Women with polycystic ovarian syndrome—characterised by excess androgens—seem to be at a greater risk of hair loss and acne. This is thanks to the excess testosterone, there is an increase in sebum and skin cell production, leading to acne, and miniaturisation of the hair follicle, which causes hair loss. While there are many oral and topical medications that are prescribed to balance these, spironolactone is a newer one picking up speed. We spoke to two dermatologists about how it works.
What is spironolactone and how does it work?
Spironolactone is a pill meant to counter water retention and traditionally used to treat high blood pressure. “It’s a diuretic—a drug which helps to eliminate water retention in the body by producing more urine,” says Dr Pankaj Chaturvedi, consultant dermatologist at MedLinks, New Delhi. However, women with combination skin that began taking the drug found that they had better skin and stronger hair—a happy side-effect.
The drug is now being used off-label to treat hormonal acne and hair loss, but only if other more direct topical and oral medications have not worked. “It has also been used to treat acne and thinning hair by taking advantage of one of its side effects, which is that it blocks the effects of androgen hormones on the skin,” says New York-based Dr Joshua Zeichner, MD, director of cosmetic and clinical research of dermatology at Mount Sinai. How does that work? It does not affect the hormone levels themselves, but rather the pill prevents them from doing their job. “Think of yourself on the highway but you can’t get off because they’re doing construction at your exit. That’s what spironolactone does. It acts as a roadblock, preventing the hormones from leaving the bloodstream and exerting their effect on the skin. If oil glands aren’t stimulated by hormones, then your body produces less oil, there are fewer blockages within the pores and because of that, less acne,” explains Dr Zeichner.
This action of spironolactone is particularly beneficial in treating adult acne, especially in women. “It is also given to women who have hirsutism (unwanted hair on face and body),” says Dr Chaturvedi. Why is favoured by many dermatologists is because it has a negative effect on facial hair and a positive effect of scalp hair. “In conditions like female pattern hair loss (hair thinning in the mid-partition of the scalp), receding hairline, and diffuse hair thinning, it helps to prevent hair loss,” he adds.
What you should know before taking spironolactone
It is important to note that hair loss caused by non-hormonal factors (like physical breakage or stress) won’t be affected by spironolactone. The same goes for acne that is not high DHT-related.
While it is a very safe drug, it should only be taken under a dermatologist, gynaecologist or endocrinologist’s supervision. “It should not be taken by someone who is planning a family, is pregnant or breastfeeding. Possible side effects are irregular menstrual cycle, mid-cycle bleeding and electrolyte imbalance (because it may cause high potassium),” warns Dr Chaturvedi.
The article was first published in Vogue
