How does the hormone spironolactone work to treat acne?

Spironolactone functions as both an androgen receptor blocker and possibly also an inhibitor of 5-alpha-reductase type 1. In doses of 50-100 mg/day, it has been shown to reduce sebum production and improve acne. In countries such as the United States with no effective anti-androgenic medications, spironolactone may be used for women with therapy-resistant acne, although it has not been formally approved for this condition.

In one study looking at spironolactone therapy in acne, one-third of the patients had complete clearing of their acne, one-third had marked improvement, and nearly one-third showed partial improvement, with less than 10% showing no improvement of their acne.

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