Spironolactone may be safe to treat female pattern hair loss in breast cancer survivors

Reviewed by Emily Henderson, B.Sc.Sep 9 2020

Spironolactone is not associated with increased risk of female breast cancer recurrence, according to research from the George Washington University (GW) Department of Dermatology. The study, published in the Journal of the American Academy of Dermatology, found that the drug may be safe for use in treating breast cancer survivors with female pattern hair loss.

Androgens contribute significantly to the pathogenesis of female patterned hair loss. The current treatment of topically applied minoxidil (also known as Rogaine), thought to increase scalp blood flow and maintain hair growth, is approved by the U.S. Food and Drug Administration. However, antiandrogen drugs, like spironolactone, have also been used to treat female patterned hair loss, but used off-label. Research confirming the safety of this drug for breast cancer survivors is critical for patients considering this treatment option.

Spironolactone is used for androgenic alopecia because of its ability to halt the progression of hair loss and its long-term safety profile. However, little is known about its safety in breast cancer survivors, which is of concern considering the drug's estrogenic effects could pose a theoretical risk of breast cancer recurrence."

Adam Friedman, MD, interim chair and professor in the Department of Dermatology at the GW School of Medicine and Health Sciences, director of the Supportive Oncodermatology Clinic at GW Cancer Center, and the senior author on the study

The multidisciplinary research team, led by first author Chapman Wei, a fourth-year MD student and research fellow in the GW Department of Dermatology, conducted a retrospective analysis of data from the Humana Insurance Database. They identified patients with a history of breast cancer and stratified groups based on spironolactone usage. They then analyzed patient characteristics and cancer recurrence rates between the cohorts.

The breast cancer recurrence rate for the group prescribed spironolactone was not statistically different from the cohort of patients who did not take spironolactone after adjusting for patient characteristics, both of which were well within the range of expected recurrence rates.

"According to our analysis, spironolactone is not independently responsible for increased risk of breast cancer recurrence," Friedman said. "The drug could be used as an additional treatment option for alopecia in female breast cancer patients who are disease-free."

The authors recommend additional prospective studies and clinical trials to further assess the efficacy and safety of spironolactone in patients who have cancer remission to confirm its safety.