QAt what age can you start using spironolactone in pediatric females?

A
Gabriela Maloney, DO

Gabriela Maloney, DO

Dermatologist
Forefront Dermatology
Brookfield, WI

Spironolactone has been used in pediatric patients since the 1960s to treat heart failure in patients with congenital heart disease, in neonates to prevent pulmonary congestion in chronic lung disease, and in ascites in children with chronic liver disease, and it has been shown to be useful in children with juvenile idiopathic arthritis as it can inhibit proinflammatory cytokines.1 In dermatology, we often use it off-label for adult female acne, hirsutism, and androgenetic alopecia, but there is a big question mark regarding the age when it is safe to prescribe it to young females.

Spironolactone is used off-label for androgenetic alopecia, and although rare, pediatric patients can develop androgenetic alopecia as young as 6 years. Spironolactone is generally used in women 18 years or older for androgenetic alopecia, but evidence in pediatric patients is very limited. If a pediatric patient has the disease, hormonal lab workup is recommended if postpubertal, and if prepubertal, the patient should see an endocrinologist to exclude early puberty onset. Compounded topical spironolactone could be a valid option in these pediatric patients alone or in conjunction with topical or oral minoxidil.2

Spironolactone has been studied for acne in young females as young as 14 years and has demonstrated safety and greater than 80% acne improvement with a median dose of 100 mg daily. The safety profile is consistent in pediatric and adult patients, and adolescents generally have a higher tolerability to spironolactone than adult women. Due to increased concerns regarding antibiotic stewardship, spironolactone could be considered as an alternative to antibiotics in postpubertal females prior to considering isotretinoin.3

References:

  1. Buck M. Aldosterone inhibitors in infants and children. Pediatric Pharmacotherapy. Jan 2004;10(1):1-5.
  2. Gomes TF, Soares RO. Pediatric androgenetic alopecia: an updated review. J Dtsch Dermatol Ges. 2023;21(1):19-25. doi:10.1111/ddg.14940
  3. 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):72-76. doi:10.1111/pde.14391