Spironolactone and melasma - Will this exacerbate my melasma?

Question

I am in my 40's and still suffer from very oily skin which causes break outs and a nasty skin texture appearance. I also have really bad melasma, mostly on my upper cheeks. I wanted to get on Accutane, but that would force me to go on a birth control that would make my melasma worse (I learned this the hard way). My doc put me on 150 mg of spironolactone. Will this exacerbate my melasma?

Raffy Karamanoukian, MD, FACS · Answer

Skin discoloration is a very prevalent problem in women over the age of twenty.  It is also increasingly common in men with increased sun exposure, but mainly occurs in women. 
Risk factors include thyroid disease, sun exposure, hormones, pregnancy, family history, PIH, and birth control. Melarase AM and Melarase PM have been extremely effective in reducing pigmentation associated with skin discoloration and hyperstimulation of melanocytes. 
In my practice, patients with hyperpigmentation benefit from twice daily application of the creams. Melarase AM in the morning, followed by Melarase PM in the evening. Melarase AM contains four active sunblocks, so additional sunscreen is not needed unless your sun exposure is very high or you had a recent procedure/laser. SPF of 30. Melarase PM contains active skin lighteners to even out skin pigmentation. If you are concerned about the development of pigmentation, contact our office to discuss details and to obtain a regimen for Melarase. 
Laser therapy works but must be combined with a therapeutic topical program before and after therapy. 
Recommendations:  5-step Daily Brightening Kit has everything you need to improve dark spots, skin discoloration, melasma, and hyperpigmentation caused by sun exposure, hormones, scarring, and the environment. It’s a powerful daily brightening kit that can help bring out your skin’s natural, healthy glow. Ideal for use on the face, neck, and hands. 
Includes: Melaclenz, Melapads, Melarase AM, Melarase PM, Elevase, and Spectrase
Best, 
Dr. Karamanoukian
#Realself100 Surgeon

Jason Emer, MD · Answer

first off, you do not have to be on birth control when being on isotretinoin. second off, isotretinion can worsen melasma as can spironoactone.  I suggest you see a meslasma expert.  Likely there is nothing you can do but take the acne medications but do your best for the melasma at the same time with sun protection, lasers, mcironeedling and skin care.

Hratch Karamanoukian, MD, FACS · Answer

Spironolactone can exacerbate melasma. Melasma needs long term commitment with skin care and avoidance of skin factors such as sun exposure (Spectrase Sun Block) which has wide UV spectrum and SPF 30+ protection. 
Daily good habits with topicals may well help you chieve your goals with a good skin system like the Brightening Kit from KareSkin (see link). You may want to start with Melarase and Pigmentation Correction Complex. Scler-X from another vendor is for PIH relief (see link). 
Melarase AM is non hydroquinone based. 
Clear + Brilliant laser can be added once you start your pretreatment with topicals. 
Best
H Karamanoukian MD FACS

Davin Lim, MBBS, FACD - Account Suspended · Answer

Very rarely Spironolactone can spark off melasma, or worsen melasma, so the answer is that is possible but not likely. 
Melasma can not be completely cured, however effective treatment are possible. This is because your skin is extremely sensitive to UV and even the smallest amount can stimulate your pigment cells to produce colour. The mainstay of treatment is strict UV protection- hats, sunglasses and SPF every 4 hours. 
  
I prefer to use a combination of creams and laser for melasma. Hydroquinone can be used (5-8%), along with vitamin A creams. I usually start my patients on laser (low dose Q switch or Picosure) a few weeks after they commence on creams. Another laser I use is the Clear and Brilliant in the Permea setting combined with creams. 
  
In some cases I combine glycolic AHA peels, and in other cases I use a tablet called Tranexamic acid to help. Melasma treatments should be tailored to each patient. 
  
All the best, Dr Davin Lim. Laser, surgical and aesthetic dermatologist. Brisbane, Australia

Spironolactone and melasma - Will this exacerbate my melasma?

Answers (4)

Answer: Melasma and spironolactone.

Answer: Melasma and spironolactone.

Recommended reading

Everything you need to know about Laser Resurfacing

Our mission is to create a world where every investment in modern beauty is Worth It.

Spironolactone and melasma - Will this exacerbate my melasma?

Answers (4)

Answer: Melasma and spironolactone.

Answer: Melasma and spironolactone.

Browse related questions

Recommended reading

Everything you need to know about Laser Resurfacing

Our mission is to create a world where every investment in modern beauty is Worth It.