If you’re living with hidradenitis suppurativa, your doctor may recommend an oral drug called spironolactone (Aldactone). This diuretic — a type of medication that reduces fluid buildup — is among the many possible HS treatment options, along with antibiotics (both topical and oral), retinoids, hormonal therapies, biologics like adalimumab (Humira), and more.
“My dermatologist has prescribed me spironolactone for my HS,” one myHSteam member wrote. “Has anyone had any experience with this? I’m a bit nervous to start it.”
Understanding more about spironolactone can help you decide if this medication may be a good treatment for you.
As a diuretic, spironolactone helps reduce fluid buildup in the body. Spironolactone comes in tablets and is approved by the U.S. Food and Drug Administration (FDA) to treat:
Treating hidradenitis suppurativa with spironolactone is considered an off-label use. This means that HS isn’t one of the conditions the drug was tested for when it was approved in 1960. Since then, researchers have looked into using spironolactone to treat HS, with some promising results, as we discuss below.
Spironolactone is also used off-label to treat acne, female pattern hair loss, and hirsutism (excessive hair growth).
Although nobody knows just what causes someone to develop hidradenitis suppurativa, it may have to do with sex hormones, which are involved in the reproductive system. Researchers have offered several reasons they believe sex hormones may play a role in HS:
Because of the observed relationship between hormones and HS, health care providers might consider using spironolactone to treat this skin condition.
In the context of hidradenitis suppurativa, spironolactone works as an antiandrogen therapy. Androgens are a type of sex hormone with many important roles in the body, such as regulating bone density and menstruation. Antiandrogen therapy blocks some of androgen’s effects.
Because hormones may be unbalanced during HS, taking medication to restore the balance may be a good strategy. Although there isn’t much research on spironolactone and HS, one study of 64 females with HS showed that spironolactone led to better results than oral antibiotics.
A 2018 study from the Journal of American Academy of Dermatology (JAAD) found that female participants taking spironolactone experienced some relief from HS. The authors reported that after seven months on spironolactone, the participants had fewer lesions (damaged skin) and less pain.
In another small study, included in a 2022 systematic review of research, 17 out of 20 women with HS had improved symptoms after taking spironolactone for three months.
Spironolactone can have many side effects, so it’s important to consider these before treatment. Side effects, which the drug label might refer to as adverse effects, include:
Higher doses of spironolactone tend to be more toxic, producing more side effects. Importantly, in the studies of spironolactone for HS, relatively few side effects were reported. In the JAAD study, nausea occurred most often.
Spironolactone isn’t considered an appropriate treatment for men with HS because of the potential side effect of breast enlargement, according to the authors of the book “HS Patient Guide.”
Spironolactone isn’t recommended for individuals who are pregnant — there’s a risk of the medication causing sex hormone changes in male babies — and is generally not recommended for HS while breastfeeding. During FDA approval, some animal studies showed that using spironolactone at high doses for long periods may cause tumors.
Because it causes the body to release water and hold on to potassium, spironolactone can strain the liver and kidneys. These organs are responsible for cleaning the blood and putting waste and electrolytes (essential minerals that support bodily functions) into urine. People with kidney disease or liver disease, as well as older individuals, should be careful with using spironolactone.
Individuals who have Addison’s disease (a condition in which you don’t make enough of the hormones aldosterone and cortisol) or too much potassium in their blood should not take spironolactone.
Some medications don’t react well with spironolactone. For example, you shouldn’t use spironolactone with eplerenone, which is another antiandrogen. You may need closer monitoring with spironolactone if you’re also taking any of the following medications:
The best way to find out if spironolactone is a good treatment for your hidradenitis suppurativa is to talk with your doctor. Dermatologists are trained to help you find the best approach to improving your symptoms — and your quality of life.
On myHSteam, the social network for people with hidradenitis suppurativa and their loved ones, more than 35,000 members come together to ask questions, give advice, and share their stories with others who understand life with hidradenitis suppurativa.
Have you ever taken spironolactone for your HS? How did using this medication affect your symptoms? Share your experience in the comments below, or start a conversation by posting on your Activities page.