Spironolactone for Hormonal Acne?

Question

I have been struggling with cystic acne on and off for 16 years. I am currently 35 and had a very bad cystic breakout back in november so my derm put me on spironolactone. I am now taking 100mg a day and am at 6 weeks. My acne gets worse before my cycle but I breakout all the time. Will the spiro work for me? I have been asking for accutane for yrs and the derm believes that it will clear me but the acne will come back. I also have had a few nodules so I am worried about more scarring.

J. Jason Wendel, MD, FACS · Answer

Thank you for your question about Spironolactone for the treatment of Acne.  Spironolactone is typically used to treat acne that is cystic and in the distribution area of the chin and jaw line.  It is an anti-andronergic medication, meaning it counteracts male hormones in the body that can drive acne.  As long as you are not pregnant, nursing, have decreased kidney function, or have sensitivity to Spironolactone you may do well on the medication if your acne is driven by these hormones.  It is ideal to start on a low dosage and increase as needed per your provider.  It is also a good idea to have baseline labs and monitor them routinely to check kidney function.  It is also likely you may need additional acne medications such as tretinoin, Aczone, sulfa wash, clindamycin gel, or other topical acne meds in addition to the Spironolactone. 
To be sure, see two or more experienced, licensed and board-certified providers in your area for a complete evaluation to make sure you are a good candidate and that it is safe for you to have treatment. I hope this helps.

Melissa Chiang, MD, FAAD · Answer

I agree with your dermatologist.  Spironolactone, along with a good topical regimen, may be the key to getting your acne under control.  I typically see "active" acne patients back every 2 months so we can see the results of our treatment and "tinker."  You really won't know if spironolactone will work until you've taken it for at least 2 months, and it's full effectiveness may not be apparent for several more months.  If you see an improvement, but your acne is still quite active, you could consider adding complimentary treatments that work by different mechanisms.

Eric Schweiger, MD · Answer

Spironolactone is an excellent treatment for cyclic acne.  As other doctors have mentioned, it is used 'off-label' for the treatment of acne, though it is routinely used by dermatologists across the country.  It takes approximately three months to see the full improvement from taking spironolactone; so, at this point I would tell you to be patient.  Sometimes spironolactone works best when combined with an oral contraceptive bill; this is something to discuss with your dermatologist. Accutane is another great treatment option for moderate to severe recalcitrant acne, though it does not always yield a long lasting result if you have true hormonal acne.

Meg Cherry, MD · Answer

Spironolactone is a blood pressure medication that can also be used to treat acne. It can be very helpful for hormonal acne which flares before the menstrual cycle and is an option to try prior to accutane. If you are taking 100mg a day and not responding after a few months of treatment, then it may not best treatment for your acne and accutane would be a reasonable next step.

Christina Steil, MD · Answer

If you are willing to take Accutane for your acne and have no contraindications, then by all means you should be treated with a course of Accutane.  Your acne will improve.  However, many females with severe hormonal acne who have been treated with Accutane, will continue to experience residual acne.  Sometimes the acne will be controlled by topicals, but many women may still need either an oral contraceptive or spironolactone to control their acne. 

	The dose of spironolactone ranges from 25-200mg/ day for acne. 

	Good Luck.

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Spironolactone for Hormonal Acne?

Answers (7)

Answer: Spironolactone for Hormonal Acne

Answer: Spironolactone for Hormonal Acne

Answer: Spironolactone verus Accutane (isotretinoin) for cyclic acne

Answer: Spironolactone verus Accutane (isotretinoin) for cyclic acne

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