Discouraged.. Cystic acne chin only on spironolactone 100 mg die since 3 months: increase spironolactone or take accutane?

32 years old, known for papulopustular Rosacea since one year well controlled with rosiver. I developed 6 months ago cystic acne on chin only.. I started spironolactone 100 mg die 3 months ago with a clearance of 80% of comedones and less cysts.. (1 cyst each two weeks instead of 2-3 cysts/week) without secondary effects. This week I developed 3 cysts in a row... Is it safe and effective to increase to 150 mg die of spironolactone or should I take accutane?

Doctor Answers 1

Spironolactone and dosage.

You have several options, firstly you can add a topical such as Erythromycin gel, clindmycin gel, or if its more rosacea than acne metronidazole gel. The other option is to increase spironolactone to 125-150 mg HOWEVER you must be under the guidance of an endocrinologist, general dermatologist or physician. Spiro can increase potassium levels, so monitoring is advised. The other option is to hold on 100mg, add Isotretionoin 20 mg 2-4 nights per week. Discuss with your medical dermatologist what is the best treatment option for you. All the best, Dr Davin S. Lim. Laser dermatologist. Brisbane. Australia. 

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