Efficacy and safety of oral spironolactone for female pattern hair loss in premenopausal women: a randomized, double-blind, placebo-controlled, parallel-group pilot study.

BACKGROUND

Oral spironolactone is widely used as an alternative treatment for female pattern hair loss, particularly in women of reproductive age. However, published data on its effects are still limited.

OBJECTIVE

This study aimed to evaluate the efficacy and safety of spironolactone 100 mg daily for female pattern hair loss in premenopausal women compared with placebo.

METHODS

Forty-eight women aged 21 to 45 years were randomly assigned to receive spironolactone 100 mg or matched placebo once daily for 24 weeks. Twice-daily minoxidil 3% solution was used for all to avoid untreated participants. Efficacy was assessed by changes in hair density and diameter using videodermoscopy and global photographic assessment.

RESULTS

After treatment, hair density and diameter increased significantly in both treatment groups (all P < 0.001). The spironolactone group showed a greater increase in changes from baseline of terminal hair counts (9.48 ± 11.25 vs 5.32 ± 6.81 hairs/cm2) and hair diameters (4.23 ± 4.58 vs 2.96 ± 2.84 μm), compared with the placebo group. However, only the P-value of terminal hair counts approached the cutoff of statistical significance (P = .063). The spironolactone group also showed greater moderate-to-marked improvement than the placebo group (38% vs 9%; P = .034). Adverse events, primarily menstrual irregularities (37.5%), were significantly higher in the spironolactone group.

LIMITATIONS: The sample size was small.

CONCLUSION

Oral spironolactone 100 mg daily for 24 weeks showed an additive effect on topical minoxidil therapy in premenopausal women with mild-to-moderate female pattern hair loss. Although it was generally well-tolerated, irregular menstruation was common.