumtoxinAIncobotulinumtoxinAPrabotulinumtoxinALetibotulinumtoxinARimabotulinumtoxinBHyaluronic Acid FillersCalcium Hydroxylapatite FillersPoly-L-lactic Acid FillersPolymethylmethacrylate FillersAutologous Fat GraftingForehead Lines TreatmentGlabellar Frown Lines TreatmentCrow's Feet TreatmentBunny Lines TreatmentChemical Brow LiftLip FlipGummy Smile CorrectionMasseter ReductionJaw SlimmingDimpled Chin SmoothingCobblestone Chin SmoothingNefertiti Neck LiftMicro-BotoxMesotoxHyperhidrosis TreatmentChronic Migraine ReliefBruxism TreatmentTMJ TreatmentCervical Dystonia TreatmentNeck Spasm TreatmentBlepharospasm TreatmentLip AugmentationLip ContouringCheekbone EnhancementTear Trough FillersNasolabial Fold SofteningMarionette Line FillersLiquid RhinoplastyNon-Surgical Nose JobJawline ContouringJawline DefinitionChin AugmentationTemple VolumisingHand RejuvenationAcne Scar Subcision Filling oral has a set of licensed and unlicensed uses. It is in the UK for heart failure, resistant hypertension and primary hyperaldosteronism. In dermatology, spironolactone is used in oral or topical form for patients if their doctor or deems it appropriate. The main uses of spironolactone for skin and hair are:


At City Skin Clinic, we use topical spironolactone in our personalised and treatments where suitable. It is often compounded alongside other where the doctor believes it will help.

Oral vs Topical Spironolactone

Possibly the most important thing to understand about spironolactone is the difference between the oral and topical forms. They are not interchangeable and they suit different people and different problems.


Oral spironolactone is a tablet that works systemically to lower activity throughout the whole body. It has by far the largest evidence base of the two forms. Your prescriber will determine the best dose and frequency for you, but common protocols involve:


Working systemically carries a higher risk of side effects (which we cover later) and requires blood tests to monitor potassium and kidney function, at higher doses. Because of its potential feminising effects, oral spironolactone is also not suitable for men.


Topical usually comes as a serum, though it can also be formulated as a cream or lotion. It is generally at 1% for the hair and 5% for the skin, though the prescriber will set this based on each patient’s medical background and needs. You apply it directly to acne-prone skin or the scalp. Compared with oral, the key differences are:


Because each topical formula is compounded to a doctor’s prescription, the strength, base and any added actives can all be tailored to you. This targets the problem from several angles in a way fixed, off-the-shelf products cannot. The trade-off, as with all compounded medicines, is that they are unlicensed and made freshly for each patient. As such, they have a shorter shelf life and need an experienced prescriber to get the formula right.


Ultimately both are prescription medicines, available as unlicensed treatment only if a doctor or other medical provider feels they are appropriate and safe for you. The right choice depends on the severity of the problem, your overall health, your tolerance for side effects and your preferences.

What Other Treatments Work Best with Spironolactone?

Both and are multi-causal conditions. Whilst spironolactone tackles the hormonal driver, it is rarely enough on its own. It works best as part of a combination that addresses all of the drivers at once.


In , the main drivers are excess oil production, pore lining, clogged pores, acne-causing bacteria and inflammation. Androgen hormones cause oil production. Spironolactone only addresses the hormonal driver, so it usually best to pair it with treatments that tackle the other causes such as:


In androgenetic hair loss, the key drivers are genetics and sensitivity to androgens (particularly DHT) at the follicle leading to the . Spironolactone blunts the androgen signal to stop hair shedding but it is not enough by itself to boost . It is usually best to combine it with treatments that stimulate hair growth or block DHT more directly:


One important note of caution is that you can not combine Spironolactone with other medicines or that raise potassium unless a doctor specifically directs it. This is one of several reasons it needs cautious prescribing and careful monitoring.

How to Use Spironolactone

How you use spironolactone depends entirely on the form and in both cases your prescriber will give you clear regarding how to use it safely and effectively. You normally apply topical spironolactone to the affected skin for acne or scalp for hair loss. Frequency is usually once or twice daily as directed and the general approach is:


Oral spironolactone is normally available in tablet form. Doctors usually the dose up gradually by your prescriber. It is usually taken with food. As it works systemically, it requires blood tests to monitor potassium and kidney function, particularly when starting or increasing the dose.


Whichever form you use, the timeline is similar to other and acne treatments. Acne tends to respond within 3-6 months, whilst hair loss can take 6-12 months before you see changes. Continued use is necessary to the benefit.

What are the Side Effects of Spironolactone?

The side effect differs significantly between the two forms. Because it works throughout the body, oral carries the greater risk. In the impressive it was generally well tolerated. However, possible side effects or oral Spironolactone include:


Topical spironolactone has minimal systemic absorption, so its side effect profile is very different and much gentler. This is one of the main reasons the topical form is used even though it is not licensed. However, there are still possible risks of topical Spironolactone use including:


This is why any form of Spironolactone is only available by prescription and requires careful evaluation of risks and before starting. With either form, stop and seek medical advice if you have a severe reaction, signs of an allergic reaction, or any side effect.

Who Can & Cannot Use Spironolactone?

Spironolactone needs careful patient selection to ensure it is appropriate, safe and effective. The main considerations doctors need to tthink about include:


These considerations apply mostly to the oral form, but anyone considering spironolactone in any form should also think through them. This is precisely why it is a prescription-only medicine.

Alternatives to Spironolactone

Obviously, Spironolactone is not the only option for treating hormonal acne or androgenetic hair loss. Whichever you are dealing with, it is one of several your prescriber will consider. More often than not a combination of treatments is necessary to tackle conditions like acne and pattern androgenetic hair loss.


For androgenetic hair loss, there are a couple of treatments that can serve as a suitable alternative to oral or . The main options are:


When it comes to treating acne in women, there are a few of treatments that can address the hormonal nature or the inflammation it causes. The main alternatives to Spironolactone for acne include:


As with everything in skin and hair, there is no single best treatment. The right choice, or the right combination, depends on the cause, your overall health and your individual . Your medical provider will shoudl help you find the best options for you.

How to Get Spironolactone in the UK

Spironolactone is prescription-only in every form, so you cannot buy it over the counter. It is only available by prescription if a doctor or other medical provider deems it is appropriate, safe and most effective option for you. The main ways suitable people might be able to access for dermatology treatment in the UK are:


At City Skin Clinic, we use topical spironolactone for suitable patients as part of personalised and treatments. The process works as follows:



At City Skin Clinic, we are passionate about personalised skin and hair care. We offer safe and effective custom treatments using ingredients like , , , , and where appropriate through our online clinic. Our doctors treat , , , , and through bespoke compounded treatments designed around you. To start your personalised plan, book a or use . The journey towards great skin and hair .



This article is for informational purposes only and is not a for medical advice, diagnosis or treatment. Always consult a qualified medical provider for any concerns or questions you might have.



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