Spironolactone is antiandrogenic and 'all acne is hormonal,' says BWH acne expert John S. Barbieri, M.D., MBA | AAD 2026

Spironolactone is a potassium-sparing diuretic that is used alone or with other medications to treat hypertension, edema and other conditions. But it also has antiandrogenic effects that make it useful as a treatment for acne, says John S. Barbieri, M.D., MBA.

“All acne is hormonal whether you’re a 14-year-old boy or a 36-year-old woman,” says Barbieri, who is director of the Advanced Acne Therapeutics Clinic at Brigham and Women’s Hospital in Boston.

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 Managed Healthcare Executive (MHE) before the meeting.

In this segment of that interview, Barbieri explains why spironolactone is effective as an anti-acne treatment—and one of the main limitations for its use. Androgens, the male sex hormone, stimulates sebaceous glands in the skin, he says. “By decreasing the activity of the sebaceous gland, the oil gland in the skin, it [spironolactone] can lead to really great improvements in acne.”

“The challenge with spironolactone,” Barbieri continues, “is because it has these antiandrogen effects, we can really only use it in women with acne. But among women with acne, it's one of our more effective systemic treatments we have.”

Spironolactone seems to be as effective, if not more effective, in the long run than oral antibiotics, according to Barbieri, and using it instead of oral antibiotics means avoiding the risks associated with the overuse of antibiotics, including antibiotic resistance, and other problems associated with antibiotics, such as an increased risk of inflammatory bowel disease and certain cancers.

Historically, prescriptions for oral antibiotics outnumbered spironolactone by
5 to 1, Barbieri says. Now it is closer to 1 to 1.

Drospirenone, a progestin that can be used in combined oral contraceptives, is antiandrogenic, notes Barbieri, so the combined oral contraceptives that include drospirenone can have a helpful antiacne effect. Clascoterone, sold as topical cream under the brand name Winlevi, is antiandrogenic and can be used by men.