BackgroundThere is limited evidence on the safety and efficacy of spironolactone in the treatment of women with acne. Thus, for many dermatologists spironolactone remains an alternative rather than a mainstay treatment for female patients with acne.MethodsAn electronic medical records search tool was used to select data from a group of women who received spironolactone to treat acne and were evaluated with the comprehensive acne severity scale (CASS) before treatment and at all follow-up visits. Data points were collected for CASS scores at each follow-up visit, concurrent and previous treatments, and side effects. These data points were used to draw conclusions about the safety and efficacy of spironolactone in this patient population.ResultsThere were 110 patients that met all eligibility requirements. Of these, 94 patients saw an improvement in their CASS score and 61 patients completely cleared their score to 0. There were 16 patients who did not improve and six who relapsed after initial improvement. The women saw an average improvement in their acne by 73.1% for the face, 75.9% for the chest, and 77.6% for the back. Fifty-one women experienced side effects, but only six found them bothersome enough to stop taking spironolactone.ConclusionA majority of women in this study saw a dramatic improvement in their acne while treated with spironolactone. There were low rates of relapse or discontinuation of the medication. To further promote the use of spironolactone as a first-line systemic treatment for women with acne, there must be more prospective controlled trials.

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Typical histopathology of PV shows suprabasal acantholysis. In our patient, the initial biopsies in the oropharynx showed no acantholytic process, but a spectrum of cellular dysplasia and chronic inflammation. Findings of cytological dysplasia in the oropharynx in the setting of a significant smoking history were particularly alarming for a premalignant lesion. To our knowledge, there have only been two prior reports describing findings of severe epithelial dysplasia concurrent with PV. In both cases -like our patient, these lesions resolved with PV directed therapy.Pemphigus can exhibit Koebner phenomenon after surgical manipulation or flare due to surgical stress [12,13]. Thus, a PV flare induced by surgical removal of a truly premalignant dysplastic lesion cannot entirely be ruled out. However, given the comparable histology at multiple sites, the development of new lesions in areas devoid of surgical trauma, and resolution with high dose corticosteroids, these alternative hypotheses remain unlikely.Reactive versus neoplastic epithelial dysplasia remains a challenging distinction to make. In the case of multifocal epithelial dysplasia, a diagnosis of PV should be entertained, particularly when multiple mucosal sites are involved.