If I stop taking Spironolactone, is it possible that my hormonal acne will come back? Please help me!

Question

I got cystic acne after I stopped taking birth control pills and I've tried antibiotics, benzoyl peroxide 10%, salicylic acid 10% creams and cleansers, glycolic acid cleansers, retinols and nothing is helping. My dermatologist prescribed me spironolactone but I'm afraid to give it a try if the acne will come back worse when I stop taking it.

Grace Liu, MD · Answer

Hi,Female hormonal acne responds exceptionally well to spironolactone.  There are many studies documenting how well it works when other acne medications have failed.  One alternative we have in our office is a prescription topical spironolactone in a cream for patients that don't want to take an oral.  We have found this to be very effective in patients that have hormonal chin acne.Warmly,Dr. Liu

Laura A. Katz, MD · Answer

Hormonal acne is a real beast and something that requires proper understanding to conquer.  HEre we go.  Hormonal cystic acne is dominated by bacteria, testosterone abundance, and believe or not, dryness NOT oilyness like it looks like.  So these are the areas that should be tackled to fix it.  First, you do not want to use peels, 10% salicylic etc because the actually naturally dry skin will attack back and produce even more oil to fight you!  Totally unfair.  The most salicylic acid you would ever want to use on your face would be like a Paulas choice pore normalizing cleanser with only .5% salicylic.  It maintains that perfect balance bet moisture and drying so that your skin does not have to fight back.  As far as the bacterial component, that's where all the cystic stuff comes from.  Simple topical cleocin wipes twice a day will quickly get rid of that bacteria without all the sun sensitivity of other topical or oral antibiotics.  As far as controlling the extra skin testosterone, a birth control that is appropriate for your body should nicely bind up extra testosterone.  Also, spironolactone, originally a blood pressure medicine was found to have significant androgen blocking properties.  Sorry that was a lot of words but i hope that helps.   HEre are two links that could be helpful,

Pamela Kimbrough, MD · Answer

Your acne will not necessarily come back worse if you stop the Spironolactone, although it may return.  Spironoloactone is actually a mild diuretic (water pill) which also blocks androgens (such as testosterone) at the follicle.  I use this medication quite a bit for help with acne, as well as unwanted facial hair.  In addition, there are typically no side effects to be concerned about.  Hope this helps!

Amy Miller, MD · Answer

Don't be afraid!  Absolutely start the spirno--if the acne is hormonal in nature it will help immensely.  When stopping birth control pills it can often take a awhile for your body to normalize its hormonal status (we're talking months).  The skin, being an organ with hormone receptors, will freak out accordingly until things settle down (like my official medical terminology?).  The spirno can help you bridge that gap and get through until the hormones regulate.  Often my patients will not let me take them off of the spirno because it works so well.  In these cases I have a compounding pharmacy create a topical cream with spirno in it.  That way you can use it long term with much less systemic effects.
Do not fear the spironolactone!  Best of luck to you,
Dr. Amy

If I stop taking Spironolactone, is it possible that my hormonal acne will come back? Please help me!

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