Journal of the American Academy of Dermatology · 2026
Hyperkalemia incidence in females over 45 years old on spironolactone for dermatologic conditions: A retrospective cohort study.
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Gregoire Samantha, Dewey Eliza, Sanchez Katherine, Biba Ursula, Ershadi Sherry, Cheng Debby, Acevedo-Fontanez Lorena, Bensellam Nora, Barbieri John S, Mostaghimi Arash
Аннотация
BACKGROUND: Spironolactone is widely used in dermatology. While routine potassium monitoring is no longer recommended in young, healthy females taking spironolactone for acne, hyperkalemia incidence, risk factors, and monitoring necessity in older females is unclear.
OBJECTIVE: To determine hyperkalemia incidence in females aged ≥45 taking spironolactone for dermatologic conditions.
METHODS: In this retrospective cohort study, 1197 Mass General Brigham medical records from January 1, 2015 through February 25, 2025 were reviewed; 398 cases were analyzed.
RESULTS: Hyperkalemia incidence was 10.1% (40/398) and more commonly observed in older patients (age ≥65: 22.4% versus ages 45-64: 7.9%) and those with ≥1 predisposing comorbidity (medically complex: 14.7% versus healthy: 7.3%). Healthy females aged 45-64 were least affected (6.3%). Patients age ≥65 with ≥1 predisposing comorbidity had the highest incidence (28.1%). Hyperkalemia was generally mild (97.5%), asymptomatic (85%), and did not impact clinical management (62.5%).
LIMITATIONS: Limitations include retrospective design and lack of comparator group.
CONCLUSION: Overall hyperkalemia risk in females aged ≥45 is higher than in younger patients and increased further in specific subpopulations. Hyperkalemia is generally mild and prescription modification is uncommon. While spironolactone use is safe for most patients, monitoring guidelines should be clarified to ensure optimal management in this population.
OBJECTIVE: To determine hyperkalemia incidence in females aged ≥45 taking spironolactone for dermatologic conditions.
METHODS: In this retrospective cohort study, 1197 Mass General Brigham medical records from January 1, 2015 through February 25, 2025 were reviewed; 398 cases were analyzed.
RESULTS: Hyperkalemia incidence was 10.1% (40/398) and more commonly observed in older patients (age ≥65: 22.4% versus ages 45-64: 7.9%) and those with ≥1 predisposing comorbidity (medically complex: 14.7% versus healthy: 7.3%). Healthy females aged 45-64 were least affected (6.3%). Patients age ≥65 with ≥1 predisposing comorbidity had the highest incidence (28.1%). Hyperkalemia was generally mild (97.5%), asymptomatic (85%), and did not impact clinical management (62.5%).
LIMITATIONS: Limitations include retrospective design and lack of comparator group.
CONCLUSION: Overall hyperkalemia risk in females aged ≥45 is higher than in younger patients and increased further in specific subpopulations. Hyperkalemia is generally mild and prescription modification is uncommon. While spironolactone use is safe for most patients, monitoring guidelines should be clarified to ensure optimal management in this population.