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Side effects of spironolactone for acne: Spironolactone for the treatment of acne in women, a retrospective study of 110 patients

Spironolactone for Acne: Benefits, Side Effects, and More

Acne is a common skin condition for many people—up to 50 million in America, in fact.

It can cause frustration, self-consciousness, and social isolation in some people.

While teenagers are most associated with acne concerns, people of all ages can be affected.

Improving acne may or may not require a personalized care plan for your skin. Everyone’s skin type will respond in different ways to different treatments.

Your dermatologist will decide treatment options based on the cause of the acne, your skin type, and a variety of other factors. 

One common treatment for acne is spironolactone (Aldactone).

This is a medication most commonly used for treating blood pressure, heart failure, and other conditions, including acne.

In this article, I’ll cover what spironolactone is, how it’s used and how it works for acne. I’ll also discuss the benefits and potential side effects, as well as who shouldn’t take this drug.

Finally, I’ll cover alternatives to spironolactone and highlight when it’s time to see a professional.

What is Spironolactone (Aldactone)?

Spironolactone (Aldactone) is a medication classified as a diuretic and an aldosterone antagonist.

Also called “water pills,” diuretics remove excess water from your body by triggering more urine production.

Spironolactone and other diuretics are most commonly prescribed to treat fluid retention for some health concerns.

Spironolactone is considered a potassium-sparing diuretic, meaning your potassium levels won’t drop significantly if you take it.

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Uses of Spironolactone

Spironolactone is most commonly used as a hormonal acne treatment in feminine-presenting patients.

It’s not often prescribed to male-presenting patients due to its effects on testosterone and other androgens.  

Using spironolactone for acne is an off-label use of the medication, meaning it has not been officially approved by the Food and Drug Administration (FDA), although medical professionals widely accept it.

Other research has studied the use of spironolactone for acne, alopecia, hirsutism, medication-induced rash, scar prevention associated with top surgery, and skin atrophy. 

The literature review of eight studies states that spironolactone is not recommended for treating hirsutism.

More research is recommended to confirm the use of spironolactone for acne, alopecia, medication-induced rash, and scar prevention associated with top surgery.

There was no conclusion on the use of spironolactone for skin atrophy. 

Occasionally, spironolactone is prescribed as a fourth-line treatment for high blood pressure, meaning multiple other medications are typically tried first.

As a potassium-sparing diuretic, spironolactone causes the body to flush out excess water and sodium (salt), which in turn lowers blood pressure.  

It is also prescribed for patients with heart failure and to prevent further cardiovascular events.

How Does Spironolactone Work for Acne?

Spironolactone is an aldosterone antagonist, meaning it slows the production of androgen hormones in the body, such as testosterone.

Androgen hormones promote masculine characteristics, so reducing these hormones may not be desirable for masculine-presenting patients.

Reduced androgen hormones mean fewer hormones will be present to bind to oil glands, preventing stimulation of oil production.

Since acne can be caused by increased oil production that clogs pores, reducing oil production may improve hormonal acne. 

While spironolactone is not a first-line treatment for severe acne, it may be prescribed after trying topical medicines and treatments such as retinol, antibiotics, or a combination of these.

Benefits

The greatest benefit of taking spironolactone is its credibility as a long-term treatment for acne in people with menstrual cycles.  

Generally, spironolactone offers the following benefits regarding acne:

  • Fewer inflamed spots, such as cysts
  • Fewer comedones, which are bumps that become inflamed
  • Less greasiness and oil production in the skin

Since spironolactone is an oral medication, not a topical one, all areas of the body that produce oils due to hormone levels will be affected.

This may result in a reduction in acne not only on the face, but also on the back, chest, and/or other areas.

Possible Side Effects

Possible side effects for patients taking oral spironolactone include:

  • Dry mouth
  • Increased potassium levels
  • Stomach cramping, diarrhea, vomiting
  • Dizziness
  • Headaches
  • Lowered blood pressure
  • Frequent urination

Spironolactone is also known to cause side effects of irregular periods and breast soreness, tenderness, and/or enlargement for patients who menstruate. 

Interactions and Warnings

Spironolactone affects potassium levels, hormone levels, and blood pressure.

Patients taking other medications for concerns regarding these should speak with a medical professional before taking oral spironolactone.

Spironolactone has negative interactions with drugs such as:

  • Potassium supplements
  • Angiotensin-converting enzyme (ACE) inhibitors 
  • Angiotensin II receptor blockers
  • Lithium
  • Non-steroidal anti-inflammatory drugs
  • Digoxin (Lanoxin)
  • Cholestyramine
  • Acetylsalicylic acid
  • Salt substitutes
  • Cyclosporine (Sandimmune)
  • Triamterene (Dyrenium)

The FDA label for oral spironolactone (Aldactone) does have a black box warning, as high doses have caused tumors in experiments involving rats.

You should limit your alcohol consumption when taking spironolactone, as alcohol may increase your risk of orthostatic hypotension.

This is sudden dizziness and a drop in blood pressure after you stand up too quickly, which can be dangerous.

When taking spironolactone, patients should monitor their blood pressure regularly to ensure no adverse effects occur.

How Quickly Does Spironolactone Work for Acne?

Initial doses of spironolactone start at 25-100mg per day and increase in a stepwise fashion every 6-8 weeks until there is a noticeable improvement in the acne.

Most people notice a therapeutic effect within 4-8 weeks. 

The average dose for someone taking spironolactone for acne and other skin concerns is 50-150mg per day. 

Taking spironolactone does not guarantee you will not experience any acne.

It may completely clear the skin, or you may need to combine it with other treatments.

Who Shouldn’t Take It

Generally, patients should not take oral spironolactone if they are:

  • Taking eplerenone
  • Planning for pregnancy
  • Pregnant or breastfeeding
  • Being treated for kidney disease

Patients diagnosed with hyperkalemia (high potassium levels) or Addison’s disease should not take oral spironolactone.

Spironolactone Alternatives

If spironolactone is not an option, some alternatives exist for acne treatment and prevention.

Oral contraceptives or birth control pills are a common alternative for treating hormonal acne.

The Cochrane Collaboration, an international research group, explored studies on birth control and acne and found that all oral contraceptives improved acne in participants.

The researchers cautioned that no one pill was found to be more effective than another, so be aware of this when looking for an oral contraceptive for acne.

Some patients turn to spironolactone after trying topicals and cream medications.

Your dermatologist may prescribe you alternative medications such as retinol, benzoyl peroxide, and topical antibiotics for treating skin concerns.

Some alternatives for spironolactone can be purchased over-the-counter. Speak with a medical professional or dermatologist to learn if spironolactone or one of its alternatives is right for you.

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Refill medications and get certain necessary prescriptions.

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When to See a Medical Professional

There are signs and symptoms you should be aware of when taking spironolactone – they signal the need for a visit with a medical professional.  

Orthostatic hypotension is a sudden drop in blood pressure after you stand that causes dizziness and sometimes fainting.

About 6% of Americans experience orthostatic hypotension. Medications can occasionally cause orthostatic hypotension, or it may be genetically inherited.

If you suspect you have orthostatic hypotension, consult a medical professional to see if you should switch your medications.

Hyperkalemia occurs when a patient’s potassium levels are too high.

This can be life-threatening if not treated properly.

Often there are no symptoms, but some hyperkalemic patients experience nausea, an irregular heartbeat, numbness or muscle weakness, abdominal cramping, or sudden collapse. 

Signs of a medical emergency when taking spironolactone include:

  • Sudden collapse
  • Seizure
  • Sudden decrease in urine output

These may be signs of a cardiac event or kidney problem that could be life-threatening. Call for emergency medical attention immediately if you experience one or more of these symptoms.

How K Health Can Help

Did you know you can get affordable primary care with the K Health app?

Download K Health to check your symptoms, explore conditions and treatments, and if needed text with a healthcare provider in minutes. 

K Health’s AI-powered app is based on 20 years of clinical data.

Frequently Asked Questions

How quickly does spironolactone work for acne?

Spironolactone is started at doses of 25-100mg per day and is increased every 6-8 weeks until you reach a dose that improves the acne. There are many variations to this regime. Improvement in acne can take 3-6 months to see. The usual dose for skin concerns is 50-150mg per day.

Will spironolactone get rid of acne?

Whether used by itself or combined with other acne treatments, spironolactone is an effective and relatively affordable medication that can help clear up stubborn acne in feminine-presenting patients. But it might take some time to see results. Talk to your provider if you’re considering spironolactone for acne.

What are the side effects of spironolactone for acne?

Common side effects of long-term use of spironolactone during acne treatment include irregular menstruation, urinary frequency, dizziness, headaches, nausea, vomiting, breast tenderness, and breast enlargement.

Does spironolactone for acne make you gain weight?

Spironolactone (sold under the brand name Aldactone) is sometimes prescribed to treat acne (among other conditions), but some people who’ve used it have reported experiencing weight gain while taking it. You can also talk to your doctor about weight gain concerns if you are on spironolactone medication.

K Health articles are all written and reviewed by MDs, PhDs, NPs, or PharmDs and are for informational purposes only. This information does not constitute and should not be relied on for professional medical advice. Always talk to your doctor about the risks and benefits of any treatment.

K Health has strict sourcing guidelines and relies on peer-reviewed studies, academic research institutions,
and medical associations. We avoid using tertiary references.

  • Aldactone (2008).
    https://www.accessdata.fda.gov/drugsatfda_docs/label/2008/012151s062lbl.pdf

  • Effect of Spironolactone on Blood Pressure in Subjects With Resistant Hypertension (2007).
    https://www.ahajournals.org/doi/10.1161/01.hyp.0000259805.18468.8c

  • Hyperkalemia (High Potassium) (2016).
    https://www.heart.org/en/health-topics/heart-failure/treatment-options-for-heart-failure/hyperkalemia-high-potassium

  • Oral Spironolactone in Post-teenage Female Patients with Acne Vulgaris (2012).
    https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3315877/

  • Orthostatic hypotension (n.d.).
    https://medlineplus.gov/genetics/condition/orthostatic-hypotension/

  • Skin conditions by the numbers (n. d.).
    https://www.aad.org/media/stats-numbers

  • Spironolactone for Acne (2022).
    https://www.goodrx.com/spironolactone/spironolactone-for-acne-how-does-it-work

  • Spironolactone for Hormonal Acne (2021).
    https://www.midlandskin.co.uk/treatments/spironolactone-acne/

  • Spironolactone: Summary Report (2021).
    https://archive.hshsl.umaryland.edu/bitstream/handle/10713/17712/Spironolactone_Final_2021_10.pdf

  • Spironolactone for the treatment of acne in women, a retrospective study of 110 patients (2017).
    https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5440451/

  • Stubborn acne? Hormonal therapy may help. (n.d).
    https://www.aad.org/public/diseases/acne/derm-treat/hormonal-therapy

  • Which birth control pills can help reduce acne? (2019).
    https://www.ncbi.nlm.nih.gov/books/NBK279209/

Side Effects, Dosage & Risks

What is spironolactone? (Aldactone)

Spironolactone is a diuretic. A diuretic is a medication pill that helps your body get rid of extra water and salt.

What is spironolactone used for?

Usually, it’s prescribed to prevent high blood pressure and heart failure, but it can also be used to help treat hormonal acne. It primarily treats acne caused by high Testosterone (i.e acne that appears during menstruation, pregnancy, or puberty), and it is not strong enough to treat acne vulgaris or cystic acne alone. In many cases, it is taken with oral contraceptives and topical acne treatments like tretinoin.  

Spironolactone is a great option for individuals seeking a long-term solution for their hormonal acne. Read on to learn if this treatment option is right for you.

How does spironolactone work for acne?

Oral spironolactone can help treat acne by blocking the effects of androgens (a.k.a male hormones) on the skin.  It serves as an anti-androgen, lowering the levels of Testosterone in the blood. Although the FDA does not list spironolactone as an anti-acne drug, it is prescribed by many doctors and dermatologists to treat hormonal acne that doesn’t respond to birth control pills. I Spironolactone can cause feminizing side effects in men.

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Who can take spironolactone to treat acne?

Spironolactone requires a doctor’s prescription. For acne, it’s usually prescribed to women with hormonal acne. Spironolactone should NOT be used if you have: adrenal insufficiency, kidney problems, diabetes, acid-base problems, liver problems, new cancer, prostate cancer, or pregnancy (it can affect XY embryos). Although it has been shown to be safe, not everyone may be able to use it. If you would like more information about  Spironolactone’s use in acne treatment, please contact your doctor. 

Spironolactone dosage for acne

Spironolactone is taken by mouth via pill or liquid. The most common dosage is between 50mg and 100mg daily, though some individuals may require up to 200mg to see changes in their skin. While it can be taken on an empty stomach, taking it with food can help prevent an upset stomach. Additionally, it is recommended that you take it earlier in the day to avoid having to get up during the night to pee. 

How long does it take for spironolactone to work?

Spironolactone usually takes a few weeks to start working. While it may not clear up your acne right away, it gradually works to decrease breakouts and oiliness. Regardless of whether or not you notice changes in your skin, it’s important to communicate with your doctor so she can monitor your progress and determine the correct dosage. 

Related content: Best Birth Control for Acne

What are the possible side effects of spironolactone?

Possible side effects of taking spironolactone include drowsiness, dizziness, lightheadedness, upset stomach, irregular periods, and headache. These symptoms are typically mild, often go away with time, and can be treated with hydration. More serious side effects are increased thirst, excess urination, mood fluctuations, unusual fatigue/weakness, muscle spasms, heavier periods, breast tenderness, persistent fever, and easy bruising/bleeding. If you experience one or more of these symptoms, contact your doctor as soon as possible. 

Allergic reactions to spironolactone are rare. However, if you experience a rash, itching/swelling (especially of the face, tongue, and throat), severe dizziness, or trouble breathing, get medical help right away. 

What happens when you stop taking spironolactone?

Unlike an antibiotic, you can take spironolactone for a long time if it’s successful at treating your acne. If you want to know how to safely stop taking spironolactone, consult a doctor so they can help you devise a plan for weaning off. Stopping spironolactone suddenly may lead to excess fluid retention and increased blood pressure. 

Should I take spironolactone for acne?

Spironolactone is typically only prescribed when other methods are unsuccessful at treating hormonal acne. It is best for hormonal acne (i.e acne that appears during menstruation, pregnancy, or puberty)and is generally not used by itself. While it is effective, it may lead to side effects that could outweigh the benefits. Additionally, you should not take spironolactone if you’re pregnant.  

Related content: What are Oral Antibiotics for Acne?

How can Pandia Health help?

When used with birth control pills, spironolactone is typically more effective in treating acne. Pandia Health has expert doctors that can help you find the best acne treatment for you as well as prescribe birth control AND get your medication with FREE delivery. Sign up today or contact us if you have any questions. If you have an existing prescription, you can transfer it to our pharmacy and get it shipped right to your mailbox. With our free delivery service, it’s never been easier to consult a doctor for Spironolactone for acne and get it delivered along with your birth control. We also prescribe the pill, patch, and ring to patients in 14 states and expanding rapidly. Check out our birth control resources today and join our community of people with uteri who are empowered to take charge of our reproductive health.

Disclaimer: The following information is for general informational purposes only and is NOT a substitute for professional medical advice. Always seek the advice of your doctor/primary care provider before starting or changing treatment.

Should I take spironolactone for acne? – Product Information

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Prescription Information

When you hear the word pimples, you probably think of a variety of faces, but pimples can occur in many different places throughout the body, and the solution isn’t as simple as smearing yourself with your favorite over-the-counter acne cream or invest in expensive skin care.

If you have severe acne on your face or acne that affects your back, chest, buttocks, or arms, you may need to see a dermatologist to control your breakouts. And if you’re a woman, you may be prescribed a common blood pressure medicine called Aldactone (spironolactone) to treat acne.

What does blood pressure medicine have to do with acne… And why is it usually prescribed only to women? Here’s everything you need to know about using spironolactone for acne.

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What is spironolactone?

Spironolactone (spironolactone coupon) is a prescription drug used to treat high blood pressure and fluid retention, but is often prescribed off-label for acne. It is usually sold under the brand name Aldactone.

“Spironolactone is probably one of the most commonly prescribed drugs in dermatology and has been used safely for over 60 years to treat acne in adult women,” he says. Joshua is a draftsman, MD, director of cosmetic and clinical research at Mount Sinai Hospital.

The drug is a diuretic, commonly known as a water tablet, which means it causes your kidneys to filter excess water from your body by increasing urine production. Spironolactone belongs to a class of diuretics called potassium-sparing diuretics that prevent the loss of potassium during this process; For a patient with high blood pressure, spironolactone can be an effective means of removing excess sodium, a common source of hypertension, without lowering potassium levels.

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How does spironolactone help with acne?

Although spironolactone has been approved by the Food and Drug Administration (FDA) for the treatment of blood pressure, Dr. Zeichner says it does not affect blood pressure when given at low doses. Instead, its side effects make it a good off-label acne treatment: it blocks the binding of sebaceous hormones and prevents the stimulation of oil production, which can lead to acne.

It is also often prescribed for women who suffer from otcystic acne, a type of pimple that sits deep on the surface of the skin rather than on top of it. Cystic acne occurs when skin pores become clogged and then infected. This is a common occurrence on the jaw line and on the chin.

However, spironolactone can also block testosterone production and cause breast development in men, so it is only given to women.

Spironolactone may not be suitable for all women with acne. According to Dr. Zeicher, it may be suitable for women who:

  • suffer from hormonal acne or rashes associated with the menstrual cycle;
  • systemic acne treatment is needed to get rid of severe acne or pimples affecting large parts of the body;
  • you have acne that is not well controlled with topical treatments alone;
  • don’t want to treat your acne with hormonal birth control;
  • and have recurrent acne after stopping oral antibiotics.

Spironolactone (more about spironolactone) is often given to teens and adult women, although pregnant women or women who may become pregnant should not take spironolactone. Its feminizing effects can reach the fetus, so testosterone levels in a male fetus may be affected by maternal use of spironolactone during pregnancy.

A typical dose of spironolactone for acne is 25 to 200 milligrams per day; according to 2012 study published at Journal of Clinical and Aesthetic Dermatology , patients should start at the lowest possible dose and gradually increase as needed. Patients often report a reduction in acne as well as a reduction in side effects at lower doses. It’s important to note that it can take about three months for the drug to have a noticeable effect on acne, and it’s not a one-time treatment, says Dr. Zeichner.

If you stop taking spironolactone, the skin will gradually return to what it is genetically programmed to do, he explains. Acne usually returns within a few months [after stopping the drug].

Is it safe to take spironolactone for acne?

Like all medicines, spironolactone may cause side effects in some patients but not in others. Before taking, it is important to discuss these side effects with your doctor and let him know about any other medicines you are taking.

Possible side effects of spironolactone include:

  • breast tenderness
  • irregular periods
  • elevated potassium
  • lightheadedness
  • nausea and vomiting
  • fatigue
  • increased urination

Dr. Zeichner says that many of these side effects are more likely when the drug is given in higher doses. It is worth noting that there is a black box warning on the drug, but this may not be a major concern if you are an otherwise healthy woman.

In one study in rats, spironolactone caused tumors in solid organs, but this has not been shown to be a problem in humans, advises Dr. Zeichner. The amount of drug administered to rats in the study was significantly higher than that given to women.

Spironolactone does not usually cause depression or mood changes. If you notice mood changes while taking it, tell your doctor. Spironolactone is sometimes prescribed to stimulate hair growth in women because it is an antiandrogen, meaning it blocks male hormones that can cause hair loss in women.

Since the drug reduces fluid retention, you may lose some weight while taking it. There is no evidence that spironolactone works as a weight loss drug, but it can help with premenstrual bloating and is often prescribed to treat symptoms of PMS and premenstrual dysphoric disorder (PMDD).

When it comes to actually taking spironolactone, Dr. Zeichner recommends taking it with food for better absorption. Because the drug affects sodium and potassium levels, you should monitor your intake of both. There is a possibility that potassium levels can become lethally high when taking spironolactone (known as hyperkalemia), so you should avoid eating large amounts of foods that contain potassium, such as bananas, avocados, and spinach.

Diuretics such as spironolactone pass through the renal system and should therefore be avoided in patients with kidney disease. According to the Mayo Clinic, patients taking potassium supplements, other medications containing spironolactone or diuretics (especially triamterene and eplerenone), and other blood pressure medications should also avoid taking spironolactone. Patients should also avoid potassium supplements as well as salt substitutes containing potassium while taking spironolactone.

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Other popular prescription topical antibiotics such as: clindamycin, topical retinoids such as tazarotene, and oral medications such as doxycycline or Accutane under a program called ipledge). Some dermatologists recommend birth control pills, especially if your breakouts are related to your menstrual cycle. Oral contraceptives can regulate the flow of hormones that affect sebum production; it often helps women with polycystic ovary syndrome, or PCOS, which usually causes an excess of male hormones.

There are also several over-the-counter acne medications, such as benzoyl peroxide (cleansers, creams, or gel), Differin gel, and a salicylic acid cleanser or moisturizer. Most prescription acne treatments have some side effects, and not all of them are compatible with everyone’s lifestyle. If you’re struggling to win the war against acne, make an appointment with a dermatologist to find out which treatment is best for you.

RELATED: Clindamycin Coupons | Learn more about clindamycin | Coupons for tazarotene | More about tazarotene | Coupons for doxycycline | About doxycycline

“Spironolactone is an affordable, effective off-label drug for treating acne in women”

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Wed, 29/03/2023 – 22:54 — M.A. Sergeeva

At a dermatology conference in Honolulu, Dr. J.C. Harper of Alabama shared her own clinical experience with off-label use of spironolactone for the treatment of acne in women.
“Spironolactone is very affordable, inexpensive and effective,” said Dr. J.C. Harper.
The aldosterone receptor antagonist spironolactone is widely used in the treatment of arterial hypertension and heart failure; the drug also has antiandrogenic properties, due to which it can be useful in the treatment of acne and hirsutism. Spironolactone reduces androgen production, inhibits 5-alpha reductase, and increases sex hormone-binding globulin (SHBG). Dosages for spironolactone in the treatment of acne range from 25 to 200 mg/day, but Dr. J.C. Harper “prefers to prescribe spironolactone at no more than 100 mg/day.”
In a previously published systematic review of experience with spironolactone in the treatment of acne in adult women, it is reported that the most common side effects of the drug are menstrual irregularities, breast engorgement and tenderness, drowsiness and headaches.
“The higher the dosage, the higher the risk of side effects,” explained Dr. J.C. Harper. With the combined use of spironolactone and oral contraceptives (COCs), menstrual irregularities are observed much less frequently; moreover, taking COCs eliminates the risk of possible feminization of the male fetus while taking spironolactone at the end of the first trimester of pregnancy. “When I first started taking patients, I told patients: if you take spironolactone, you will also need COCs. But the longer I worked, the more I became convinced that spironolactone can be useful both for those women who are contraindicated in taking COCs, and for those who simply do not want to take contraceptives.
A large retrospective study of data over a 14-year period showed that monitoring of potassium levels is not required for healthy women taking spironolactone for the treatment of acne.
“Healthy women between the ages of 18 and 45 who are not taking other medications do not need to monitor their blood potassium levels. I do not track this indicator,” said Dr. J.C. Harper.
From the start of spironolactone to the onset of clinical effect, it can take about three months, according to a report by Dr. J.C. Harper.
“Treatment is long and most often spironolactone is given in combination with other acne medications – topical retinoids, systemic antibiotics, or even isotretinoin.”
A study of long-term use of spironolactone for the treatment of acne in 403 patients showed that physicians most frequently prescribed spironolactone at a dosage of 100 mg/day, with 68% of patients also treated with topical retinoids, 2.2% with systemic antibiotics, 40.7 % – COC. The study included 32 patients with PCOS, 1 with a history of breast cancer, 5 patients had disorders of the blood coagulation system.