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A recent updated Cochrane review on the use of spironolactone* in hirsutism and acne concluded that there is no evidence for its effectiveness in acne

Calvani M, Benatti P, Mancinelli A, D'Iddio S, Giordano V, Koverech A, Amato A, Brass EP: Carnitine replacement in end-stage renal disease and hemodialysis
Among other things, the authors point to the diets effects on the central nervous system, which may attenuate the pathological desire to lose weight and mitigate other symptoms characteristic of eating disorders [249]

Cytokine-associated emotional and cognitive disturbances in humans
