Review Artikel: Spironolakton Sebagai Obat Off-Label Untuk Jerawat Pada Wanita Dewasa

Aulia Zulfa; Ellin Febrina

doi:10.24198/farmaka.v21i3.47905

Review Artikel: Spironolakton Sebagai Obat Off-Label Untuk Jerawat Pada Wanita Dewasa

Aulia Zulfa, Ellin Febrina

Abstrak

Jerawat merupakan penyakit kulit yang umum terjadi pada remaja dan dewasa. Jerawat dewasa dapat berupa jerawat persisten (jerawat dari sejak remaja) atau onset (jerawat muncul >25 tahun). Prevalensi jerawat dewasa paling banyak terjadi pada wanita dibandingkan laki-laki. Peningkatan produksi sebum menjadi salah satu faktor terjadinya jerawat. Spironolakton sebagai obat anti-adrenergik memiliki efek antagonis reseptor androgen dengan mekanisme inhibisi reseptor androgen secara kompetitif dengan dihidrotestosteron untuk menurunkan produksi sebum. Penggunaan spironolakton untuk jerawat masih tergolong obat off-label. Obat off-label merupakan obat yang digunakan untuk pengobatan gejala klinis tetapi tidak sesuai dengan informasi obat yang disetujui oleh Food and Drug Administration (FDA) atau Badan POM. Penulisan artikel ini bertujuan untuk mengetahui efektifitas dan rentang dosis bagi spironolakton untuk terapi jerawat pada pasien Wanita dewasa. Artikel ini berupa kajian naratif dengan menggunakan database SpringerLink, PubMed dan ScienceDirect dengan kata kunci spironolactone dan acne dari 2013-2023. Hasilnya, beberapa penelitian menunjukkan bahwa spironolakton efektif dan dapat memberikan perbaikan klinis pada jerawat dengan pemberian dosis rendah (50-100 mg/hari). Pematauan serum kalium juga diperlukan untuk menjegah terjadinya efek samping hiperkalemia.

Teks Lengkap:

PDF

Referensi

Armanini, D., Andrisani, A., Bordin, L., & Sabbadin, C. (2016). Spironolactone in the treatment of polycystic ovary syndrome. Expert Opinion on Pharmacotherapy, 17(13), 1713–1715. https://doi.org/10.1080/14656566.2016.1215430

Bettoli, V., Zauli, S., & Virgili, A. (2015). Is hormonal treatment still an option in acne today? British Journal of Dermatology, 172(S1), 37–46. https://doi.org/10.1111/bjd.13681

Bhate, K., & Williams, H. C. (2013). Epidemiology of acne vulgaris. British Journal of Dermatology, 168(3), 474–485. https://doi.org/10.1111/bjd.12149

Biggar, R. J., Andersen, E. W., Wohlfahrt, J., & Melbye, M. (2013). Spironolactone use and the risk of breast and gynecologic cancers. Cancer Epidemiology, 37(6), 870–875. https://doi.org/10.1016/j.canep.2013.10.004

Cadegiani, F. A., Wambier, C. G., & Goren, A. (2020). Spironolactone: An Anti-androgenic and Anti-hypertensive Drug That May Provide Protection Against the Novel Coronavirus (SARS-CoV-2) Induced Acute Respiratory Distress Syndrome (ARDS) in COVID-19. Frontiers in Medicine, 7(July), 1–5. https://doi.org/10.3389/fmed.2020.00453

Da Cunha, M. G., Fonseca, F. L. A., & MacHado, C. D. A. S. (2013). Androgenic hormone profile of adult women with acne. Dermatology, 226(2), 167–171. https://doi.org/10.1159/000347196

Eichenfield, L. F., Krakowski, A. C., Piggott, C., Del Rosso, J., Baldwin, H., Friedlander, S. F., … Thiboutot, D. M. (2013). Evidence-based recommendations for the diagnosis and treatment of pediatric acne. Pediatrics, 131(SUPPL. 3). https://doi.org/10.1542/peds.2013-0490B

Eworuke, E., Cosgrove, A., Her, Q. L., Lyons, J. G., Martin, D., & Adimadhyam, S. (2022). Spironolactone Utilization among Patients with Reduced and Preserved Ejection Fraction Heart Failure. Pharmacoepidemiology, 1(3), 89–100. https://doi.org/10.3390/pharma1030009

Fisk, W. A., Lev-Tov, H. A., & Sivamani, R. K. (2014). Epidemiology and Management of Acne in Adult Women. Current Dermatology Reports, 3(1), 29–39. https://doi.org/10.1007/s13671-014-0071-4

Gabbard, R. D., Hoopes, R. R., & Kemp, M. G. (2020). Spironolactone and XPB: An old drug with a new molecular target. Biomolecules, 10(5), 1–14. https://doi.org/10.3390/biom10050756

Garg, V., Choi, J. K., James, W. D., & Barbieri, J. S. (2021). Long-term use of spironolactone for acne in women: A case series of 403 patients. Journal of the American Academy of Dermatology, 84(5), 1348–1355. https://doi.org/10.1016/j.jaad.2020.12.071

Han, X. D., Oon, H. H., & Goh, C. L. (2016). Epidemiology of post-adolescence acne and adolescence acne in Singapore: a 10-year retrospective and comparative study. Journal of the European Academy of Dermatology and Venereology, 30(10), 1790–1793. https://doi.org/10.1111/jdv.13743

Hauk, L. (2017). Acne Vulgaris: Treatment Guidelines from the AAD. American Family Physician, 95(11), 740–741.

Isvy-Joubert, A., Nguyen, J. M., Gaultier, A., Saint-Jean, M., Le Moigne, M., Boisrobert, E., … Dreno, B. (2017). Adult female acne treated with spironolactone: A retrospective data review of 70 cases. European Journal of Dermatology, 27(4), 393–398. https://doi.org/10.1684/ejd.2017.3062

Jansen, R. . (2013). Off-Label Use of Medication. In Legal and Forensic Medicine (pp. 1601–1615). https://doi.org/10.1007/978-3-642-32338-6

Kim, G. K., & Del Rosso, J. Q. (2012). Oral spironolactone in post-teenage female patients with acne vulgaris: Practical considerations for the clinician based on current data and clinical experience. Journal of Clinical and Aesthetic Dermatology, 5(3), 37–50.

Lavers, I. (2017). Exploring skin anatomy, function and site-specific treatment options. Journal of Aesthetic Nursing, 6(4), 172–180. https://doi.org/10.12968/joan.2017.6.4.172

Leelaphiwat, S., Jongwutiwes, T., Lertvikool, S., Tabcharoen, C., Sukprasert, M., Rattanasiri, S., & Weerakiet, S. (2015). Comparison of desogestrel/ethinyl estradiol plus spironolactone versus cyproterone acetate/ethinyl estradiol in the treatment of polycystic ovary syndrome: A randomized controlled trial. Journal of Obstetrics and Gynaecology Research, 41(3), 402–410. https://doi.org/10.1111/jog.12543

Mackenzie, I. S., Morant, S. V., Wei, L., Thompson, A. M., & MacDonald, T. M. (2017). Spironolactone use and risk of incident cancers: a retrospective, matched cohort study. British Journal of Clinical Pharmacology, 83(3), 653–663. https://doi.org/10.1111/bcp.13152

Pakhiddey, R., Paul, S., Mandal, A. K., & Kumar, V. (2015). Epidermal androgen receptors in acne vulgaris patients before and following oral isotretinoin. Journal of the Anatomical Society of India, 64(1), 42–47. https://doi.org/10.1016/j.jasi.2015.04.002

Park, J. H., Bienenfeld, A., Orlow, S. J., & Nagler, A. R. (2018). The Use of Hormonal Antiandrogen Therapy in Female Patients with Acne: A 10-Year Retrospective Study. American Journal of Clinical Dermatology, 19(3), 449–455. https://doi.org/10.1007/s40257-018-0349-6

Patiyasikunt, M., Chancheewa, B., Asawanonda, P., Noppakun, N., & Kumtornrut, C. (2020). Efficacy and tolerability of low-dose spironolactone and topical benzoyl peroxide in adult female acne: A randomized, double-blind, placebo-controlled trial. Journal of Dermatology, 47(12), 1411–1416. https://doi.org/10.1111/1346-8138.15559

Poinas, A., Lemoigne, M., Le Naour, S., Nguyen, J. M., Schirr-Bonnans, S., Riche, V. P., … Dréno, B. (2020). FASCE, the benefit of spironolactone for treating acne in women: study protocol for a randomized double-blind trial. Trials, 21(1), 571. https://doi.org/10.1186/s13063-020-04432-w

Rocha, M. ., & Bagatin, E. (2018). Adult-onset acne : prevalence , impact , and management challenges. Clinical, Cosmetic and Investigational Dermatology, 11, 59–69.

Rossignol, P., Claggett, B. L., Liu, J., Vardeny, O., Pitt, B., Zannad, F., & Solomon, S. (2018). Spironolactone and Resistant Hypertension in Heart Failure with Preserved Ejection Fraction. American Journal of Hypertension, 31(4), 407–414. https://doi.org/10.1093/ajh/hpx210

Santer, M., Lawrence, M., Renz, S., Eminton, Z., Stuart, B., Sach, T. H., … Layton, A. M. (2023). Effectiveness of spironolactone for women with acne vulgaris (SAFA) in England and Wales: pragmatic, multicentre, phase 3, double blind, randomised controlled trial. BMJ (Clinical Research Ed.), 381, e074349. https://doi.org/10.1136/bmj-2022-074349

Searle, T. N., Al-Niaimi, F., & Ali, F. R. (2020). Spironolactone in dermatology: uses in acne and beyond. Clinical and Experimental Dermatology, 45(8), 986–993. https://doi.org/10.1111/ced.14340

Shah, N., Shukla, R., Chaudhari, P., Patil, S., Patil, A., Nadkarni, N., & Goldust, M. (2021). Prevalence of acne vulgaris and its clinico-epidemiological pattern in adult patients: Results of a prospective, observational study. Journal of Cosmetic Dermatology, 20(11), 3672–3678. https://doi.org/10.1111/jocd.14040

Skroza, N., Tolino, E., Mambrin, A., Zuber, S., Balduzzi, V., Marchesiello, A., … Potenza, C. (2018). Adult acne versus adolescent acne: A retrospective study of 1,167 Patients. Journal of Clinical and Aesthetic Dermatology, 11(1), 21–25.

Tan, J. K. L., & Bhate, K. (2015). A global perspective on the epidemiology of acne. British Journal of Dermatology, 172(S1), 3–12. https://doi.org/10.1111/bjd.13462

Thiede, R. M., Rastogi, S., Nardone, B., Sadowsky, L. M., Rangel, S. M., West, D. P., & Schlosser, B. J. (2019). Hyperkalemia in women with acne exposed to oral spironolactone: A retrospective study from the RADAR (Research on Adverse Drug Events and Reports) program. International Journal of Women’s Dermatology, 5(3), 155–157. https://doi.org/10.1016/j.ijwd.2019.04.024

Trivedi, M. K., Shinkai, K., & Murase, J. E. (2017). A Review of hormone-based therapies to treat adult acne vulgaris in women. International Journal of Women’s Dermatology, 3(1), 44–52. https://doi.org/10.1016/j.ijwd.2017.02.018

Vargas-Mora, P., & Morgado-Carrasco, D. (2020). Spironolactone in Dermatology: Uses in Acne, Hidradenitis Suppurativa, Female Pattern Hair Loss, and Hirsutism. Actas Dermo-Sifiliográficas (English Edition), 111(8), 639–649. https://doi.org/10.1016/j.adengl.2020.03.015

Wang, Y., & Lipner, S. R. (2020). Retrospective analysis of adverse events with spironolactone in females reported to the United States Food and Drug Administration. International Journal of Women’s Dermatology, 6(4), 272–276. https://doi.org/10.1016/j.ijwd.2020.05.002

Wittich, C. M., Burkle, C. M., & Lanier, W. L. (2012). Ten common questions (and their answers) about off-label drug use. Mayo Clinic Proceedings, 87(10), 982–990. https://doi.org/10.1016/j.mayocp.2012.04.017

Yang, C. T., Kor, C. T., & Hsieh, Y. P. (2018). Long-term effects of spironolactone on kidney function and hyperkalemia-associated hospitalization in patients with chronic kidney disease. Journal of Clinical Medicine, 7(11). https://doi.org/10.3390/jcm7110459

Zaenglein, A. L., Pathy, A. L., Schlosser, B. J., Alikhan, A., Baldwin, H. E., Berson, D. S., … Bhushan, R. (2016). Guidelines of care for the management of acne vulgaris. Journal of the American Academy of Dermatology, 74(5), 945-973.e33. https://doi.org/10.1016/j.jaad.2015.12.037

DOI: https://doi.org/10.24198/farmaka.v21i3.47905

DOI (PDF): https://doi.org/10.24198/farmaka.v21i3.47905.g21509