Non-Antibiotic Treatment for Women with Persistent Acne: Study

A team of researchers led by the University of Southampton has shown that spironolactone—a readily available drug used to treat high blood pressure—could help the thousands of women who suffer from persistent acne.

The SAFA study, funded by the National Institute for Health and Care Research (NIHR), is the first large-scale clinical trial to provide evidence that spironolactone is an effective treatment for the skin condition. The results of the trial were published in the British Medical Journal.

Almost a third of women who have acne in adolescence continue to be affected in adulthood. This can be a huge physical and psychological burden to those who suffer from persistent outbreaks. Topical treatments (creams and gels), available from a pharmacy or on prescription, are the first-line treatment for acne. They are effective for many people, but if they don’t work then GPs will often prescribe oral antibiotics to be used alongside the creams and gels. This can add to the growing burden of antibiotic resistance in the population, according to the researchers.

According to Professor Alison Layton from Harrogate and District NHS Foundation Trust and the Skin Research Centre at the University of York, and co-lead of the SAFA trial, spironolactone also reduces the main hormone that leads to the development of acne.

“However, previous studies of spironolactone for acne have been very small and there was no definitive proof that it actually worked,” Layton said.

“We hope the publication of these results will mean more GPs and dermatologists feel confident to prescribe spironolactone as a treatment for acne,” said Professor Miriam Santer, GP and Professor of Primary Care Research at the University of Southampton and co-lead of the trial.  “The drug is already included in treatment guidelines for persistent acne in the US and Europe, and we hope this trial will lead to a change in the UK guidelines.”

Trial Details

The SAFA trial recruited more than 400 women, aged over 18, with acne that had persisted for more than six months and where oral antibiotics would have normally been the next treatment. Half were randomly allocated to take spironolactone, while the other half were given a placebo. The women were asked to complete questionnaires on their acne and quality of life relating to the condition at the start of the trial and then at 12 and 24 weeks into their treatment.

“The results showed that the women taking spironolactone saw a significant improvement in their acne after 12 and 24 weeks compared to those on the placebo,” said Professor Santer. “A significantly higher proportion of people also reported that they felt satisfied that their skin had been helped compared with those receiving placebo, and any side effects were uncommon and very minor.These results show that spironolactone could offer an alternative to antibiotics for many women with persistent acne to use alongside topical acne treatments.”

The SAFA trial was run by the Southampton Clinical Trials Unit. It was funded by a Health Technology Assessment grant from the National Institute for Health and Care Research (NIHR) and was sponsored by the University of Southampton.