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Cosmos Study

Off-Label Spironolactone Use Rising as Antibiotic Use Declines for Acne Treatment in Women

May 23, 2024
Dual-Team Study
Team A:Kersten Bartelt, RNAlex Piff
Team B:Tony Dunnigan, MDJoe Deckert, PhD

Key Findings

  • The use of oral antibiotics for acne treatment declined from 41% to 27% of prescriptions between 2017 and 2023, while the prescription of spironolactone for acne treatment increased from 27% to 47% of prescriptions in the same period.

There are many treatment options available for hormonal acne in women, including topical treatments and oral medications such as antibiotics, contraceptive pills, and off-label use of spironolactone.1 However, with growing concerns surrounding antibiotic resistance, the prescription of oral antibiotics necessitates further review of risk-benefit analysis.2 Additionally, there have been reports of spironolactone effectively treating acne.3 To understand how the prescribing of oral antibiotics and spironolactone for acne treatment has changed over time, we studied 972,439 prescriptions for oral antibiotics, oral contraceptives, or spironolactone placed during encounters with an acne diagnosis between 2017 and 2023.

We found that in 2017 and 2018, oral antibiotics were the most frequently prescribed acne treatment of those studied, accounting for more than one-third of prescriptions. However, this trend shifted in 2019 when spironolactone became the most commonly prescribed medication among the three groups. As of 2023, spironolactone constituted nearly half of the acne-related prescriptions studied.

Figure 1
Proportion of Oral Acne Treatment Prescriptions by Type Over Time
Proportion of Oral Acne Treatment Prescriptions by Type Over Time
Figure 1. The proportion of prescriptions for oral acne treatments by prescription type over time.

These data come from Cosmos, a dataset created in collaboration with a community of Epic health systems representing more than 246 million patient records from 1,400 hospitals and more than 32,500 clinics from all 50 states and Lebanon. This study was completed by two teams that worked independently, each composed of a clinician and research scientists. The two teams came to similar conclusions. Graphics by Mark LeBay. 

References

  1. Ludmann P. Acne: Diagnosis and treatment. American Academy of Dermatology. Published March 19, 2024. https://www.aad.org/public/diseases/acne/derm-treat/treat. Accessed April 24, 2024.
  2. Baldwin H. Oral Antibiotic Treatment Options for Acne Vulgaris. J Clin Aesthet Dermatol. 2020 Sep;13(9):26-32. Epub 2020 Sep 1. PMID: 33133338; PMCID: PMC7577330.
  3. Stubborn acne? Hormonal therapy may help. Aad.org. https://www.aad.org/public/diseases/acne/derm-treat/hormonal-therapy. Accessed May 3, 2024.