If you haven’t heard of spironolactone, it’s a prescription drug used to treat health issues like high blood pressure and heart failure. However, what most people don’t know is that it can be used as an acne treatment, too. Alice Lang, a 23-year-old blogger from North Wales, discovered this after nearly 10 years of struggling with acne and experimenting with a wide range of prescribed medications, including birth control. Lang recently opened up to Popsugar about her experience, and how spironolactone ultimately saved her skin.
It was while she was working in Vietnam — Lang is an avid traveler — that her blemishes became more severe than ever, and she realized it was time to explore other options. Before visiting a new doctor, Lang did her own research and stumbled upon spironolactone while looking into polycystic ovarian syndrome (or PCOS), which is a hormonal disorder known to cause acne. Once she read more on the drug, she decided to visit a dermatologist in Vietnam, explained her findings, and convinced the doctor to let her try the treatment under her supervision. “I began taking 50 milligrams a day. It didn’t work at all for around two months — in fact, my acne seemed to get worse at first,” Lang told Popsugar. “But suddenly, my acne began clearing up and now, four months later, I have no acne at all. It’s amazing!”
Lang posted about her experience using spironolactone on her personal blog in January, along with several striking before-and-after photos to show how much her skin improved. “Here is a photo on Spironolactone,” she wrote. “The top image is what my face looked like at this stage (the reason there’s yellow patches is because the only thing which would help heal my spots was turmeric — which also stained your skin for a few days. What a mess). The bottom image is now (makeup free).”
Courtesy of Alice Lang
It’s pretty evident that spironolactone made a significant difference in Lang’s skin health, but her experience made us wonder: Is the drug actually safe to use as an acne treatment? According to Joshua Zeichner, the director of cosmetic and clinical research in dermatology at Mount Sinai Hospital in New York City, yes it is.
“Spironolactone is my special weapon against acne in adult women and is a very safe medication,” Zeichner tells Allure. He says the drug is perhaps the most effective tool he has to treat hormonal breakouts, as it’s formulated to block oil production. “If the oil glands do not make as much oil, there will be fewer blockages in the pores, less food to feed acne-causing bacteria, and less shininess,” he says. Spironolactone results typically appear within a few weeks, but Zeichner says the drug reaches “peak effect” at around three months.
The one caveat? While spironolactone will prove effective as long as you’re on it, when, and if, you go off of the medication, your body will revert back to developing pimples, says Zeichner. Like with most medications, there are side effects, such as breast tenderness, irregular periods, and potentially birth defects. So if you’re contemplating pregnancy, talk with your doctor before going on the drug.
All of this to say: If you struggle with hormonal acne and have yet to find a treatment that works for you, make an appointment with your dermatologist for more information on spironolactone.
For more acne reads:
- Blogger With Acne Shares Makeup-Free Selfies and Messages of Support
- Acne-Positive Blogger Dropped From Campaign for “Skin Issues”
- All the Models In this Portrait Series Have Acne
Now, find out how to clear up cystic acne in four easy steps:
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- Stubborn acne? Hormonal therapy may help
- What exactly is hormonal therapy for acne?
- How well does hormonal therapy work, and is it safe?
- What’s involved in taking hormonal therapy for acne?
- How long does it take to see results?
- How long do most patients take hormonal treatments?
- What are the possible side effects?
- What helps get the best results?
- A Pill For Hormonal Acne
- Females with acne stay on spironolactone longer than antibiotics in real-world usage study
Stubborn acne? Hormonal therapy may help
Women who have acne along their jawline and lower face tend to have good results from hormonal therapy for acne. Do you continue to see acne along your lower face, jawline, and neck despite trying all sorts of acne treatments? Have you taken an antibiotic to treat your acne and been disappointed with the results? Are you struggling to clear acne on your chest or back as well?
Women who answer yes to any of these questions may want to consider hormonal therapy for acne.
What exactly is hormonal therapy for acne?
Any medication that acts on our hormones is called hormonal therapy. Two hormonal therapies that can effectively clear acne in women are:
Oral contraceptive pills (better known as birth control pills or “the pill”)
How well does hormonal therapy work, and is it safe?
The pill: Many studies have looked at how well oral contraceptive pills fight acne. The pill has been found effective at treating blackheads, whiteheads, pimples, and acne nodules and cysts.
In fact, the pill has proven so effective that the US Food and Drug Administration (FDA) has approved some oral contraceptives for treating acne.
The pill is generally considered safe for women. Some women, however, should not take it. Your dermatologist can tell you whether the pill may be a safe and effective treatment option for you.
Spironolactone: Doctors prescribe this medication to treat high blood pressure. It’s also prescribed for people who are retaining too much fluid.
Dermatologists have been prescribing it for many years to treat acne and excess hair growth in women. When other acne treatments don’t work, it can effectively treat deep-seated, tender acne on the lower face, jawline, or neck.
Spironolactone is not prescribed to treat acne in men due to side effects. Men have developed breasts while taking this medication to treat acne.
Spironolactone is generally considered safe for healthy women.
Taking both spironolactone and the pill can increase effectiveness. This combination has another advantage. It’s essential to use birth control while taking spironolactone. If you get pregnant while taking spironolactone, your baby can have serious birth defects.
Spironolactone may also be prescribed without the pill. If you’re 35 years of age or older, the pill may not be an option for you and only spironolactone may be prescribed. Taking spironolactone without the pill is also recommended when you have a medical condition that makes it unsafe to take the pill, such as having had a blood clot or stroke.
When taken alone, spironolactone can be quite effective. In looking at the medical records of 85 women who took spironolactone, researchers found that 1/3 of the women had complete clearing and 1/3 had noticeably less acne. Only 7% saw no improvement.
A word of caution
If you can get pregnant, you’ll need to use birth control while taking spironolactone.
Studies have also shown spironolactone to be effective. Improvement ranges from a 50% to 100% reduction in acne.
Before taking spironolactone, it’s important to know that this medication is a diuretic, so you’ll find yourself urinating more often. If this could be a problem, let your dermatologist know.
Spironolactone and potassium
If you take spironolactone, too much potassium can be dangerous. Skip the coconut water and supplements that contain potassium.
What’s involved in taking hormonal therapy for acne?
These medications must be prescribed by a doctor. Each is a pill that you would take daily.
If you’re wondering whether hormonal therapy could help clear your acne, you may want to make an appointment to see a dermatologist. After examining your acne and gathering the necessary information about your health, this doctor can tell you if hormonal therapy may be an option.
Before you see a dermatologist, it helps to prepare for your appointment. You’ll want to be able to tell your dermatologist the following:
Medical conditions you have (or had), including high blood pressure, heart disease, blood clots, migraines, or cancer
Medications you take
Supplements and other natural products you take
Surgeries you’ve had
Medical conditions of close blood relatives, including cancer, kidney disease, or heart disease
If the pill is an option for you, you will have your blood pressure taken to rule out high blood pressure. You don’t need a Pap smear or pelvic exam before a dermatologist can prescribe the pill to treat acne.
Before your dermatologist prescribes spironolactone, you will need some blood tests.
If you begin hormonal therapy, you will need to keep follow-up visits with your dermatologist. Spironolactone requires that you gradually increase the dose, so you’ll need to see your dermatologist every 4 to 6 weeks when you start taking it.
How long does it take to see results?
As with other acne treatments, it takes time to see results. On average, women notice improvement as follows:
The pill: 2 to 3 months
Spironolactone: A decrease in breakouts and oilness in a few weeks
How long do most patients take hormonal treatments?
When hormonal therapy helps to clear acne, a patient may stay on it for a long time. You will often stop other acne treatments such as an antibiotic and medication that you apply to your skin. Hormonal therapy can be used alone to prevent new breakouts.
Taking hormonal therapy long term appears to be safe.
Studies show that taking spironolactone at the same time every day can give you the best results.
What are the possible side effects?
To reduce the risk of a woman developing serious side effects, dermatologists carefully screen their patients before prescribing hormonal therapy. Possible side effects include the following.
The pill. Taking the pill increases the risk of:
High blood pressure
While these side effects may not seem worth the risk, most women who are healthy do not have side effects. In fact, the risk of developing blood clots is greater during pregnancy and just after having a baby than when taking the pill.
It’s also important to know that there is less risk of serious side effects today than in past. Today, the pill contains less estrogen.
Some women taking the pill develop melasma, or dark patches on their face. Protecting your face from the sun can help prevent these patches.
Breakthrough bleeding is another possible side effect. You can often prevent this by taking the pill at the same time each day.
Acne and the pill
If you take the pill, you can reduce your risk of blood clots by staying active, drinking lots of water, and not smoking.
Spironolactone. When taking spironolactone without a birth control pill, the most common side effects are:
Painful periods and cramping
These side effects may be decreased when women also take the pill.
Other possible side effects of taking spironolactone include fatigue, headache, and dizziness. These rarely cause a woman to stop taking the medication.
You may also see a warning about breast cancer in the information that comes with the medication. This warning was included after researchers gave animals very high doses of spironolactone. Some of the animals developed breast cancer.
The possibility that this medication increases a woman’s risk of getting breast cancer is still controversial.
We really don’t have evidence that shows taking spironolactone increases the risk of getting breast cancer. In one study, 1,475 patients prescribed spironolactone were followed for 3 to 7 years. During that time, 9 cases of breast cancer were reported. If none of these patients had taken spironolactone, it is expected that about 8 of them would have developed breast cancer during that time. Other studies have shown similar results.
What helps get the best results?
When taking hormonal therapy for acne, it helps to:
Give the medication time to work
Take the medication at the same time every day
Use everything on your acne treatment plan
Keep all follow-up appointments with your dermatologist
Contact your dermatologist’s office right away if you experience signs of a serious side effect, such as cramping in your leg or arm
Hormonal therapy is an option for many women with stubborn acne, but it’s not always the only option. A dermatologist can tell you what can help clear your stubborn acne.
Carol, R. “Hormonal therapies serve as key adjunct acne treatment.” Dermatol World. 2012 May (Acne suppl). 2-6.
Ebede TL, Arch EL, et al. “Hormonal treatment of acne in women.” J Clin Aesthet Dermatol. 2009; 2(12): 16–22.
Harper JC. “Use of oral contraceptives for management of acne vulgaris. Practical considerations in real world practice.” Dermatol Clin. 2016;34(2):159-65.
Kim GK, Del Rosso JQ. “Oral spironolactone in post-teenage female patients with acne vulgaris: Practical considerations for the clinician based on current data and clinical experience.” J Clin Aesthet Dermatol. 2012;5(3):37-50.
Plovanich M; Weng QY, et al. “Low usefulness of potassium monitoring among healthy young women taking spironolactone for acne.” JAMA Dermatol. 2015;151(9):941-4.
Reynolds RVS. “Hormonal treatment for acne.” Presented during the forum: Acne guidelines: Translating evidence into practice. 2017 Annual Meeting of the American Academy of Dermatology; 2017 March 3-7. Orlando, FL.
Zaenglein AL, Pathy AL et al. “Guidelines of care for the management of acne vulgaris.” J Am Acad Dermatol. 2016;74:945-73.
A Pill For Hormonal Acne
When you talk about acne and its various treatments, experiences start to feel like different levels in a video game. Some people only make it to the topicals before their acne clears up, and some of us go beyond that, into retinoids, antibiotics, and medicated pads. Perhaps you’ll take the bonus detour (The Pill), or maybe you go all the way and reach the super boss, Accutane. One thing you might not know, though, is that there’s a secret level: the level known as spironolactone.
It’s oral, it’s hormonal, it’s only for women (power up!), and it’s the only thing that’s worked for me. Originally formulated to treat hypertension and a few other cardiovascular troubles, spironolactone is a drug that, at a lower dose, can help with hormonal acne. It’s also an androgen blocker (that delivers just the teensiest bit of progestin) and a diuretic. Let’s break that down, shall we?
Androgens (like testosterone) are responsible for a few masculine-leaning traits—things like body-hair growth and sebum production. Spiro blocks some of the body’s production of androgens, which is why it’s not generally prescribed to men. Though on my early days on spironolactone, initial searches led me not only to a death-is-surely-near WebMD article, but more originally, to several transgender community boards sharing stories about the drug. It’s prescribed to trans women for almost the same reason as it would be to me—to block male hormones. It’s likely my dosage varies with that of a trans woman, but it’s still interesting to be at that kind of intersection of experience. Sure enough, my body hair got thinner and lighter.
And though it treats hormonal acne, it’s not a quick fix. Spiro takes abut three months to kick in, and it’s possible you’ll still get small monthly menstrual-cycle-related breakouts on it. The main difference is that you’ll get a manageable, gone-in-two-days kind of zit—not an entire situation on your face. And right, it’s a diuretic, which means you’ll be going to the bathroom more times a day than you’d prefer. It’s also potassium-sparing, which means there’s a slight risk of building up too much potassium in your body. It’s advised that you cut down on potassium-rich foods while on the drug (not a problem with papaya, tougher with tomatoes) and get your blood checked every six months to a year (depending on your dosage and doctor).
For a medical perspective, I spoke to Certified Physician Assistant Loree A. Easley of Mid-South Dermatology and Skin Cancer Center, who first prescribed me the drug back in the day. “I feel spironolactone is a wonderful medication to help post-teenage or adult female acne patients,” Easley said. “Adult female acne patients tend to present a typical pattern of acne close to the chin and jawline with hard nodules that are painful and long lasting, often with dark marks or scarring that occurs as the acne resolves,” Whereas other forms of acne could be bacterial, spironolactone treats the hormonal. “I like to explain that spironolactone is blocking the skin’s sensitivity to testosterone, the male hormone that is causing the acne to the jawline where a male would have a beard,” she added.
I’ve been on spiro for a few years. As long as you keep coming up fine on your blood work, you can stay on it as long as you like (pregnancy aside, if that’s your thing—it doesn’t impact any kind of birth control if it isn’t). For some reason, spiro is the acne solution that still seems to fly under the radar, as it has nowhere near the cultural cache of Accutane nor the universal reputation of salicylic acid. And yet mercifully, after years of pustular frustration, it’s the one thing that has given me an ordinary complexion. Because that’s the thing with acne—if you have it long enough, you stop hoping for perfect skin. You just want normal, average skin—the kind of skin that the guy sitting next to you at the DMV has—not great, not bad, just regular-person skin that never gets complimented but also never gets uncomfortably scanned by your daily barista. And spironolactone lets me feel like that there’s nothing between me and the world at all—just the standard-issue body casing everyone else gets. Let me tell you, it feels great to just be regular.
So at the risk of sounding like a pharmaceutical ad, if you’ve got acne that’s not going away, talk to your doctor about spironolactone. Pretty sure dermatologists love conversations that start with, “So I read on the internet..,”
Photographed by Tom Newton.
Females with acne stay on spironolactone longer than antibiotics in real-world usage study
Female patients with acne may benefit from continuing treatment with spironolactone longer than with oral antibiotics, according to a retrospective study of women with acne published in the Journal of the American Academy of Dermatology.
Among those treated for at least a year, patients continued spironolactone for about 90 days longer on average, than those on antibiotic therapy, reported John S. Barbieri, MD, of the department of dermatology at the University of Pennsylvania, Philadelphia, and associates. “The extended drug usage survival of spironolactone suggests that, in routine clinical practice, spironolactone may have good long-term effectiveness and tolerability,” they wrote. “Since female patients often have persistent acne into adulthood and given concerns regarding antibiotic overuse among acne patients, it is possible that using spironolactone as a first-line agent before oral antibiotics could improve outcomes for female patients with acne,” they added.
In the study, they pointed out that spironolactone is emerging as a possible alternative to oral antibiotic therapy, but “little is known about long-term outcomes with spironolactone for those who have an initial positive response and how it compares to other alternatives.”
To examine the duration of acne treatment with spironolactone versus oral antibiotics, the researchers analyzed data during 2010-2016 in the Optum Clinformatics Data Mart. They included data on female patients aged 12-40 years, with at least two diagnosis codes for acne, who received spironolactone or oral antibiotics for at least 12 months. They used multivariate Cox proportional hazard models to assess differences in duration of therapy for spironolactone, compared with oral antibiotics.
The mean duration of a treatment course was significantly longer among the 4,321 patients treated with spironolactone than among the 7,517 patients treated with oral tetracycline-class antibiotics (697.8 days vs. 604.4 days; P less than .001). Compared with treatment with oral tetracyclines, the hazard ratio for discontinuing spironolactone treatment was 0.74, after researchers controlled for the age at diagnosis and treatment, history of polycystic ovarian syndrome, and history of combined oral contraceptive or topical retinoid treatment.
Patients who receive spironolactone and patients who receive oral antibiotics may represent different populations, the authors noted. In addition, guidelines advise limiting antibiotic treatment to 3-6 months, and antibiotic discontinuations may have been related to these recommendations. “It is not possible to determine whether medication discontinuation occurred due to lack of efficacy, cost, side effects, resolution of acne, or other factors,” they said, adding that prospective studies are needed “to identify the optimal treatment approaches for female patients with moderate to severe acne.”
The study was funded in part by the National Institute of Arthritis and Musculoskeletal and Skin Diseases. Dr. Barbieri is supported by NIAMS and receives partial salary support through a Pfizer Fellowship in Dermatology Patient Oriented Research grant to the Trustees of the University of Pennsylvania.
SOURCE: Barbieri JS et al. J Am Acad Dermatol. 2019 Mar 21. doi: 10.1016/j.jaad.2019.03.036.