Efficacy of different topical spironolactone treatments for acne vulgaris: A meta-analysis.

BACKGROUND

Topical spironolactone could serve as an alternative to oral therapy for acne vulgaris, but its efficacy requires further validation.

OBJECTIVES

This study aimed to evaluate the efficacy of topical spironolactone monotherapy for acne vulgaris in systemically healthy patients.

METHODS

A PRISMA-compliant meta-analysis was conducted, searching PubMed, Cochrane Library, Embase, and Medline for controlled trials on exclusive topical spironolactone use.

RESULTS

Four trials (N=212) met criteria. Compared to baseline, the 5% spironolactone gel significantly reduced both Acne Severity Index (ASI; mean difference (MD) = -7.65, 95% CI [-10.63 to -4.67], p < 0.00001) and Total Lesion Count (TLC; MD = -13.50, 95% CI [-16.26 to -10.73], p < 0.00001). Similar reductions were observed with the 1% spironolactone gel (ASI; MD = -6.02, 95% CI [-7.84 to -4.20], p < 0.00001; TLC; MD = -17.60, 95% CI [-21.62 to -13.58], p < 0.00001), whereas, the 2% spironolactone solution only showed improvement in ASI (MD = -25.4, 95% CI [-39.61 to -11.91], p = 0.0005). Compared to the vehicle control, the 5% gel demonstrated efficacy in reducing both ASI (MD = -6.46, 95% CI [-9.70 to -3.23], p < 0.00001) and TLC (MD = -6.82, 95% CI [-11.67 to -1.98], p = 0.006).

CONCLUSION

This meta-analysis demonstrates that topical spironolactone is an effective and well-tolerated monotherapy for mild-to-moderate facial acne, with its efficacy varying by formulation and concentration. These findings provide clinicians with evidence-based insights for selecting alternative topical treatments. Future studies with larger sample sizes and longer follow-up are warranted to confirm these results.