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If you’re living with hidradenitis suppurativa (HS), your doctor may recommend an oral drug called spironolactone. “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 treatment may be a good option for you.
As a diuretic, spironolactone helps reduce fluid buildup in the body. Spironolactone comes in tablets.
It’s approved by the U.S. Food and Drug Administration (FDA) to treat:
Treating HS with spironolactone is considered an off-label use. This means that the FDA hasn’t approved it as a treatment for HS. But researchers have looked into using spironolactone to treat HS, with some promising results.
Spironolactone is also used off-label to treat acne, female-pattern hair loss, and hirsutism (excessive hair growth).
Spironolactone may be used to control HS, along with other HS treatments. These may include antibiotics, retinoids, steroid injections, hormonal therapies, biologics, and more.
Nobody knows just what causes someone to develop HS. But medical experts believe sex hormones linked with the reproductive system may be involved. Researchers have offered several reasons they believe sex hormones may play a role in HS:
Because of the observed relationship between hormones and HS, your care team might consider spironolactone to treat it.
Spironolactone works as an antiandrogen therapy for HS. Androgens are a type of sex hormone with many important roles in the body. For instance, androgens help regulate bone density and menstruation. The antiandrogenic effects of spironolactone may reduce the effects of androgens in some people.
There isn’t much research on spironolactone and HS. In one retrospective review published in the Journal of Cutaneous Medicine and Surgery, 29 females with HS were prescribed one of five antiandrogen therapies:
The review showed that the antiandrogen therapies led to better results than oral antibiotics.
A 2018 study in the Journal of the American Academy of Dermatology found that female participants taking spironolactone noticed some relief from HS. The authors reported that after seven months on spironolactone, the participants had fewer inflamed lesions (damaged skin) and less pain.
Another small study was included in a 2022 systematic review published in the International Journal of Molecular Sciences. It noted that 17 out of 20 women with HS had improved symptoms after taking spironolactone for three months.
Research to date has been mostly small case series or reviews. Larger randomized trials are needed to provide more data to support the most effective treatments for HS.
Spironolactone can have many side effects. It’s important to consider these before treatment. Side effects, which the drug label might refer to as adverse effects, include:
Some adverse effects, including gynecomastia (breast tenderness or enlargement), are dose-related.
In the studies of spironolactone for HS, relatively few side effects were reported. One study found that nausea occurred most often.
Most research has been conducted on women, and some adverse events like gynecomastia, affect mostly men. Clinicians may weigh the potential benefits of spironolactone treatment against adverse effects such as gynecomastia. But medical guidelines frame hormonal therapy as an option for some women.
Spironolactone may not be the right choice for everyone. Read on for information about who should be more cautious about this medication.
Spironolactone isn’t recommended for individuals who are pregnant. According to the prescribing information, there’s a risk of the medication causing sex hormone changes in male babies or harm to other developing organs.
Current evidence indicates that spironolactone seems to be acceptable while breastfeeding. Always discuss this in advance with a lactation specialist or healthcare professional.
Spironolactone may affect kidney or liver function. That’s because it changes how your body handles potassium and fluids. These organs clean the blood and put 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. It causes the body to release water and hold on to potassium. Your body may lose too much fluid, which could worsen kidney function in people at risk.
Impaired kidney function raises the risk of high potassium, which can affect various bodily functions. Severe cirrhosis (a type of liver disease) requires cautious dosing and monitoring.
Individuals with Addison’s disease or too much potassium in their blood shouldn’t take spironolactone. Addison’s disease is a condition in which you don’t make enough of the hormones aldosterone and cortisol.
Certain medications don’t react well with spironolactone. For example, you shouldn’t use spironolactone with eplerenone. This is another aldosterone-blocking (hormone-blocking) medication.
You may need closer monitoring with spironolactone if you’re also taking any of the following medications:
During FDA approval, some studies in rats were conducted. These showed that using spironolactone at high doses for long periods may cause tumors. But an analysis of humans found no statistically significant increase in cancer risk. However, the authors said more research is needed because the evidence is still limited.
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.
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This has prevented me from having a sex life with my husband of 34 years thetr painful i hate it
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Spironolactone is working wonders for me. My HS has become more manageable. Flares are smaller without much pain or itch and there is very little, if any, drainage. This was the only drug that cured… read more
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