Spironolactone for Hormonal Acne?

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.

Doctor Answers 6

Spironolactone for hormonal acne - wait at least 2 months to judge effectiveness

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.

Hormonal Acne Treatments

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.

Eric Schweiger, MD
New York Dermatologic Surgeon
3.8 out of 5 stars 13 reviews

Spironolactone for Hormonal Acne

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.

Meg Cherry, MD
Birmingham Dermatologic Surgeon
5.0 out of 5 stars 6 reviews

Spironolactone verus Accutane (isotretinoin) for cyclic acne

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.

Christina Steil, MD
Chicago Dermatologist
4.7 out of 5 stars 17 reviews

Spironolactone is a great medication

Provided you are not planning to get pregnant, it can work very well for cystic acne, especially if you notice acne worsening around your periods.  Your doctor may change your dose if your acne hasn't cleared, as some patients respond well at lower doses and others need higher doses to clear acne.  Hang in there, and  hopefully you'll be happy with your skin soon!

Zoe Veritas, MD
New York Dermatologist

Spironolactone vs Accutane

Spironolactone is effective for many people with acne, and it's often tried before Accutane. If you've struggled with acne for this long though, my inclination would not be to make you go through a round of Spironolactone as I don't think it will do enough. As long as you don't plan to become pregnant I would put you on Accutane as in most cases, if followed correctly by the patient and dosed correctly, there is an 85% success rate of acne being gone forever.

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.