Concerns about spironolactone as an acne treatment ease, says BWH acne expert John S. Barbieri, M.D.,MBA | AAD 2026

Spironolactone is not a new medication, but it has been fairly slow to catch on as a treatment for acne.

In an interview with Managed Healthcare Executive (MHE), John S. Barbieri, director of the Advanced Acne Therapeutics Clinic at Brigham and Women’s Hospital in Boston, spoke about some of the possible explanations for the relatively slow update of spironolactone. Barbieri gave an update on spironolactone as an acne treatment this morning at the 2026 American Academy of Dermatology Annual Meeting in Denver. He spoke with MHE before the meeting.

Lack of large studies of spironolactone is one reason, Barbieri says. “There were certainly people who were using it based on anecdotal experience, but we didn't have some of the larger studies like we have with oral antibiotics. So I think evidence base is certainly part of it,” he says.

Another factor was worry that spironolactone would increase the risk of hyperkalemia because it is a potassium-sparing diuretic, Barbier said. Physician and patients have been advised to have blood potassium levels monitored. But a number of studies have found the risk to be negligible.

“The risk of hyperkalemia is so low that there may be limited usefulness to this kind of monitoring,” says Barbieri. “And I think reducing that potential need for monitoring makes the medicine less concerning to potential patients who might want to take it. It also makes it easier logistically for people.”

Barbieri cautioned, though, that potassium monitoring may still be warranted in older individuals because kidney function declines with ages. There are also certain medications, such as ACE inhibitors, that increase the risk of hyperkalemia.

Lingering concerns that spironolactone might be associated with increased risk of certain cancers have been assuaged by studies showing no such risk, Barbieri said. Meanwhile, data from observational studies have shown that oral antibiotics, an alternative to spironolactone, are associated with an increased risk of colon cancer.

“As we've gained data about the efficacy from these clinical trials, more information about the limited usefulness of potassium monitoring and more data to reassure us about other potential risks and side effects like cancer, I think that has enabled people to use spironolactone more often for acne,” observes Barbieri.