A 29-year-old woman has moderate inflammatory acne concentrated on the lower face and jaw, flaring premenstrually each cycle. She has irregular periods and mild hirsutism. Topical adapalene plus benzoyl peroxide has given incomplete control over 4 months. She is not planning pregnancy. Which systemic agent is most appropriate as an add-on because it directly antagonises androgen action on the pilosebaceous unit?
- A Spironolactone ✓
- B Metformin
- C Oral clindamycin
- D Dapsone
Correct answer: A. Spironolactone
Explanation
Adult female hormonal-pattern acne with perimenstrual flare responds to antiandrogen therapy. Spironolactone blocks the androgen receptor and also reduces androgen synthesis, lowering sebum output, so it is the standard add-on when topical therapy fails. Metformin improves insulin resistance in PCOS but has no direct antiandrogen effect on the sebaceous gland, which makes it the tempting but incorrect choice.
Reference: Fitzpatrick's Dermatology, 9th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.