Why didn't Spironolactone work for me?

Question

I am a 21 year old female with mild to moderate acne. When I was prescribed this med, my main concern was monthly pimples that were large, painful, and never formed a head. I would usually only get one at a time, and some whitheads. When I began taking Spiro, my acne got dramatically worse. I had closed comedones that stayed for months, actual "acne" breakouts on my forehead, and even the same larger pimples. I am off it now and am almost clear again. I was on it for 3 almost 4 months.

M. David Cole, MD, FAAD · Answer

I'm not quite sure why your acne got worse with spironolactone.  I have never seen this.  However, given your young age, I would not have chosen spironolactone as a treatment for you, unless you have obvious evidence of excess testosterone (increased hair growth, deep voice, irregular periods) suggestive of PCOS.  And even then, there are other treatments which should be tried from an endocrinologic perspective (metformin, etc.).  The best treatment for you would likely be a topical retinoid and an oral tetracycline family antibiotic.  If this didn't work, then you may need to consider Accutane.

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