Spironolactone for Acne: A Complete Guide

It's being called the "miracle pill" for hormonal acne.

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It wasn't until I hit my late 20s that I started to explore spironolactone for acne. Prior to that, I was mostly zit-free — save for the odd pimple that would pop up around my period. But as soon as I turned 28, something changed. I started getting a few hormonal, cystic pimples on my chin and jawline, regardless of where I was in my monthly cycle. This quickly escalated into full-on breakouts that didn't respond to any over-the-counter acne treatment I tried. But before turning to a prescription treatment, namely, spironolactone, I tapped dermatologists to learn more.

Keep reading to find out everything there is to know about spironolactone for acne.

What Is Spironolactone?

"Spironolactone has been around for over 50 years," Dr. Cybele Fishman, a board-certified dermatologist in New York City tells me. "It was originally used as a blood pressure medicine because it's a diuretic and when you pee more your blood pressure goes down. Now, it's not regularly used to lower blood pressure, but to treat hormonal acne, female pattern hair loss, and PCOS [polycystic ovary syndrome] due to its anti-androgen activity."

How It Works

Spironolactone acts as a roadblock for androgen hormones in your body by preventing them from overstimulating the skin's oil glands. "In women with hormonal acne, androgens appear to have a strong impact on sebaceous gland activity," explains Dr. Fishman. "Spironolactone blocks the effect of those androgens. Testosterone and dihydrotestosterone are the main ones, but progesterones also have some androgen activity." This is why women often experience breakouts right before their period, as they get a spike in progesterone.

What to Expect

"It takes about three months at the right dose to get the full effect," says Dr. Joshua Zeichner, director of cosmetic and clinical research in dermatology at Mount Sinai Hospital in New York City. "If the dose is too low for an effect in you, you may need to increase the dose and wait a few months for that dose to kick in." If you've been taking the pill for over three months and your hormonal acne situation isn't any better, it might be time to try a new dose or another treatment option.

Who It's For

"When using it to treat acne, spironolactone is only used in women and tends to work best for women with hormonal acne, menstrual flares, adult-onset acne, or conditions with hormone abnormalities and acne (e.g. PCOS)," explains Dr. Sejal Shah, cosmetic dermatologist and founder of Smarter Skin Dermatology in New York City "It is also often used in women whose acne is resistant to conventional therapies." "At a high enough dose, it has some effect on all women," adds Dr. Zeichner.  "The issue is that at higher doses it may be associated with side effects like breast tenderness or irregular periods, which get in the way of using it."

Side Effects

You Will Pee — A Lot

The pill itself is a diuretic, so frequent urination is expected. Personally, I peed every 30 minutes the first week or so I was on spironolactone. (Yes, I counted.) The interval eventually tapered off, but I still pee more than I did before I started taking the medication.

Your Period Cramps May Worsen

Taking spironolactone may also affect your period. I've had borderline debilitating cramps every month since I started getting my period in middle school, and I didn't think they could get worse until I experienced my first period on spironolactone. Dr. Shah says it's possible that these intensified cramps could be caused by hormonal changes from taking the drug. My cycle lasts longer, too. (Lucky me, right?). But what I haven't dealt with is spotting, which is a common side effect of spironolactone.

You May Feel More Tired Than Usual

When my body was adjusted to spironolactone, I was so exhausted I could have easily fallen asleep standing up while in line at the grocery store — even though I was taking a very small dose of the medicine. Since then, my energy levels are back to what they used to be before taking the pill. "Spironolactone blocks the hormone aldosterone, which can lead to fatigue," Dr. Shah explains. "In addition, it can lower the blood pressure, and if this drop is sudden, you may feel tired."

Is Spironolactone Safe?

Sure, the everyday side effects of spironolactone are minimal, but what about the long-term risks of being on it? Breathe a sigh of relief, because it falls under "very safe" on the spectrum of medications. However, if you are planning on getting pregnant, you shouldn't take spironolactone. "Theoretically it can cause birth defects, so you should use contraception if you are on it," says Dr. Zeichner.

And although it's not associated with cancers (including breast or ovarian) in humans, both Dr. Zeichner and Dr. Shah note that spironolactone does have a black box warning because high doses have caused tumors in rats.

The Final Takeaway

Spironolactone may sound too good to be true, but if you've struggled with hormonal acne and have exhausted other treatment options, this pill may finally be the exception you've been searching for. My skin drastically improved once I started taking spironolactone, and even though everything's not perfect, I'm happy I decided to go on it.

Frequently Asked Questions

  • Will my acne come back if I stop taking spironolactone?

    The reality is that spironolactone only works when you're on it. If you do stop taking it, it's possible that your hormonal acne will come back. "The effect of the body's hormones will go back to what it was before you started," says Dr. Zeichner.

  • Is it possible to still get breakouts while taking spironolactone?

    According to Dr. Zeichner, it's possible to experience mild breakouts after being on spironolactone for a year. "You are not the same person you were a year ago," Dr. Zeichner said. "The hormones and sensitivity to those hormones may change over time, which means you may need to adjust your dose."

  • Is Accutane or spironolactone better?

    It depends. Both are used to treat acne but Accutane typically only requires a few months of treatment while spironolactone is a medication you'll need to use long-term in order for it to be effective. However, spironolactone tends to have milder side effects than Accutane. That being said, spironolactone might not work for everyone. You should talk to your dermatologist to see which treatment is best for you.

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