Spironolactone or Accutane for oil and congestion?

Question

I have limited break outs but severely oily skin and congested pores that become stretched as a result. One doctor recommended spironolactone and another recommended a course of 20mg Accutane. Re spironolactone I am confident it will work as it worked for my sister but I am concerned about the association with cancer and the need to take a pill every day. I was also told that Accutane may not help with oil after the treatment. Which course is safest and most effective?

Anna Chacon, MD, FAAD · Answer

Both Spironolactone and Accutane (isotretinoin) can be effective in managing oily skin and congested pores, but they work in different ways and have different side effect profiles.
Spironolactone is a diuretic that has anti-androgen effects, meaning it can help reduce sebum production and potentially improve oily skin and congested pores. However, it typically needs to be taken long-term for continued effect and does have potential side effects, such as dizziness, increased urination, and menstrual irregularities. The association with cancer is based on animal studies and the relevance to humans is uncertain.
Accutane, on the other hand, works by reducing the size and output of sebaceous (oil) glands. It can be very effective for severe acne and for people with oily skin. The effects on sebum production can be long-lasting, even after discontinuing the medication. However, it has a range of potential side effects, including dry skin and lips, joint pain, and more serious potential effects like mood changes and birth defects if taken during pregnancy. Regular blood tests are required to monitor for these potential side effects.
In terms of effectiveness, both can be effective, but Accutane is generally considered more potent. In terms of safety, both medications have potential side effects that need to be considered and monitored.

Laura A. Katz, MD · Answer

From your description, altho it is tough to say without a pic, it sounds like you have hormonal acne..the kind where it gets cystic, pustules don't ever want to rupture compoletely and disappear.  It seems oily but it is actually a dry condition like other acnes but it will fight you and become oily if you try to dry your skin out.   Usually hormonal acne is caused by a combination of testosterone by product buildup, dryness, and bacteria.  All three need to be addressed.  Things to address with regards to the dihydrotestosterone in your skin could be birth control pills which bind up extra testosterone or spironolactone, originally a blood pressure medicine that was also found to be a blocker of male hormones.  To address the bacterial portion, topical cleocin wipes twice a day without being over drying or sun sensitive.  Also, you want to resist the temptation to use drying substances like retin a or accutane/  Just use paulas choice clear pore normalizing cleanser twice a day.  it only has .5% salicylic acid in it so your skin will not overdry.   Hope this helps.

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