Spironolactone May Be Helping my Moderate Acne. but my Skin is Dry, Red, and Irritated?

Spironolactone does not usually cause dry, red, irritated skin.  It more typically causes breast tenderness, spotting between menses, lightheadedness.The reason for irritated skin may be:1) irritant contact dermatitis - are you applying otc or prescription topical acne medications that are breaking down your skin barrier?2) allergic contact dermatitis - are you using a product/fragrance that you are allergic to?3) rosacea - is your acne actually rosacea, which is characterized by redness and sensitivity4) seborrheic dermatitis - do you have a component of seborrheic dermatitis, which is characterized by redness and flaking.   Seborrheic dermatitis is less likely to cause sensitivity though.

Dry skin is not usually a side effect of spironolactone.  If you are using another topical acne medicine with it, these may be the cause.  Based on your description it sounds like you may have seborrheic dermatitis (facial dandruff).  This won't respond to moisturizer alone.  You may need a topical steroid or another medication to control it.  Check with a board-certified dermatologist.

In general, you should be applying moisturizer all the time, whether you're taking spironolactone or not. A good, sensitive moisturizer for the face will be hydrocortisone 1%, available OTC from any pharmacy. This will help with the dryness and the redness. Apply it to damp skin, as it helps it be absorbed better. Then I would recommend a good, full body lotion like Lubriderm.