Spironolactone
It is an oral aldosterone antagonist and potassium-sparing diuretic having blocker action on androgen receptor and 5-alpha reductase inhibitor activity (38). It is the most effective antiandrogenic agent for acne (13). Spironolactone has been used to manage acne in women with PCOS as an alternative to oral isotretinoin and COCs (39). It has been found that spironolactone in conjunction with COCPs improved acne by 50% (35). The recommended daily dose is 50 mg to 200 mg daily (11); however, it is usually best to start at 50 mg daily and increase to 100 mg daily if clinical response is not adequate after 2 to 3 months (33). Low doses of 25 mg twice daily or 25 mg daily may be adequate for some women (40).