Magan Medical Clinic, Dermatology
We provide quality dermatology care with compassion. Our specialty is medical dermatology, including:
Note: Cosmetic treatments are not performed in Dermatology but instead by Magan’s Medical Aesthetics Laser Center.
If you have psoriasis or hair questions, Dr. Chiang possesses special expertise. He completed fellowships in both fields at University of California, San Francisco where he saw a wide spectrum of patients (including the most severe), performed clinical trials, and published research.
We take pleasure in serving our community including Covina, West Covina, San Dimas, Rancho Cucamonga, Baldwin Park, Azusa, Glendora, Upland, El Monte, Duarte, Monrovia, Arcadia, La Puente, and Diamond Bar.
Same day appointments often available. No referral is necessary if you have PPO insurance. We accept a wide range of insurance plans (unfortunately, we do not accept Medi-Cal as primary insurance, only as secondary insurance).
For appointments, please call (626) 331-6411. We look forward to serving you!
"What’s New in..."
A monthly column by Dr. Chiang
What's New in Acne
Spironolactone is a medication I sometimes use for healthy females who are practicing effective birth control with moderate to severe acne that has failed standard first line therapy (usually topicals and/or oral antibiotics). This medication is used in other specialties for its diuretic properties (it makes you pee more, thus lowering blood pressure). However, for acne, it has antiandrogen properties.
Limitations include that it is not FDA approved for acne. It may cause birth defects, by blocking testosterone esp for a male fetus. Thus, concurrent 100% adherence to birth control pills possibly in conjunction with condom usage or an IUD is preferred (I do not prescribe these, patients will need to see their primary care doctor or Ob/Gyn). If not, strict adherence to effective birth control measures is mandatory, ie. 100% adherence to condoms for the complete duration of all intercourse. If birth control pills or an IUD is not used, monthly laboratory pregnancy testing is likely mandatory. Laboratory pregnancy testing is primarily used both because it usually detects pregnancy sooner and more reliably than OTC methods, but also for medicolegal reasons. While no one wishes to take any risk to a baby, the risk “occurs approximately six weeks post-conception, and if inadvertent administration is discontinued at an early state, the potential risk to the male fetus is negligible.” Thus, a monthly pregnancy test will help decrease the risk a male fetus is exposed too long to the medication.
There is potential for cancer, specifically estrogen-dependent malignancies such as breast cancer. The package insert has a warning that tumors were found in rats given ~25-250 times the usual human dose (on a body weight basis). Thus, patients with a family history of breast cancer or worry about the risk of breast cancer may wish to avoid this medication. That being said, in a 8 year follow-up study, there were zero cases of breast cancer out of 91 patients (although 4 patients underwent biopsies with benign outcomes).
Common side effects include increased urination, irregular periods, and breast tenderness.
In addition, it can elevate potassium levels (hyperkalemia) which is a potentially serious adverse effect. This can lead to heart issues, muscle cramps, and/or weakness. Traditionally, potassium levels are checked at baseline, after 1 month of medication, and with any increase in dosage. This is despite this side effect being rare. However, a recent chart review by Dr. Plovanich found no practical potassium elevation in 974 healthy young women taking spironolactone. Healthy was defined as no heart issues, no kidney issues, and no medications with potential for interaction. Young was defined as 18 to 45 years, but on average 27 years. The rate of elevated potassium values was the same as the general population rate (0.72% in treated vs 0.76 in the untreated population). Of the 13 elevated values, 6 were normal on re-testing and no action was taken by the clinician in the remaining 7 (indicating it was not clinically significant). Thus, the conclusion was “routine potassium monitoring is unnecessary for healthy young women taking spironolactone for acne.”
For my summary, I’d say spironolactone is acne medication to be considered for healthy females who accept the risks. I’ve never been a huge fan of the medication, but some of my patients find it quite helpful. It is not the strongest medication as isotretinoin (Accutane) is clearly more effective with longer lasting results, but some patients prefer not to take isotretinoin for various reasons. Many patients dislike the frequent laboratory testing for spironolactone and overall the evidence would make me willing to decrease or not perform laboratory testing for patients who understand that many physicians would still recommend laboratory testing (partially due to the FDA recommendation for laboratory testing), are on a birth control pill (ideally with condom usage as well) or a IUD, and that they accept the risk of side effects.
If you have acne or other skin issues, please make an appointment for dermatology consultation at (626) 331-6411 to discuss your options.
Charles Chiang, MD, FAAD
- Plovanich M, et al. Low Usefulness of Potassium Monitoring Among Healthy Young Women Taking Spironolactone for Acne. JAMA Dermatol 2015
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