41, female, topical spironolactone for adult hormonal cystic acne on jawline?

Question

Im 41 female, have struggled on and off with jawline hormonal cystic acne and it is very upsetting. Is topical spironolactone effective? I dont like the idea of systemically taking this med orally. I have tried many other treatments. use retin a currently with little benefit, took accutane about 15 years ago with some temporary improvements. I have scarring and continue to breakout , I dont know what else to do, any suggestions please help

Sergio Martinez Lecompte, MD · Answer

Hi! I like to treat Adult Women's Acne with Spironolactone, it is safe and in most cases a very effective option even for long term treatments. But if you are in the U.S. there is a topically relatively new effective option, Clascoterone is a topical medication that you can discuss with your practitioner,.

Laura A. Katz, MD · Answer

Hormonal acne is its own fierce beast and behaves and responds differently than all of the other acnes typically treated by dermatologist.  Therefore success rates tend to be low without a true understanding of whats going on with the skin.  Here's the breakdown on hormonal acne.  First, it's actually a naturally dry condition rather than an oily one like most people think.  People usually attack with severely overdrying treatments like accutane, peels, excessive benzoyl peroxide, etc.  This is the first mistake.  You actually want to use for twice daily cleansing a cleanser that has no more than .5% sallicylic acid.  The best one on the market right now is the paula's choice pore normalizing cleanser. You have to make sure that you are ordering the one with the ,5% salicylic acid.  Next, there is a significant bacterial component that needs to be addressed with hormonal acne.  Topical clindamycin phosphates wipes bid have the least side effects, systemic effects and sun sensitivity and do a great job on bacterial suppression.  The last significant component to the hormonal acne is the hormonal imbalance and dihydrotestosterone excess.  These can be treated in two usual ways.  Oral spironolactone, traditionally a blood pressure medication also has androgen blocking capabilties.  Or, the proper birth control pill can increase the sex hormone binding globulin enough to sequester the extra testosterone in the skin.  If these three areas of concern are not all treated together you won't be able to be successfully treated.  Here is a helpful link with some before and after pics.

41, female, topical spironolactone for adult hormonal cystic acne on jawline?

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