Spironolactone for Hidradenitis Suppurativa: How Does It Work? | myHSteam

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Spironolactone for Hidradenitis Suppurativa: How Does It Work?

Posted on September 25, 2023

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.

What Is Spironolactone?

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:

  • High blood pressure
  • Heart failure (when the heart doesn’t pump enough blood to vital organs)
  • Swelling associated with kidney or liver disease
  • An excess of the hormone aldosterone

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).

Hidradenitis Suppurativa and Hormones

HS can cause painful abscesses and nodules in the underarms. Sometimes sinus tracts, or channels under the skin, can form and leak pus. (CC BY-NC-ND 3.0 NZ/DermNet)

HS lesions can show up on the inner thighs and also affect the genitals and buttocks. (CC BY-NC-ND 3.0 NZ/DermNet)

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:

  • Women are more likely than men to have HS, according to the journal JAMA Dermatology. Some researchers think this greater risk may stem from a difference in sex hormones.
  • The onset of HS usually follows puberty, when the body starts to produce more sex hormones.
  • Hormonal therapy such as oral contraceptives, also known as the birth control pill, can treat people with HS. Metformin, an antidiabetic drug that balances hormones, is also used in HS treatment.
  • Some people experience more HS symptoms before their menstrual periods and during menopause.

Because of the observed relationship between hormones and HS, health care providers might consider using spironolactone to treat this skin condition.

Spironolactone for Hidradenitis Suppurativa

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.

Side Effects of Spironolactone

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:

  • Digestive problems such as nausea, vomiting, and diarrhea
  • Electrolyte imbalances (increased potassium levels) that lead to shaking, fainting, and light-headedness
  • Skin symptoms such as rash and alopecia (hair loss)
  • Neurological effects such as confusion, headache, and tiredness

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.”

Who Shouldn’t Take Spironolactone?

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:

  • Lithium, a mood stabilizer for bipolar disorder
  • Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen
  • Digoxin, a treatment for heart failure or arrhythmia (irregular heartbeat)
  • Cholestyramine, which reduces high cholesterol levels
  • Any drug that increases potassium levels in the body

Talk to Your Doctor

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.

Talk With Others Who Understand

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.

Posted on September 25, 2023
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Jazmin N. McSwain, PharmD, BCPS completed pharmacy school at the University of South Florida College of Pharmacy and residency training at Bay Pines Veterans Affairs. Learn more about her here.
Hannah Actor-Engel, Ph.D. is a multidisciplinary neuroscientist who is passionate about scientific communication and improving global health through biomedical research. Learn more about her here.

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