TOPLINE:

In a retrospective cohort study, hyperkalemia occurred in 1 in 10 women older than 45 years who were prescribed spironolactone for dermatologic conditions, with the highest risk among those older than 65 years with predisposing comorbidities but was generally mild and asymptomatic.

METHODOLOGY:

• To evaluate the incidence of hyperkalemia in older women taking spironolactone for skin conditions, researchers analyzed 398 medical records from Brigham and Women’s Hospital and Massachusetts General Hospital, Boston, of women aged 45 years or older treated with spironolactone for acne, hair loss, hirsutism, or hidradenitis suppurativa, from January 2015 through February 2025.
• The mean patient age was 54.7 years and the majority were White (77.4%) and non-Hispanic individuals (85.4%); 10.6% were Black individuals.
• Spironolactone, an anti-androgenic agent used off-label to treat skin conditions, was most commonly prescribed for acne (47.5%), with the most common starting dose of 50 mg and the most common maximum dose of 100 mg.
• Potassium laboratory monitoring was categorized at three timepoints: baseline (within 1 year prior to initiation, including the start date), post-initiation (day 1 to 6 months after the start date), and dose increase monitoring (from day 1 to 6 months after starting the maximum dose).
• Hyperkalemia was defined as a serum potassium > 5.0 mEq/L; severity, timing, and management were assessed.

TAKEAWAY:

• The overall hyperkalemia incidence was 10.1%, with higher rates in women aged 65 years or older compared with those aged 45-64 years (22.4% vs 7.9%; odds ratio, 3.02; P = .004). The incidence among healthy women aged 45-64 years was 6.3%.
• Women with at least one predisposing comorbidity had higher hyperkalemia rates than those without comorbidities (14.7% vs 7.3%), the difference, however, was not statistically significant.
• Most hyperkalemia cases were mild (97.5%), 85% were asymptomatic, and 62.5% did not lead to changes in spironolactone management.
• Hyperkalemia occurred at a mean of 20.5 months after spironolactone initiation, with most cases developing outside the expected monitoring window of week 1-4.

IN PRACTICE:

Identifying hyperkalemia with routine laboratory testing “infrequently impacts clinical management or patient outcomes,” the authors concluded, adding that “clinical decision making around potassium laboratory monitoring should account for age ≥ 65 and patients’ medical complexity.” Monitoring guidelines “for spironolactone’s use in dermatology should be developed over time; for now, individualized clinical decision making is key,” they added. They noted that potassium monitoring is currently not recommended for young, healthy women taking spironolactone for skin conditions.

SOURCE:

This study was led by Samantha Gregoire, BS, and Eliza Dewey, BS, from Brigham and Women’s Department of Dermatology, Boston, and was published online on February 6 in the Journal of the American Academy of Dermatology.

LIMITATIONS:

The study limitations included retrospective design, lack of a direct comparator group to younger cohorts, limited assessment of dose-response relationships, potentially missed hyperkalemia incidents.

DISCLOSURES:

This study did not receive any funding. Three authors disclosed receiving consulting fees and research funding from AbbVie, ACOM Health, Bioniz, Boehringer Ingelheim, Concert, Digital Diagnostics, Eli Lilly, Equillium, Hims & Hers Health, Pfizer Honeydew Care, Sanofi Pasteur, and Twi Biotechnology; having equity from ACOM Health, Figure 1, and Hims & Hers Health; and having licensing/royalties from Concert and Pfizer. Full disclosures are noted in the original article.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.