Skip to main content
SpringerLink
Log in

Spironolacton in dermatologischen Behandlungen

„On-label-“ und Off-label-Indikationen

Spironolactone in dermatological treatment

On and off label indications

  • Leitthema
  • Published:
Der Hautarzt Aims and scope Submit manuscript

Zusammenfassung

Für Spironolacton sind bisher noch keine Indikationen durch die FDA/EMEA bestätigt worden. Dennoch wird es „off-label“ eingesetzt, unter anderem zur Behandlung von Akne und Haarausfall bei Frauen, Hidradenitis suppurativa und Hirsutismus. Dies liegt in seinem Wirkmechanismus begründet. Spironolacton beeinflusst die hormonkontrollierte Talg- und Schweißsekretion und androgenstimuliertes Haarwachstum. Die von Dermatologen empfohlene mittlere Tagesdosierung beträgt 50–100 mg. Schwangere und Stillende sollten Spironolacton nicht anwenden. Bei Männern ist der Einsatz aufgrund des Feminisierungsrisikos kontraindiziert. Obwohl weitere Studien zu Wirksamkeit und Sicherheit notwendig sind, wird Spironolacton als dermatologisch nützlicher Wirkstoff betrachtet.

Abstract

There are no currently FDA/EMEA- approved dermatologic indications for spironolactone and its off-label uses are, among others, female acne, female pattern hair loss, hidradenitis suppurativa or hirsutism. The rationale behind these relays on the mechanism of action of spironolactone which interferes with the hormone-controlled sebum and sweat gland secretion and with androgen stimulated hair growth. The average dose used by the dermatologits is 50–100 mg daily. It should not be used in pregnant and lactating women and it is not used in men due to the risk of feminization. Although further studies to assess its efficacy and safety are necessary, currently spironolactone is regarded as a useful tool in the dermatologic treatment armamentarium.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Literatur

  1. Macdonald F (1997) Dictionary of pharmacological agents. CRC, pp 1832–1833

  2. US Food and Drug administration Website (2013) http://www.fda.gov (Zugegriffen: 29.06.2013)

  3. Sawaya ME (2007) Antiandrogens and androgen inhibitors. In: Wolverton SE (ed) Comprehensive dermatologic drug therapy, 2nd edn. Elsevier, pp 417–435

  4. Vellacott ID, O’Brien PM (1987) Effect of spironolactone on premenstrual syndrome symptoms. J Reprod Med 32:429–434

    PubMed  CAS  Google Scholar 

  5. Young RL, Goldzieher JW, Elking-Hirsch K (1987) The endocrine effects of spironolactone used as an antiandrogen. Fertil Steril 48:223–228

    PubMed  CAS  Google Scholar 

  6. Beermann B, Gorschinsky-Grind M (1980) Clinical pharmacokinetic of diuretics. Clin Pharmacokinet 5:221–245

    Article  PubMed  CAS  Google Scholar 

  7. Wilson J (1996) Androgens. In: Hardman JG, Limbird LE, Molinoff PB et al (eds) Goodman & Gilman’s pharmacological basis of therapeutics, 9. edn. McGraw-Hill, New York, pp 1441–1457

  8. Chen W, Thiboutot D, Zouboulis CC (2002) Cutaneous androgen metabolism: basic research and clinical perspectives. J Invest Dermatol 119:992–1007

    Article  PubMed  CAS  Google Scholar 

  9. Choudhry R, Hodginns MB, Van Der Kwast TH et al (1992) Localisation of androgen receptors in human skin by immunohistochemistry: implications for the hormonal regulation of hair growth, sebaceous gland and sweat glands. J Endocrinol 133:467–475

    Article  PubMed  CAS  Google Scholar 

  10. Liang T, Hoyer S, Yu R et al (1993) Immunocytochemical localization of androgen receptors in human skin using monoclonal antibodies against the androgen receptor. J Invest Dermatol 100:663–666

    Article  PubMed  CAS  Google Scholar 

  11. Thigpen AE, Silver RI, Guileyardo JM et al (1993) Tissue distribution and ontogeny of steroid 5α-reductase isoenzyme expression. J Clin Invest 91:101–105

    Google Scholar 

  12. Thiboutot D, Harris G, Iles V et al (1995) Activity of the type 1,5α-reductase activity exhibits regional differences in isolated sebaceous glands of whole skin. J Invest Dermatol 105:2019–2214

    Article  Google Scholar 

  13. Imperato-McGinley J, Gautier T, Cai LQ et al (1993) The androgen control of sebum production. Studies of subjects with dihydrotestosterone deficiency and complete androgen insensitivity. J Clin Endocrinol Metab 76:524–528

    Article  PubMed  CAS  Google Scholar 

  14. Imperato-McGinley J, Miller M, Wilson JD et al (1992) A cluster of male pseudohermaphrodites with 5α-reductase deficiency in Papua New Guinea. Clin Endocrinol (Oxf) 34:293–298

    Google Scholar 

  15. Akamatsu H, Zouboulis CC, Orfanos CE (1992) Control of human sebocyte proliferation in vitro by testosterone and 5-alpha-dihydrotestosterone is dependent on the localization of the sebaceous gland. J Invest Dermatol 99:509–511

    Article  PubMed  CAS  Google Scholar 

  16. Duffy DM, Legros RS, Chang L et al (1995) Metabolism of dihydrotestosterone to 5α-androstane-3α,17β-diol glucuronide is greater in the peripheral compartment then in the splanchnic compartment. Fertil Steril 64:736–739

    PubMed  CAS  Google Scholar 

  17. Im S, Lee ES, Kim W et al (2000) Expression of progesterone receptor on human keratinocytes. J Korean Med Sci 15:647–654

    PubMed  CAS  Google Scholar 

  18. Layton AM (2010) Disorders of the sebaceous glands. In: Burns T, Breathnach S, Cox N et al (eds) Rook’s textbook of dermatology, 8th edn. Wiley-Blackwell, ch 42.9

  19. Hay RJ, Adriaans BM (2010) Bacterial infections. In: Burns T, Breathnach S, Cox N et al (eds) Rook’s textbook of dermatology, 8th edn. Wiley-Blackwell, pp ch 30.77–30.79

  20. Messenger AG, Berker DAR de, Siclair RD (2010) Disorders of hair. In: Burns T, Breathnach S, Cox N et al (eds) Rook’s textbook of dermatology, 8th edn. Wiley-Blackwell, ch 66.13

  21. Brown J, Farquhar C, Lee O et al (2009) Spironolactone versus placebo or in combination with steroids for hirsutism and/or acne. Cochrane Data Base Syst Rev 2:CD000194

    Google Scholar 

  22. Strauss JS, Krowchuk DP, Leyden JJ et al (2007) Guidelines of care for acne vurgaris management. J Am Acad Dermatol 56:651–663

    Article  PubMed  Google Scholar 

  23. Nast A, Dreno B, Bettoli V et al (2012) European evidence-based (S3) Guidelines for the treatment of acne. J Eur Acad Dermatol Venereol 26(Suppl 1):1–29

    Article  PubMed  Google Scholar 

  24. Preneau S, Dreno B (2012) Female acne—a different subtype of teenager acne? J Am Acad Dermatol Venereol 26:277–282

    Article  CAS  Google Scholar 

  25. Chiu HY, Tsai TF (2011) Topical use of systemic drugs in dermatology: a comprehensive review. J Am Acad Dermatol 65:1048.e1–e22

    Article  PubMed  Google Scholar 

  26. Farqhar C, Lee O, Toomath R et al (2003) Spironolactone versus placebo or in combination with steroids for hirsutism and/or acne. Cochrane database syst rev: CD000194

    Google Scholar 

  27. Messenger AG, De Berker DA, Sinclair RD (2010) Disorders of hair. In: Burns T, Breathnach S, Cox N et al (eds) Rook’s textbook of dermatology, 8th edn. Wiley-Blackwell, ch 66.80

  28. Olsen EA, Messenger AG, Shapiro J et al (2005) Evaluation and treatment of male and female pattern hair loss. J Am Acad Dermatol 52:301–311

    Article  PubMed  Google Scholar 

  29. Sinclair R, Patel M, Dawson TL Jr et al (2011) Hair loss in women: medical and cosmetic approaches to increase scalp hair fullness. Br J Dermatol 165 (Suppl 3):12–18

    Article  PubMed  CAS  Google Scholar 

  30. Yazdabadi A, Green J, Sinclair R (2009) Successful treatment of female-pattern hair loss with spironolactone in a 9-year-old girl. Australas J Dermatol 50:113–114

    Article  PubMed  Google Scholar 

  31. Saha L, Kaur S, Saha PK (2012) Pharmacotherapy of polycystic ovary syndrome—an update. Fundam Clin Pharmacol 26:54–62

    Article  PubMed  CAS  Google Scholar 

  32. Alhusayen R, Shear NH (2012) Pharmacologic interventions for hidradenitis suppurativa: What does the evidence say? Am J Clin Dermatol 13:283–291

    Article  PubMed  Google Scholar 

  33. Mitts TF, Bunda SF, Wang Y, Hinek A (2010) Aldosterone and mineralocorticoid receptor antagonists modulate elastin and collagen deposition in human skin. J Invest Dermatol 130:2396–2406

    Article  PubMed  CAS  Google Scholar 

  34. Greenberg A (2000) Diuretic complications. Am J Med Sci 319:10–24

    Article  PubMed  CAS  Google Scholar 

  35. Cumming DC (1990) Use of spironolactone in treatment of hirsutism. Cleve Clin J Med 57:285–287

    Article  PubMed  CAS  Google Scholar 

  36. Danielson DA, Jick H, Hunter JR et al (1982) Nonestrogenic drugs and breast cancer. Am J Epidemiol 116:329–332

    PubMed  CAS  Google Scholar 

  37. Tayler KH, Zirwas MJ (2013) Pregnancy and dermatologic therapy. J Am Acad Dermatol 68:663–671

    Article  Google Scholar 

  38. Katz HI (1998) Guide to adverse treatment interaction for skin, hair and nail disorders. Lippincott-Raven, Philadelphia, pp 160–161

Download references

Einhaltung ethischer Richtlinien

Interessenkonflikt. C.M. Salavastru, K. Fritz und G.S. Tiplica geben an, dass kein Interessenkonflikt besteht. Dieser Beitrag beinhaltet keine Studien an Menschen oder Tieren.

Author information

Authors and Affiliations

  1. 2nd Clinic of Dermatology, “Colentina” Clinical Hospital, Bucharest, Romania

    C.M. Salavastru & G.S. Tiplica

  2. “Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania

    C.M. Salavastru, K. Fritz & G.S. Tiplica

  3. Hautärzte und Laserzentrum, Landau, Deutschland

    K. Fritz

Authors
  1. C.M. Salavastru
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. K. Fritz
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. G.S. Tiplica
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to C.M. Salavastru.

Zusatzmaterial online

Rights and permissions

Reprints and permissions

About this article

Cite this article

Salavastru, C., Fritz, K. & Tiplica, G. Spironolacton in dermatologischen Behandlungen. Hautarzt 64, 762–767 (2013). https://doi.org/10.1007/s00105-013-2597-y

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00105-013-2597-y

Schlüsselwörter

Keywords

Search

Navigation