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• W2891439397 abstract "Spironolactone is a mineralocorticoid receptor antagonist used in the management of edema associated with liver cirrhosis, heart failure, nephrotic syndrome, and primary hyperaldosteronism. 1 PfizerAldactone (spironolactone) [prescribing information]. April 2018 Google Scholar It is also indicated for hypertension, although primarily prescribed in conjunction with other antihypertensives owing to its weak diuretic activity. Spironolactone has a steroid-like structure with an affinity for progesterone and androgen receptors, resulting in potential estrogenic adverse effects, such as gynecomastia, menstrual irregularities, and decreased libido. 2 Kim G.K. del Rosso J.Q. Oral spironolactone in post-teenage female patients with acne vulgaris practical considerations for the clinician based on current data and clinical experience. J Clin Aesthet Dermatol. 2012; 5: 37-50 PubMed Google Scholar It is a direct antagonist of the androgen receptor, which blocks androgens such as testosterone from binding to and activating the receptor. 3 Corvol P. Michaud A. Menard J. Freifeld M. Mahoudeau J. Antiandrogenic effect of spirolactone: mechanism of action. Endocrinology. 1975; 97: 52-58 Crossref PubMed Scopus (209) Google Scholar , 4 Toto R.T. Metabolic derangements associated with diuretic use: insulin resistance, dyslipidemia, hyperuricemia, and androgenic effects. in: Seldin D.W. Giebisch G.H. Diuretic Agents: Clinical Physiology and Pharmacology. Academic Press, San Diego, CA1997: 630-632 Crossref Google Scholar The antiandrogenic effects of spironolactone have been used off-label to effectively manage hirsutism in women with polycystic ovary syndrome and for the management of acne vulgaris in selected women. 2 Kim G.K. del Rosso J.Q. Oral spironolactone in post-teenage female patients with acne vulgaris practical considerations for the clinician based on current data and clinical experience. J Clin Aesthet Dermatol. 2012; 5: 37-50 PubMed Google Scholar , 5 Mimoto M.S. Oyler J.L. Davis A.M. Evaluation and treatment of hirsutism in premenopausal women. JAMA. 2018; 319: 1613-1614 Crossref PubMed Scopus (14) Google Scholar , 6 Martin K.A. Anderson R.R. Chang J.R. et al. Evaluation and treatment of hirsutism in premenopausal women: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab. 2018; 103: 1233-1257 Crossref PubMed Scopus (128) Google Scholar , 7 Sato K. Matsumoto D. Iizuka F. et al. Anti-androgenic therapy using oral spironolactone for acne vulgaris in Asians. Aesth Plast Surg. 2006; 30: 689-694 Crossref PubMed Scopus (42) Google Scholar , 8 Charny J.W. Choi J.K. James W.D. Spironolactone for the treatment of acne in women, a retrospective study of 110 patients. Int J Womens Dermatol. 2017; 3: 111-115 Crossref PubMed Scopus (36) Google Scholar Spironolactone may be used alternatively or adjunctively in women who are not responding to conventional therapy (e.g., retinoids or benzoyl peroxide) or in those who are unable to take oral isotretinoin. 2 Kim G.K. del Rosso J.Q. Oral spironolactone in post-teenage female patients with acne vulgaris practical considerations for the clinician based on current data and clinical experience. J Clin Aesthet Dermatol. 2012; 5: 37-50 PubMed Google Scholar Spironolactone in doses of 25 to 200 mg/day has been shown to inhibit sebaceous gland activity with noticeable reduction of acne papules within 4 to 8 weeks. Women with higher levels of circulating androgens are predisposed to increased sebum production, but spironolactone has also been effective in women without elevated serum androgens. This may be due to higher amounts of tissue-derived androgens, 3-alpha-androstanediol glucuronide and androsterone glucuronide, in some patients. 2 Kim G.K. del Rosso J.Q. Oral spironolactone in post-teenage female patients with acne vulgaris practical considerations for the clinician based on current data and clinical experience. J Clin Aesthet Dermatol. 2012; 5: 37-50 PubMed Google Scholar Common adverse reactions reported with the use of spironolactone during treatment for acne include hyperkalemia, irregular menstruation, urinary frequency, dizziness, headaches, nausea, vomiting, and breast tenderness. 8 Charny J.W. Choi J.K. James W.D. Spironolactone for the treatment of acne in women, a retrospective study of 110 patients. Int J Womens Dermatol. 2017; 3: 111-115 Crossref PubMed Scopus (36) Google Scholar The incidence of these adverse reactions is relatively low when doses of spironolactone are 25 to 50 mg/day but should be considered in the context of patient-specific risk factors. Gynecomastia and feminization, particularly in higher doses, may make spironolactone a less attractive option for men. 2 Kim G.K. del Rosso J.Q. Oral spironolactone in post-teenage female patients with acne vulgaris practical considerations for the clinician based on current data and clinical experience. J Clin Aesthet Dermatol. 2012; 5: 37-50 PubMed Google Scholar , 8 Charny J.W. Choi J.K. James W.D. Spironolactone for the treatment of acne in women, a retrospective study of 110 patients. Int J Womens Dermatol. 2017; 3: 111-115 Crossref PubMed Scopus (36) Google Scholar , 9 Hembree W.C. Cohen-Kettenis P.T. Gooren L. et al. Endocrine treatment of gender-dysphoric/gender-incongruent persons: an endocrine society clinical practice guideline. J Clin Endocrinol Metab. 2017; 102: 3869-3903 Crossref PubMed Scopus (974) Google Scholar Timothy R. Hudd, PharmD, AE-C, Associate Professor of Pharmacy Practice, Massachusetts College of Pharmacy and Health Sciences, Boston, MA Pirneeka Chugh, PharmD, BGB Group, New York, NY Kathy Zaiken, PharmD, Professor of Pharmacy Practice, Massachusetts College of Pharmacy and Health Sciences, Boston, MA" @default.
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• W2891439397 date "2018-11-01" @default.
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• W2891439397 title "A unique case of buffalo hump after prolonged use of spironolactone" @default.
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• W2891439397 doi "https://doi.org/10.1016/j.japh.2018.07.005" @default.
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