TABLE 1.

Potential indications for oral spironolactone in post-teenage female patients with acne vulgaris^* 20, 22–27

POTENTIAL INDICATIONS WHERE ORAL SPIRONOLACTONE THERAPY CAN BE CONSIDERED IN WOMEN WITH POST-TEENAGE ACNE VULGARIS
Women with acne flares that cycle with menstruation
Women on oral contraceptives or wanting to be on oral contraceptives who exhibit moderate-to-severe acne vulgaris (AV), especially with a “hormonal pattern” clinically (see text)
Women not responding to conventional therapy and not wanting to use oral isotretinoin or who are not candidates for oral isotretinoin
Women with late-onset AV, or persistent-recurrent AV past the teenage years, even in the absence of clinical signs of hyperandrogenism and with normal results of hormonal level testing
Women with late-onset AV (acne tarda) or sudden onset of AV
Clinical signs of hyperandrogenism, such as hirsutism, androgenic alopecia, and/or increased sebum production with AV

^*These are suggested indications where use of oral spironolactone may be considered as a therapeutic option. However, it is important that each patient be evaluated fully to determine the applicability of this option and to exclude any reasons why spironolactone would not be a good choice (i.e., past medical history, possible drug interactions), at least without proper monitoring or further evaluation.