O06 Building the case for evidence-based guidance for spironolactone use in women with hidradenitis suppurativa: three UK studies triangulating prescribing across dermatology and primary care

Abstract

Hidradenitis suppurativa (HS) is a chronic inflammatory disease predominantly affecting women. Spironolactone is increasingly used off-licence in HS, extrapolated from acne data, yet formal guidance is lacking. Our aims were to characterize real-world prescribing, monitoring and perceptions of spironolactone use in women with HS across UK dermatology services and primary care, and to identify areas of variation supporting the need for evidence-based guidelines. Three complementary studies were undertaken. (i) A retrospective multicentre service evaluation across four UK tertiary dermatology centres reviewed spironolactone prescribing over 24 months. (ii) A national anonymized survey of UK dermatology clinicians was distributed via the UK Dermatology Clinical Trials Network and BAD. (iii) A pilot general practitioner survey explored confidence managing HS and spironolactone use in primary care. The service evaluation identified 62 female patients (median age 35 years). Baseline monitoring was inconsistent, with blood tests documented in 39% and blood pressure in 16%. Dosing of spironolactone varied widely (25–200 mg daily). Side effects were recorded in 13%, and treatment discontinuation in 21%. The national dermatology survey received 96 responses; 74 clinicians prescribed spironolactone for HS, most commonly as adjunctive therapy for mild-to-moderate disease. Starting doses of 50 mg were typical, with maximum doses of 150–200 mg. Monitoring and follow-up practices varied substantially. Notably, 89% of respondents supported a randomized clinical trial. The general practitioner survey (n = 19) demonstrated limited experience and confidence in HS management. While most respondents reported moderate confidence recognizing HS, only 16% had ever prescribed spironolactone for HS. Importantly, confidence in prescribing increased markedly when clear guidelines were assumed, with 68% reporting they would feel moderately or very confident under a structured protocol. Marked variation exists in spironolactone prescribing and monitoring across care settings. Dermatology and primary care clinicians express uncertainty but support robust clinical trial data, underscoring the urgent need for evidence-based national guidance.