Is spironolactone safe long term? I am not sure the benefits outweigh the side effects and want to know if I should stay on it.

Thank you for your question about Spironolactone.  The lowest recommended does for Spironolactone to treat hormonal acne is 50mg.  I would encourage you to speak to your healthcare provider to see if it would be safe to take along with birth control.  Spironolactone is not safe in pregnancy, therefore I would caution recommend without speaking to your gynecologist. 
One safe and easy treatment we recommend to all of our patients are our Koji Pads.  Kojic acid along with Arbutase work well for brightening the skin and preventing blemishes.
To be sure, see two or more experienced, licensed and board-certified providers in your area for a complete evaluation to make sure you are a good candidate and that it is safe for you to have treatment. I hope this helps.

Thanks for your question.  It is not uncommon for dermatologists to prescribe spironolactone along with birth control and they can work well together.  Please call your prescribing physician's office and discuss your questions, since they might have a protocol they follow for acne and will know your individual case better than a general question for a large community.  It is not harmful to take both spironolactone with birth control, and I would rather have my patients on birth control and then start the spironolactone as a "boost".  I would not recommend taking just spironolactone if you are considering pregnancy any time soon, as it is never recommended during pregnancy and you wouldn't want to take any chances.
Best of luck!