PA14 Spironolactone for the treatment of acne vulgaris affecting female patients aged 18 years and under: results from a UK and Irish survey

Abstract Acne vulgaris (acne) is a common condition that causes psychological and social morbidity, with peak prevalence from 15 to 20 years (Layton AM, Ravenscroft J. Adolescent acne vulgaris: current and emerging treatments. Lancet Child Adolesc Health 2023; 7: 136–44). Spironolactone is effective for acne in adult women [Santer M, Lawrence M, Renz S et al. Effectiveness of spironolactone for women with acne vulgaris (SAFA) in England and Wales: pragmatic, multicentre, phase 3, double blind, randomised controlled trial. BMJ 2023; 381: e074349]. Our aim was to establish current practice of healthcare practitioners prescribing spironolactone for adult women and those aged < 18 years, and to determine safety concerns to inform a future clinical trial. A 39-question survey was sent to dermatology healthcare professionals through the UK Dermatology Clinical Trials Network (UKDCTN), the British Society for Paediatric and Adolescent Dermatologists (BSPAD), the Irish Association of Dermatologists (IAD) and regional groups. It was open for 6 weeks (December 2024 to January 2025). In total, 116 responses were received from doctors, nurses and pharmacists (82% from the UK and 18% from the Republic of Ireland). Of these, 66% had > 6 years of clinical experience treating skin conditions in patients aged ≤ 18 years. Of the 91% who had prescribed spironolactone for adult women nearly all found it effective (61% somewhat effective, 37% very effective). Prescribing uncertainties for adult patients include duration (48%), weaning and stopping (44%), monitoring requirements (28%) and dose (21%). Over one-third (n = 43, 37%) had prescribed spironolactone for female patients aged ≤ 18 years, almost exclusively for adolescents aged > 11 years (98%). Dosing, baseline blood tests, monitoring renal function, and uptitrating the dose varied. Nearly half (44%) prescribed 50 mg once daily, with most (72%) uptitrating the dose. Overall, 70% check baseline bloods and 60% monitor bloods. Advice provided regarding contraception varied. Safety concerns among those prescribing for patients aged < 18 years included teratogenicity. Of those prescribing for patients aged < 18 years, 5% described spironolactone as not at all effective, 59% slightly or moderately effective, and 14% very or extremely effective, while 5% were unsure. Side-effects reported included postural hypotension, headaches, menstrual irregularities and polyuria. Nearly all thought it would be helpful to investigate spironolactone use for female patients aged ≤ 18 years (92%, 105 of 114). This survey shows variation in clinical practice treating acne with spironolactone. Nearly all respondents reported some effectiveness in adults, but there was less certainty in those aged ≤ 18 years, although the number of respondents was smaller. The main safety concerns were regarding fertility, teratogenicity, hormonal implications and lack of long-term data. L.O. and Z.M. are first coauthors.