P121 Spironolactone for the treatment of acne in women with skin of colour: a retrospective study

Abstract

Acne is a common inflammatory condition, yet a paucity of literature guides management in skin of colour (Fitzpatrick phototypes III–VI). Differences in presentation and sequelae, including higher rates of postinflammatory hyperpigmentation and scarring, should inform treatment. Oral spironolactone is an off-licence hormonal treatment for moderately severe acne in women; however, existing literature does not specifically address skin of colour. This study assesses the effectiveness and adverse effects of spironolactone in women of colour with acne. A retrospective analysis was conducted across a dual-site NHS trust from October 2023 to October 2025, including women with skin of colour aged ≥ 18 years taking spironolactone for acne. Data collected included prior treatments, baseline severity, comorbidities, treatment response, time to effect, adverse effects, potassium monitoring and reasons for discontinuation. The study included 41 patients aged 18–49 years. Spironolactone doses ranged from 25 to 150 mg. Twenty-six patients (63%) reported improvement, while five (12%) reported no improvement or worsening acne. Treatment effect was undocumented in four (10%), and six (15%) discontinued treatment before follow-up, following adverse effects. Time to improvement varied with severity: 1–2 months for mild, 1–8 months for moderate, and 3 months to 3 years for severe acne. During treatment, 15 patients (37%) reported adverse effects, predominantly menstrual irregularities, dizziness and breast tenderness. Baseline potassium was assessed in 31 patients (76%), with normal results. Follow-up potassium levels were monitored in 28 (68%). A single episode of hyperkalaemia occurred in three patients (7%), with one significant case in a 44-year-old taking mesalazine for ulcerative colitis with elevated baseline creatinine. Spironolactone can be effective for treating acne in women with skin of colour, with 63% reporting improvement. Acne severity influences time to improvement, an important consideration given increased risk of hyperpigmentation and scarring. Although potassium monitoring remains common practice, hyperkalaemia is rare. Accordingly, potassium monitoring should be guided by individual risk.