Treatment of Acne Vulgaris by Topical Spironolactone Solution Compared With Clindamycin Solution

Abstract

Background: Acne vulgaris is a common skin problem that is encountered in daily clinical work, affecting mostly the adolescent and young adult age group. Many topical therapies have been used in the treatment of mild to moderate types of acne vulgaris. However, none of these modalities is uniformly effective; furthermore, acne vulgaris is also associated with relapse and many topical side effects.Objective: To compare the effectiveness and side effects of topical 2% spironolactone solution and 1.5% clindamycin solution in the treatment of mild to moderate acne vulgaris.Material and methods: This was a single-blinded therapeutic clinical comparative study conducted at the Dermatology Center at Medical City in Baghdad, Iraq, from April 2019 to March 2020. Sixty-eight patients with mild to moderate acne vulgaris on the face were included. All sociodemographic data related to the disease were recorded for each patient. Patients were divided into two groups according to the type of therapy: group A (35 patients) used 2% spironolactone solution and group B (33 patients) used 1.5% clindamycin solution. All cases in both groups were instructed to use the solutions twice a day for 12 weeks in the same manner. Patients were seen every two weeks to evaluate the response to therapy and to report any topical side effects; then, follow-up was carried out for one month after cessation of therapy to evaluate relapse.Results: Spironolactone solution significantly decreased comedone count (p < 0.0001), while the clindamycin solution had no effect on comedones. Although spironolactone was slower than clindamycin solution in reaching the maximum therapeutic effect, the reduction in papules was comparable to that of clindamycin, but it exhibited a greater reduction of pustules (p > 0.05) and the Acne Severity Index (ASI; p > 0.05). Patients in the spironolactone group were more satisfied than those in the clindamycin group. Only minimal local side effects were reported in both groups that did not require cessation of therapy.Conclusion: Spironolactone solution is an effective and well-tolerated topical treatment for mild to moderate acne vulgaris and is superior to clindamycin solution.

Role of topical spironolactone in the treatment of acne: A systematic review of clinical trials—Does this therapy open a path towards favorable outcomes?

“…Walton et al 19 did not have adequate data to assess the outcome. Afzali et al, Keladari et al, Naoimi et al, and Ayatollahi et al adequately reported their outcomes, but Walton et al did not have the available data for the reported results 15–19 . All five of the included studies had clear‐cut inclusion and exclusion criteria 15–19 .…”

“…Three of the included trials assessed the effects of topical spironolactone supplements on skin conditions including skin redness, sebum, moisture, dryness, sensitivity, melanin, elasticity, and pH levels among the individuals 15,18,19 . Only one study evaluated the patient satisfaction rate with topical spironolactone in comparison to placebo 16 …”

“…Out of the five trials included, only Naoimi et al 16 evaluated patient satisfaction in the case and control groups. In the case group treated with 2% spironolactone, 31 (88.6%) patients were fully satisfied, three (8.6%) patients were partially satisfied, and one (2.9%) patient was not satisfied 16 .…”

“…Currently, no single treatment has been specified as the standard therapy for acne and ongoing clinical trials are investigating potential agents that could serve as a breakthrough in the management of acne vulgaris. Recent evidence shows that spironolactone in topical form has similar efficacy as its oral form with comparatively fewer adverse events associated with its use 15–19 . Hence, our review aimed to investigate the efficacy of topical spironolactone based on improvements in inflammatory or noninflammatory lesions, skin changes, and patient satisfaction rate in the treatment of acne vulgaris.…”

Androgen Receptor Inhibitors in the Treatment of Acne Vulgaris: Efficacy and Safety Profiles of Clascoterone 1% Cream

“…In one small single-blinded study, topical spironolactone 2% solution was shown to significantly reduce comedone count compared to no effect on comedones by clindamycin. 14 Additionally, compared to clindamycin, the topical application of spironolactone resulted in a more significant reduction of patients’ Acne Severity Index (ASI). Similar results have been achieved in other clinical trials.…”