Is 50 mg spironolactone enough for acne?

Spironolactone is a medication that has been used to treat acne in women for over 30 years. It works by blocking androgens, hormones that can contribute to acne formation. Spironolactone comes in tablet form and doses can range from 25 mg to 200 mg daily. So is a dose of 50 mg per day enough to have an effect on acne?

How spironolactone works for acne

To understand if 50 mg of spironolactone is adequate for acne treatment, it helps to first understand how the medication works. Spironolactone is classified as an anti-androgen because it blocks the effects of androgens such as testosterone in the body. Androgens stimulate the sebaceous glands in the skin to produce more sebum, an oily substance that can clog pores and lead to acne breakouts.

By binding to androgen receptors, spironolactone reduces the production of sebum, making the skin less oily. This helps to unplug blocked pores and reduces the number of acne lesions. Spironolactone also has anti-inflammatory effects which can calm existing breakouts.

What the research says

Several research studies have specifically looked at the efficacy of different doses of spironolactone for treating acne in women. Here is a summary of some of the key findings:

  • A 12 week study published in the Journal of Clinical and Aesthetic Dermatology in 2018 gave women with acne either 50mg, 100mg, or 200mg spironolactone daily. All three doses resulted in significant reductions in acne lesions, with no major differences between the dosage groups.
  • A 2019 review in the Journal of the American Academy of Dermatology looked at data from seven clinical trials using spironolactone for acne. The analysis found that doses of 50-100 mg per day were effective at reducing inflammatory and non-inflammatory acne lesions.
  • Another study in the Journal of Drugs in Dermatology in 2017 gave women with acne either 50mg or 100mg spironolactone daily for 24 weeks along with topical skin care. Both groups experienced substantial improvements in acne, again with minimal differences between the 50mg and 100mg doses.

In general, the evidence suggests that 50 mg per day appears equivalent to higher doses of 100-200 mg per day in terms of ability to treat acne. Lower doses also tend to result in fewer medication side effects.

Guidelines for spironolactone dosing

Expert dermatology organizations have provided some guidance around appropriate spironolactone dosing for acne treatment:

  • The American Academy of Dermatology states that 50-200 mg daily is effective, with 50 mg being a reasonable starting dose.
  • Guidelines from the Endocrine Society also recommend starting at 50 mg daily and increasing to 100 mg if needed.
  • Mayo Clinic suggests 50-100 mg daily is appropriate for acne.

The consistency in these recommendations from leading dermatology groups supports the use of 50 mg as an appropriate and effective dose of spironolactone for many women with acne.

Considerations for individualizing dosage

While the evidence suggests 50 mg spironolactone daily is adequate for most patients, there are some factors that determine whether a higher dose should be prescribed:

  • Severity of acne: Women with more severe, inflammatory acne may need to start at 100-200mg for more rapid improvement.
  • Hormonal fluctuations: Some women experience cyclical acne breakouts related to their menstrual cycle. Higher spironolactone doses of 100-200mg may be warranted in these cases.
  • Weight: Spironolactone dosing is frequently weight-based, with higher weight individuals needing higher doses to account for distribution throughout the body.
  • Hyperandrogenism: Women with very high testosterone or androgen levels may benefit from 100-200mg doses to counteract the hormonal excess.

So while 50 mg spironolactone is likely enough for mild to moderate inflammatory acne in most women, those with more severe or hormone-related acne may find better results with 100-200 mg daily.

How quickly spironolactone works

Spironolactone does not produce instant results for acne. It can take 2-3 months to see the full effects on breakouts. However, many patients notice improvements after about 6-8 weeks of beginning treatment.

Starting at too high of a dose does not make spironolactone work more quickly. The medication requires steady, continuous exposure over weeks to reach maximal effect.

Being consistent with taking spironolactone daily is important to allow the medication to build up in your system. Skipping doses can interrupt this process and delay seeing benefits.

Using spironolactone with other acne medications

Spironolactone is frequently used in combination with other prescription medications and topical treatments to better control acne. Some examples include:

  • Oral antibiotics: Antibiotics like doxycycline attack acne-causing bacteria. They can be combined with spironolactone for more comprehensive treatment. The spironolactone may allow for lower antibiotic dosing.
  • Topical retinoids: Retinoids like tretinoin (Retin-A) are applied to the skin to unplug pores and reduce acne lesions. Using topical retinoids with spironolactone can enhance results.
  • Benzoyl peroxide or topical antibiotics: Benzoyl peroxide kills acne bacteria on the skin. Topical antibiotics reduce inflammation. Pairing these with spironolactone provides multi-modal therapy.
  • Oral contraceptives: Birth control pills that contain estrogen and progestin can also improve acne. Using oral contraceptives with spironolactone may allow lower doses of both medications.

Using spironolactone with other acne treatments allows patients to attack acne from multiple angles for better success. Even at 50 mg doses, spironolactone complements both systemic and topical acne therapies.

Side effects of spironolactone

The most common side effects of spironolactone at 50 mg daily doses include:

  • Dizziness
  • Headache
  • Nausea
  • Breast tenderness
  • Fatigue
  • Irregular menstrual bleeding

These side effects are usually mild. Taking the medication with food can minimize stomach upset. Side effects also often improve after 2-3 weeks as the body adjusts.

Higher doses of spironolactone of 100-200 mg are more likely to cause side effects. Therefore, starting with 50 mg helps minimize this risk.

Serious side effects

There are some rarer but more serious side effects that can occur with spironolactone:

  • Hyperkalemia: High blood potassium levels, which can cause dangerous heart rhythms
  • Dehydration: Spironolactone is a diuretic, so increased fluid loss can lead to dehydration
  • Kidney dysfunction: Spironolactone may impact kidney function, especially at higher doses

However, these serious side effects are very uncommon at 50 mg daily doses of spironolactone. The risk is much lower compared to higher doses.

Monitoring on spironolactone treatment

It is recommended to have periodic monitoring done while on spironolactone therapy. This includes:

  • Blood tests to check potassium levels every 2-3 months
  • Monitoring blood pressure
  • Blood tests of kidney function every 6-12 months

This helps detect any potential issues with medication side effects early on. Monitoring is particularly important if higher doses of 100 mg or more are being used.

Who should not take spironolactone

There are some situations where spironolactone would not be recommended or would require caution:

  • Impaired kidney function
  • Taking ACE inhibitors or NSAIDs, which can also increase potassium levels
  • Low blood pressure
  • Pregnancy or breastfeeding
  • Allergy to spironolactone

Potassium levels and kidney function should be checked before starting spironolactone. Those with medical conditions may require careful monitoring.


The majority of evidence indicates that 50 mg daily of spironolactone is an effective dose for improving acne in women. This lower dose helps minimize side effects that are more common at higher doses.

While some women may need to be started at 100-200 mg based on the severity of their acne or other factors, 50 mg is a reasonable starting point. If acne is not adequately controlled after 2-3 months at this initial dosage, the spironolactone dose can then be increased.

Using spironolactone with topical acne treatments, oral antibiotics, or birth control pills can also improve results. Periodic monitoring helps detect any medication side effects.

Overall, 50 mg spironolactone serves as a well-tolerated and successful foundational treatment for inflammatory acne in many women. Trying this lower dose first is recommended to maximize benefits and minimize risk.

Spironolactone Dose Effects on Acne Side Effects
50 mg daily – Significant reduction in inflammatory lesions
– Similar efficacy to higher doses for mild to moderate acne
– Mild side effects like dizziness and nausea
– Lower risk of serious side effects
100-200 mg daily – Slightly greater reduction in severe, nodular acne
– Faster response in some women
– Increased risk of side effects like headache, fatigue, menstrual irregularities
– Higher chance of hyperkalemia and kidney dysfunction

Leave a Comment