Spironolactone for cystic acne and weight gain/other side effects?

As far as spironolactone side effects, it can cause its own menstrual irregularities esp when you first use it. Since it is originally a diuretic blood pressure agent, you have to monitor potassium. Weight gain shouldnt really be an issue since you tend to urinate more fluids when you are on it. Spironolactone is handy in hormonal cystic acne because it also has androgen blocking effects.

Back to cystic acne. Hormonal cystic acne is its own world of beastiness. It is dominated by testosterone collection, bacteria, hormone imbalance and believe it or not, dryness not oiliness. It often gets improperly treated because physicians try to use a traditional acne approach. This does not work wtih hormonal cystic acne. You do not want to use all that benzoyl peroxide, high percent salicylic acid, peels, etc.. what you want to use for cleanser is something like paulas choice pore normalizing cleanser with only .5% salicylic acid. Just enough balance to keep your skin not oily but not overdry at the same time. You only need it twice a day. The bacterial part has to be addressed with something. Oral antibiotics are really not so good long term because they are systemic medications and the affect systemwide flora which effects our whole immune system especially the gi tract. Topical clindamycin 1 percent wipes twice per day do just the trick without the systemic effects of sun sensitivity. If your periods are irregular, I would suggest that you stay on a not predominantly progesterone dominate based pill and something that is monophasic ( single phase) something like norgestimate based like estarylla. I hope this is helpful for you. Here are some helpful links

Thanks for your question. I would not say that weight gain is a concern I have had patients report. The most common side effects I have reported and affect treatment course is headaches and dizziness. Less commonly reported by my patients are menstrual irregularity (quite common but not really a problem for most), fatigue, and decreased libido (sexual desire). Overall most do very well without any complication and are happy with the medicine but it is slower to see results compared to many acne treatments sometimes taking 3 months to see substantial changes. Good luck.