Spironolactone or Accutane: which is the better acne drug?

Question

I'm a 32-year-old woman and my face is covered with acne. I've tried numerous topical treatments, diet modification, and birth control pills with no success. About 60% of my acne resides on my chin and the rest is scattered throughout my face. I'm sick of avoiding events because I look like a Proactiv before picture and I'm ready to try a prescription. Would you recommend Spiro or Accutune? Can a patient take both simultaneously? I'm desperate to expedite this process.

Alim R. Devani, MD, FRCPC · Answer

The best thing to start with would be antibiotics for a few months and see how it goes. If you have cystic or scarring acne, accutane is a great option but comes with some side effects. Accutane works in 90% of cases and only fails 10% of the time. If you are worried about side effect, start on a lose dose and go from there. I think spironolactone is a good medication in the right patient but less predictable results and has a high recurrence after stopping. Be sure your on good skin care products that are oil free and also switch to mineral makeup. Good skin care products fo a long way. Try to find ZO Obagi products, I find they are very effective in acne treatments.

Estee Williams, MD · Answer

Both work very well. I agree with the other answers given, especially the recommendation to start an oral antibiotic (this should be tried before Accutane or spironactone are even considered in a female in her childbearing years) but will add a few points:-if you have signs of hyperandrogenism (literally too much male hormone) such as hairs where a male would have, deep voice, overly oily skin, or irregularly spaced periods (occurring more than 35 days apart), then you must have bloodwork to check for a hormonal imbalance -if a hormonal issue is discovered then spiro may turn to be more beneficial for you than Accutane, in combination with an oral contraceptive pill -if there is no hormonal imbalance, but you have irregular periods, then you may have Polycystic Ovarian Syndrome; a work up should be pursued -if all is normal, then you can go either way depending on your ability to handle side effects, since Accutane has more side effects but the results are generally more predictable -both spiro and Accutane can cause birth defects and will require you use highly effective birth control -unless there is a reason that you cannot take an oral antibiotic, you should start there. Be well.

John Louis Ratz, MD · Answer

Unfortunately, there is no quick way to treat acne. Spironolactone is usually nused for hormonal acne or acne that doesn't respond to antibiotics. Accutane is for severe cystic acne, but has some nasty side effects including elevated cholesterol and trigycerides (google "Accutane side effects"). Antibiotics are the mainstay for treatment for inflammatory acne, and are available in both oral and topical forms.However, ANY acne treatment can take 2 months before you might notice improvement. I suggest you see a good dermatologist for evaluation and treatment, but would not recommend that you start with either Accutane or Spironolactone.              jlr

Davin Lim, MBBS, FACD - Account Suspended · Answer

OK, Accutane has more side effects, but it offers a long term cure. The chance of this working is in the order of 99%. I like Spironolactone, especially in treating adult female jawline hormonal acne. The dose is usually 100mg, and apart from checking potassium levels, side effects are rare. The downside? Acne may come back if you stop the drug. I ve done a review on hormonal treatments for acne in the link below.All the bestDr Davin LimDermatologistBRISBANE, Australia

Spironolactone or Accutane: which is the better acne drug?

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Answer: Depends on your life circumstances.... read more

Answer: Depends on your life circumstances.... read more

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Spironolactone or Accutane: which is the better acne drug?

Answers (4)

Answer: Depends on your life circumstances.... read more

Answer: Depends on your life circumstances.... read more

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Recommended reading

Everything you need to know about Spironolactone For Acne

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