I'm on my 7th week of 100mg Spiro, and my acne is the worst it has ever been. Is it normal for it to get so much worse? (Photo)

Hello there.  Let's first look at what each medication does.  Retinol products bind to the retinoic acid receptors in your skin and stimulate cell turnover, but at the price of some extreme overdrying in certain cases.  This overdrying leads to your skin going into a defensive mode and actually producing more oil, which results in more acne.  The minocin is an oral antibiotic that is supposed to be addressing the bacterial component of your acne.  Long term oral antibiotic use can result in skin sensitivity and disruption of the good bacteria in your body.  Spironolactone is a diuretic medicine that attempts to decrease the male hormone component of your acne.  From the looks of your photographs, it looks like you are suffering from hormonal cystic acne with a bacterial component and that you are having reactive oil production from the over drying affects of the retinol product on a daily basis. Hormonal acne is a different kind of acne that requires more indiviualized treatment.  At Laura A. Katz, MD PC in Monroe, Mi, we would probably treat your acne with a combination of topical cleocin roll on for the bacterial component, with cleansing of the alcohol tip after each application.  We would also use low dose birth control if there were no contraindications.  Using birth control would decrease the testosterone breakdown products in your skin and help clear up the cystic areas by binding them up using an increase in a protein called sex hormone binding globulin.  Spironolactone would be added later possibly to further decrease the testosterone products only if birth control and cleocin were not enough.