A generic high blood pressure drug has become the most commonly prescribed oral medication to treat acne in women, overtaking antibiotics and birth control pills, a new report from Epic Research shows.
The report, conducted on behalf of NBC News, found that spironolactone made up 47% of all oral medications prescribed to women for acne in 2023, up from 27% in 2017. Prescriptions for oral antibiotics — previously the go-to pill for acne — decreased from 41% to 27% in the same time period.
The shift is likely driven in part by the American Academy of Dermatology’s call to limit the use of antibiotics when possible, according to Dr. John Barbieri, a dermatologist and epidemiologist at Brigham and Women’s Hospital in Boston. Those prescribing guidelines, which Barbieri helped write, have encouraged dermatologists since at least 2016 to limit prescribing antibiotics in an attempt to combat drug resistance.
“There’s been more interest in antibiotic stewardship over the past few decades than prior to that, so I think those trends have helped to spur these shifts,” Barbieri said.
Antibiotics including doxycycline have long been prescribed for acne. They work by targeting acne-causing bacteria and decreasing inflammation, though they can come with side effects including increased sensitivity to the sun and gastrointestinal issues.
Barbieri said that “the growing evidence supporting the safety and effectiveness of spironolactone,” which is used off-label, has also likely contributed to the rising prescribing rates.
While the drug was approved as a high blood pressure medication in 1960, it was in the 1980s that some doctors began prescribing it to women for acne.
Dr. Jessica Krant, a dermatologist at Laser and Skin Surgery Center of New York, said that she prescribes spironolactone more now than she used to.
“The more years we go on with it out in the market, and everybody being generally OK with it, the more comfortable I get prescribing it,” Krant said.
Dr. Patricia Oyetakin, a dermatologist at Medical Dermatology Specialists in Atlanta, is among a younger generation of doctors who learned about spironolactone in medical school.
“If it’s hormonal acne, I will always have the conversation about spironolactone,” she said. That patient, Oyetakin said, is typically “still having her menstrual cycles, late 20s and onwards in age and having the hormonal pattern acne.”
Hormonal acne appears on the lower face, chin, jawline and neck, she said.
“You know you’re dealing with the testosterone or androgen receptors in the skin and in the glands, the active ingredient has to be something that addresses specifically that hormone,” she added.
Spironolactone works by blocking these hormones, which can clog pores and cause acne by increasing oil production in the skin.
Birth control pills can also be an effective treatment for this type of acne, and indeed, can be prescribed by dermatologists for this reason. However, prescriptions of birth control for acne also fell from 2017 to 2023, Epic Research found.
That change may be the result of women choosing other means of contraception. Oyetakin, Barbieri and Krant all said they have patients who have switched to intrauterine devices, or IUDs, which means that even if they’d previously been taking a birth control pill for acne, they’d have to stop.
“We do know that over time, IUD rates have gone up over the last two decades,” said Dr. Deborah Bartz, who is an obstetrician-gynecologist at Brigham and Women’s Hospital.
That change could be another reason spironolactone use has gone up.
When patients make the switch from oral contraceptives to another form, they may develop acne, especially on areas of the body they hadn’t before, Krant said. “Some of them do definitely break out more with those hormonal IUDs,” she added.
“There are a lot of people who just taking a birth control pill for contraception were treating their acne, and now if they’re using other forms of contraception, they might be more likely to develop acne or have acne that’s harder to control,” Barbieri said. Those patients may then need an additional medication, like spironolactone, to treat that acne, he added.
