Spironolactone combined with what else? (Photo)

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.  

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