Dermatología en Costa Rica: Spironolactone for Treatment of Female Pattern Hair Loss Journal of the American Academy of Dermatology

TAKE-HOME MESSAGE

In this retrospective observational study, 79 women with female pattern hair loss (FPHL) were treated with oral spironolactone as monotherapy or in combination with topical minoxidil, low-level laser light device, or iron supplementation. At an average dose of 100 mg daily for a minimum of 6 months, all patients maintained or improved their initial Sinclair score (SS). Improvement in SS was correlated with severity of FPHL (R, 0.96). On average, an initial SS of 1.5 to 2.0 increased by 0.32, an initial SS of 2.5 to 3.0 increased by 0.93, and an initial SS of 3.5 to 4.0 increased by 1.19. Of the 45 patients who used spironolactone for >6 months, 64% had their best response at 1 year or longer. The most commonly reported side effect was dizziness/lightheadedness (17%), with some patients requiring spironolactone dose reduction (14%) or discontinuation (4%).

Spironolactone may be effective in FPHL, with the most efficacy in patients with an initial SS of 2.5 or higher. Duration of treatment also impacts efficacy, as approximately two-thirds of patients had their best response after a year of treatment. Patients should be counseled about potential side effects and dose adjustments to be made when needed.

– Margaret Hammond, MD

Written by: Paradi Mirmirani MD

Spironolactone, a weak androgen receptor inhibitor, has worked its way into the therapeutic ladder for female pattern hair loss (FPHL) despite a lack of high-level, evidence-based data. In my practice, if a woman with FPHL is postmenopausal or not desirous of pregnancy, I consider finasteride as a first-line oral treatment because of its more specific mechanism of action and more favorable side-effect profile. However, are there certain situations in which spironolactone should be the first choice for oral treatment? This retrospective observational study has a number of limitations, which in some ways, raise more questions than the study answers. Specifically, the heterogeneity of the patient population and the treatment regimens make it difficult to determine whether there is a specific subset of patients who would benefit from spironolactone.

Nevertheless, the population in this study mirrors the real-world situation in which we practice, and there are some take-home points that can be useful for the physician. First, you don't need a high dose. The average dose of spironolactone in this study was 100 mg daily, so higher doses of 200 mg per day reported in other studies may not be needed. Because 14% of the patients required a dose reduction due to side effects, one should be mindful of staying on the lower end of the dosing regimen. Second, don't lose hope. Patients who had more severe hair loss noted greater benefits with their treatment regimen. Lastly, it can take a while. Of the patients who were on spironolactone longer than 6 months, the majority showed their best response at 1 year of use or longer.

Abstract

Female pattern hair loss (FPHL) is the most common form of alopecia in females. Currently, topical minoxidil is the only FDA approved treatment, however the systemic agent spironolactone is prescribed off-label despite few, physician-reported outcome studies supporting its efficacy in FPHL1,2.

Journal of the American Academy of Dermatology