Oral and Topical Spironolactone in Adult Female Acne: A Narrative Review Comparing Systemic and Local Approaches

Background

Adult female acne (AFA) affects 12-45% of women over 25 years of age and is frequently resistant to conventional therapies. The antiandrogenic properties of spironolactone have positioned it as a promising non-antibiotic alternative. While oral spironolactone has been increasingly studied, its topical formulation remains comparatively underexplored, and recent evidence syntheses have generally pooled both routes of administration rather than comparing them within a framework specific to AFA.