Eficacia de la espironolactona en el tratamiento del acné vulgar. Una revisión sistemática
Resumen
Objetivo: Analizar la eficacia de la terapia con espironolactona en el tratamiento del acné vulgar reportada desde 1980 hasta Marzo del 2021. Métodos: Se realizó una búsqueda en las siguientes bases de datos: Scopus, PubMed, Embase, Science direct, Cochrane Library y Google Scholar, se seleccionaron aquellos artículos que reportaron el seguimiento de pacientes con Acné Vulgaris tratados con espironolactona. Tres revisores evaluaron la calidad metodológica mediante la “Mixed Methods Appraisal Tool” (MMAT), versión 2018. Resultados: Se seleccionaron 15 artículos con tratamientos acompañantes, comparativos o ambos y cinco artículos con monoterapia de espironolactona que no se complementaban ni comparaban. Se reportó una eficacia variable en los 20 artículos que fueron seleccionados. Las cinco reacciones adversas con mayor frecuencia en los estudios analizados fueron: alteraciones menstruales, hiperkalemia, pigmentación localizada en el sitio del tratamiento, mareos y fatiga. Conclusiones: Considerar que aún con la diversidad de tipos de estudios, se reporta un gran porcentaje de disminución del acné, por lo tanto, las evidencias indican que el tratamiento podría ser eficaz bajo condiciones controladas.
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Heng AHS, Chew FT. Systematic review of the epidemiology of acne vulgaris. Sci Rep. 2020;10(1):5754.
Schäfer T, Nienhaus A, Vieluf D, Berger J, Ring J. Epidemiology of acne in the general population: the risk of smoking. Br J Dermatol. 2001;145(1):100-4.
Bagatin E, Timpano DL, Guadanhim LR dos S, Nogueira VMA, Terzian LR, Steiner D, et al. Acne vulgaris: prevalence and clinical forms in adolescents from São Paulo, Brazil. An Bras Dermatol. 2014;89(3):428-35.
Bhate K, Williams HC. Epidemiology of acne vulgaris: Epidemiology of acne vulgaris. Br J Dermatol. 2013;168(3):474-85.
Janani S, Sureshkumar RA. Comprehensive Review on Acne, its Pathogenesis, Treatment, In-Vitro and In-Vivo Models for Induction and Evaluation Methods. Int J Pharm Sci. 2019; 10(7): 3155-77.
Law MPM, Chuh AAT, Lee A, Molinari N. Acne prevalence and beyond: acne disability and its predictive factors among Chinese late adolescents in Hong Kong: Acne disability and its predictive factors among Chinese late adolescents. Clin Exp Dermatol. 2010;35(1):16-21.
Agüero de Zaputovich F, Samudio M. Características clínicas y epidemiológicas de pacientes que consultan por acné. Mem Inst Investig Cienc Salud. 2015;13(1):7-16.
White GM. Recent findings in the epidemiologic evidence, classification, and subtypes of acne vulgaris. J Am Acad Dermatol. 1998;39(2):34–7.
Krowchuk DP. Managing acne in adolescents. Pediatr Clin North Am. 2000;47(4):841-57.
Collier CN, Harper JC, Cafardi JA, Cantrell WC, Wang W, Foster KW, et al. The prevalence of acne in adults 20 years and older. J Am Acad Dermatol. 2008;58(1):56-9.
Zaenglein AL, Pathy AL, Schlosser BJ, Alikhan A. Guidelines of care for the management of acne vulgaris. J Am Acad Dermatol. 2016;74(5):945-73.
Shaw JC. Acne: effect of hormones on pathogenesis and management. American Journal of Clinical Dermatology. Am J Clin Dermatol. 2002;3(8):571-8.
Strauss JS, Krowchuk DP, Leyden JJ, Lucky AW, Shalita AR, Siegfried EC, et al. Guidelines of care for acne vulgaris management. J Am Acad Dermatol. 2007;56(4):651-63.
Mills OH, Kligman AM, Pochi P, Comite H. Comparing 2.5%, 5%, and 10% benzoyl peroxide on inflammatory acne vulgaris. Int J Dermatol. 1986;25(10):664-7.
Leyden JJ, Hickman JG, Jarratt MT, Stewart DM, Levy SF. The efficacy and safety of a combination benzoyl peroxide/ clindamycin topical gel compared with benzoyl peroxide alone and a benzoyl peroxide/erythromycin combination product. J Cutan Med Surg. 2001; 5:37-42.
Armanini D, Andrisani A, Bordin L, Sabbadin C. Spironolactone in the treatment of polycystic ovary syndrome. Expert Opinion on Pharmacotherapy. 2016;17(13):1713-5.
Menard RH, Guenthner TM, Kon H, Gillette JR. Studies on the destruction of adrenal and testicular cytochrome P-450 by spironolactone. Requirement for the 7alpha-thio group and evidence for the loss of the heme and apoproteins of cytochrome P-450. J Biol Chem. 1979;254(5):1726-33.
Azarchi S, Bienenfeld A, Lo Sicco K, Marchbein S, Shapiro J, Nagler AR. Androgens in women. J Am Acad Dermatol. 2019;80(6):1509-21.
Moher D, Liberati A, Tetzlaff J, Altman DG, PRISMA Group. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS Med. 2009;6(7):e1000097.
Goodfellow A, Alaghband-Zadeh J, Carter G, Cream JJ, Holland S, Scully J, et al. Oral spironolactone improves acne vulgaris and reduces sebum excretion. Br J Dermatol. 1984;111(2):209-14.
Afzali BM, Yaghoobi E, Yaghoobi R, Bagherani N, Dabbagh MA. Comparison of the efficacy of 5% topical spironolactone gel and placebo in the treatment of mild and moderate acne vulgaris: a randomized controlled trial. J Dermatolog Treat. 2012;23(1):21-5.
Barbieri JS, Choi JK, Mitra N, Margolis DJ. Frequency of treatment switching for spironolactone compared to oral tetracycline-class antibiotics for women with acne: A retrospective cohort study 2010-2016. J Drugs Dermatol. 2018;17(6):632-8.
Krunic A, Ciurea A, Scheman A. Efficacy and tolerance of acne treatment using both spironolactone and a combined contraceptive containing drospirenone. J Am Acad Dermatol. 2008;58(1):60-2.
Muhlemann MF, Carter GD, Cream JJ, Wise P. Oral spironolactone: an effective treatment for acne vulgaris in women. Br J Dermatol. 1986;115(2):227-32.
Patiyasikunt M, Chancheewa B, Asawanonda P, Noppakun N, Kumtornrut C. Efficacy and tolerability of low‐dose spironolactone and topical benzoyl peroxide in adult female acne: A randomized, double‐blind, placebo‐controlled trial. J Dermatol. 2020;47(12):1411-6.
Cusan L, Dupont A, Gomez J-L, Tremblay RR, Labrie F. Comparison of flutamide and spironolactone in the treatment of hirsutism: a randomized controlled trial. Fertil Steril. 1994;61(2):281-7.
Kriplani A, Thulkar J, Agrawal N, Kulshrestha V, Ammini AC, Kumar G. A comparative study of Díane-35 plus spironolactone and Díane-35 plus finasteride in cases of hirsutism and acne. Int J Endocrinol Metab. 2009; 7:235-41.
Park JH, Bienenfeld A, Orlow SJ, Nagler AR. The Use of Hormonal Antiandrogen Therapy in Female Patients with Acne: A 10-Year Retrospective Study. Am J Clin Dermatol. 2018;19(3):449-55.
Charny JW, Choi JK, James WD. Spironolactone for the treatment of acne in women, a retrospective study of 110 patients. International Journal of Women’s Dermatology. 2017;3(2):111-5.
Shaw JC. Low-dose adjunctive spironolactone in the treatment of acne in women: A retrospective analysis of 85 consecutively treated patients. J Am Acad Dermatol. 2000;43(3):498-502.
Roberts EE, Nowsheen S, Davis DMR, Hand JL, Tollefson MM, Wetter DA. Use of spironolactone to treat acne in adolescent females. Pediatr Dermatol. 2021;38(1):72-6.
Vijayendran N, Kale M, Jamale V, Nikam B, Hussain A, Patil SJ. Efficacy and Safety Profile of Spironolactone 50mg v/s Isotretinoin 10mg in the Treatment of Female Patients with Acne Vulgaris Grade 1-2 - A Double Blinded, Randomized Comparative Study. JMSCR. 2018;6(2):166-78.
Roberts EE, Nowsheen S, Davis MDP, McEvoy MT, Newman CC, Sartori Valinotti JC, et al. Treatment of acne with spironolactone: a retrospective review of 395 adult patients at Mayo Clinic, 2007-2017. J Eur Acad Dermatol Venereol. 2020;34(9):2106-10.
Turowski CB, James WD. The efficacy and safety of amoxicillin, trimethoprim-sulfamethoxazole, and spironolactone for treatment-resistant acne vulgaris. Adv Dermatol. 2007; 23:155-63.
Sato K, Matsumoto D, Iizuka F, Aiba-Kojima E, Watanabe-Ono A, Suga H, et al. Anti-androgenic therapy using oral spironolactone for acne vulgaris in Asians. Aesthetic Plast Surg. 2006;30(6):689-94.
Isvy-Joubert A, Nguyen J-M, Gaultier A, Saint-Jean M, Le Moigne M, Boisrobert E, et al. Adult female acne treated with spironolactone: A retrospective data review of 70 cases. Eur J Dermatol. 2017;27(4):393-8.
Yemisci A, Gorgulu A, Piskin S. Effects and side-effects of spironolactone therapy in women with acne. J Eur Acad Dermatol Venereol. 2005;19(2):163-6.
Grandhi R, Alikhan A. Spironolactone for the treatment of acne: A 4-year retrospective study. Dermatology. 2017;233(2–3):141-4.
Cortez de Castro G, Pacheco A, Naranjo H, Palacios A. Spironolactone in thetreatment of acne [Espironolactona en el tratamiento del acne]. Dermatol Venez. 1986; 24:103-105.
Arora MK, Yadav A, Saini V. Role of hormones in acne vulgaris. Clin Biochem. 2011;44(13):1035-40.
Layton AM, Eady EA, Whitehouse H, Del Rosso JQ, Fedorowicz Z, van Zuuren EJ. Oral spironolactone for acne vulgaris in adult females: A hybrid systematic review. Am J Clin Dermatol. 2017;18(2):169-91.
Searle TN, Al-Niaimi F, Ali FR. Spironolactone in dermatology: uses in acne and beyond. Clin Exp Dermatol. 2020;45(8):986-93.
Lucky AW. Endocrine aspects of acne. Pediatr Clin North Am. 1983;30(3):495–9.
Zouboulis C, Chen W-C, Thornton M, Qin K, Rosenfield R. Sexual hormones in human skin. Horm Metab Res. 2007;39(2):85-95.
Alan S, Cenesizoglu E. Effects of hyperandrogenism and high body mass index on acne severity in women. Saudi Med J. 2014;35(8):886-9.
Batterink J, Stabler SN, Tejani AM, Fowkes CT. Spironolactone for hypertension. Cochrane Database Syst Rev. 2010;(8):CD008169.
Carone L, Oxberry SG, Twycross R, Charlesworth S, Mihalyo M, Wilcock A. Spironolactone. J Pain Symptom Manage. 2017;53(2):288-92.
Shaw JC, White LE. Long-term safety of spironolactone in acne: Results of an 8-year followup study. J Cutan Med Surg. 2002;6(6):541-5.
Katsambas AD, Dessinioti C. Hormonal therapy for acne: why not as first line therapy? facts and controversies. Clin Dermatol. 2010;28(1):17-23.
Han JJ, Faletsky A, Barbieri JS, Mostaghimi A. New acne therapies and updates on use of spironolactone and isotretinoin: A narrative review. Dermatol Ther (Heidelb). 2021;11(1):79–91.