Spironolactone vs Accutane? (Photo)

Question

Hello, I have had hormonal acne since high school and I am now 26. I have tried all sorts of things but my doctor put me on 25mg of Spironolactone once a day. I have been on it for four months and have not seen a huge difference, maybe just a little less breakouts but not a big improvement. He wants to prescribe me Accutane but I know it is the most aggressive treatment. The half life of Spironolactone is very short and I am wondering if 25mg once a day is not enough to make a big improvement?

Jason Emer, MD · Answer

start spironolactone with accutane. with accutane you need to do at home peels and in office facials and laser.

All of my accutane/isotretinoin/acne patients do our accutane protocol from emeragecosmetics (where we do free skincare consults daily) and peels like aerify/cosmelan/enlighten.

Acne requires a combination approach to get long term improvement.  For all patients on isotretinoin, we require them to be on skin care such as vitamin C (Skinceuticals Phloretin CF, EmerageSkin AOX-C), glycolic cream (jan Marini bioclear, EmerageSkin enzymatic polish) , kojic acid serums (Skinceuticals phytoplus) and hyaluronic acid serum (IS clinical hydra cool serum, Skinceuticals B5, EmerageSkin hyla B) in the morning and retinols  (reve skin 1.0 and sente biocomplete serum) and salicylic acid (reveskin acne purifying enhancer), growth factors and peptides (anetageMD, EmerageSkin Re-Fit Face/Eye) night.

All of our patients get clear+brilliant non ablative laser along with a microsecond YAG laser such as aerolase or laser genesis and microneedling with PRP or microneelding RF like intensif or fractora monthly to help improve breakouts, speed the healing process, and improve scarring and facial redness while on the isotretinoin/accutane.  LED light therapy, cosmelan/enlighten/AERIFY peels, salt facial or dermalinfusion can be done as well to speed up the improvement. I suggest tyou go to an expert who combines skin care, lasers, microneedling, PRP, and facials while on oral medications for acne.  Best, Dr. Emer.

Viktoryia Kazlouskaya, MD · Answer

Accutane is a miracle medication in the right hands; however, I would try to increase the Spironolactone dose first. I usually try 50-200 mg for a few months before giving up...wish you the best

Reuel Aspacio, MD, FAAD - Account Suspended · Answer

Thank you for your question and photograph. Spironolactone and isotretinoin (Accutane) are both effective treatments, however, each therapy treats a different underlying cause. Spironolactone helps treat hormonal acne, and if low dose is not effective, then a slow increase is an option. Isotretinoin is an effective acne treatment but comes with many side effects and monthly responsibilities. I highly recommend you consult with your dermatologist regarding your questions and concerns about therapy. Take care and good luck.

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