Spironolactone safe and effective for treating acne in women, research confirms

22nd May 2023

Spironolactone is a cheap, safe and effective for treating women with acne that can also be used in the longer term, a large UK study has shown.

The randomised controlled trial of 410 women over the age of 18 years with mild, moderate and severe acne found a significant difference in both in quality of life and self-reported acne improvement compared with placebo.

Reporting the results in the BMJ, researchers from the University of Southampton said the NIHR-funded trial was the first to provide clinical evidence that spironolactone was effective for the skin condition.

Differences were seen by 12 weeks but were more marked and statistically significant by 24 weeks, they said.

By this time, the number needed to treat for participants to report improvement in the condition of their skin was five.

There did not seem to be a difference in effectiveness between women who had PCOS and those who did not, the researchers noted.

It could mean a change in the way the condition is treated including a reduction in the number of antibiotics prescribed, as currently recommended in UK guidelines when topical treatments have not worked, they concluded.

More frequent headaches was the only difference in adverse effects between the two groups who were started on 50 mg spironolactone or matched placebo, increasing to two tablets daily at six weeks if tolerated, which was the case for more than 95% of participants.

Two other trials underway are looking at higher starting doses of the treatment.

Questions relative effectiveness in comparison with other treatments, use in younger age groups and which subgroups benefit would be answered in other studies, the team added.

Spironolactone is ‘fantastic alternative’

A linked editorial said the women in the study had already heard about spironolactone as a possible treatment on social media and were keen to try it.

Study author Professor Miriam Santer, a GP and professor of primary care research at the University of Southampton, said spironolactone could provide a ‘fantastic alternative’ to oral antibiotics in women where topical treatments had not worked.

‘We hope the publication of these results will mean more GPs and dermatologists feel confident to prescribe spironolactone as a treatment for acne,’ she said. ‘The drug is already included in treatment guidelines for persistent acne in the US and Europe, and we hope this trial will lead to a change in the UK guidelines.’

Professor Alison Layton from Harrogate and District NHS Foundation Trust and the Skin Research Centre at the University of York, who also worked on the study, said dermatologists had been prescribing the drug for severe acne for some time.

‘This is a cheap medication which has been used for decades in the treatment of high blood pressure. The drug also reduces the main hormone that leads to the development of acne.

‘However, previous studies of spironolactone for acne have been very small and there was no definitive proof that it actually worked.’

Professor Andrew Farmer, director of NIHR’s Health Technology Assessment programme, said: ‘The findings from this important trial provide compelling evidence which could help thousands of women affected by persistent acne.

‘The treatment provides a valuable alternative to antibiotics and ensures clinicians can also better avoid the harms that can arise from antimicrobial resistance.’

A version of this story was originally published by our sister publication Pulse.

Screening endoscopy before 50 associated with reduced risk of CRC diagnosis in women

9th June 2022

Screening endoscopy in women under 50 significantly reduces the risk of a colorectal cancer diagnosis at age 55 according to a US study

The use of screening endoscopy in women before the age of 50 is associated with a 55% lower risk of being diagnosed with colorectal cancer (CRC) at age 55. This was the conclusion of a prospective cohort study of US women.

According to the International Agency for Research on Cancer, in 2020 there were almost 2 million colorectal cancer diagnoses and nearly one million deaths, making it the third most commonly diagnosed cancer type in the world.

Although incidence rates among those of screening age have decreased, data from the US shows that among individuals under 50 years of age, the incidence rate has increased by approximately 2% between 2011 and 2016.

According to the American Cancer Society, screening for CRC is associated with a significant reduction in CRC incidence and CRC-related mortality and have recommended that adults aged 45 years and older with an average risk of CRC should undergo regular screening.

Furthermore, long-term follow studies suggest that screening endoscopy is associated with a reduced colorectal-cancer mortality. Nevertheless, there are limited data on the value of screening endoscopy in younger patients.

For the present study, the US researchers used data in the Nurses’ Health Study II, primarily because participants in this prospective registry were aged 26 to 45 at enrolment and this therefore provided an opportunity to examine any potential associations between the age of screening endoscopy and the development of CRC.

Using 1991 as the baseline because this was the first year when questions about screening endoscopy were included, participants were asked in subsequent questionnaires if they had undergone sigmoidoscopy or colonoscopy in the past two years and the reason for this screening.

The primary endpoint was overall CRC incidence although the researchers included the incidence of younger-onset CRC (diagnosed before age 55) and CRC mortality as secondary outcomes.

Screening endoscopy and development of colorectal cancer

A total of 111,801 women with a median of 36 years at enrolment were included in the analysis and followed for 26 years, during which time 519 incident cases of CRC were documented. Compared to women who underwent screening endoscopy age 50 or later, those who underwent a screen before 45 years of age were more likely to have a family history of CRC.

When compared to women who did not undergo screening endoscopy, the adjusted hazard ratios (HRs) for any CRC were 0.37 (95% CI 0.26 – 0.53) for women aged under 45 years, 0.43 (95% CI 0.29 – 0.62) for those 45 to 49 years of age and 0.46 (95% CI 0.30 – 0.69) for those 55 years and older. Hence there was a significantly lower risk of incident CRC when screening was started before the age of 45.

The authors calculated that the absolute reduction in the estimated cumulative incidence of CRC up to age 60 was 72 per 100,00 people if screening endoscopy was started between the ages of 45 to 49 compared to being performed between the ages of 50 to 54.

The risk of being diagnosed with CRC at age 55 was 55% lower if screening was started before the age of 45 (HR = 0.45, 95% CI 0.29 – 0.70) and equally lower (HR = 0.43) when started between the ages of 45 and 49.

The authors concluded that earlier screening endoscopy (before 50 years of age) was associated with a significantly lower risk of both CRC and a diagnosis before age 55.

Citation
Ma W et al. Age at Initiation of Lower Gastrointestinal Endoscopy and Colorectal Cancer Risk Among US Women JAMA Oncol 2022

Non-traditional cardiovascular risk factors higher in women

1st September 2021

Swiss researchers have found that non-traditional risk factors for cardiovascular disease appear to affect women more than men.

According to research presented at the European Stroke Organisation Conference (ESOC), non-traditional risk factors for cardiovascular disease, appear to be increasing more in women than men. Researchers from the University of Zurich, Switzerland, turned to data contained in the Swiss Health Survey. This was established in 1981/82 and designed to provide data from a representative sample on a number of health-related issues such as perceived health status, use of health services and demand for health care. Information is collected every 5 years and since 2010, the data formed part of the Swiss population census. 

Using data obtained in 2007, 2012 and 2017 on 22,000 men and women, the researchers identified an increase in the number of women who reported non-traditional risk factors for cardiovascular disease. This change appeared to coincide with an increase in the proportion of women who reported working full-time, which had increased from 38% in 2007 to 44% by 2017. The data showed that the number of individuals reporting stress at work had risen from 59% in 2012 to 66% in 2017. Furthermore, the proportion reporting non-traditional factors such as being tired and fatigued had also increased from 23% to 29%, but had risen to 33% among women compared to 26% in men, with a slightly higher level of severe sleep disorders in women (8%) compared to men (5%).

Fortunately, the study observed that the more traditional cardiovascular disease risk factors had stabilised over the study period, with 27% having hypertension, 18% a raised cholesterol level and 5% diabetes. Nevertheless, while obesity had increased to 11%, the level of smoking had reduced slightly from 10.5 to 9.5 cigarettes per day though both obesity and levels of smoking were higher in men.

According to the study authors, Dr Martin Hänsel and Dr Susanne Wegener, “our study found men were more likely to smoke and be obese than women, but females reported a bigger increase in the non-traditional risk factors for heart attacks and strokes, such as work stress, sleep disorders, and feeling tired and fatigued.”

Reference

10-year trends in cardiovascular risk factors in Switzerland: non-traditional risk factors are on the rise in women more than in men. Presented at the European Stroke Organisation Conference, September 2021