Spironolactone combined with what else? (Photo)

Question

Hi, my face erupted with acne this August. My texture began to turn bumpy (clogged pores) and then pimples began on the cheeks spreading to the jawline. I have really oily skin. My blood tests showed I have high testosterone. My new derm pressured me into Accutane but I felt it would be a temporary solution. We agreed with Spironolactone but I feel that I'd need to take more than just Spiro. I scar easily. What do you recommend to take along with it?

Melissa Chiang, MD, FAAD · Answer

Your acne is severe and I am worried about scarring.  I think you should give accutane a try, since it is the most powerful and effective acne medication.  Even if it doesn't control your acne completely, it will likely improve it. Regarding spironolactone, I often combine it with a topical regimen.  Retinoids are my favorite, so long as the patient isn't getting excessive sun exposure.  I also frequently combine doxycycline or minocycline with spironolactone.

John Louis Ratz, MD · Answer

Any treatment for acne can take 6 to 8 weeks before you might see improvement. So if you have just recently started the spironolactone, you might want to give it some more time. If not, an antibiotic would be a consideration. Antibiotics are available in both oral and topical forms. I would suggest starting with 2% topical erythromycin solution twice daily just to avoid taking two oral medications at the same time. Another topical is clindamycin. However, it can have some rare but serious side effects(I suggest you google it). Yet another option is topical dapsone which is relatively new, but can work very well in some people.I would discuss this with your dermatologist. jlr

Spironolactone combined with what else? (Photo)

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