If you suffer from acne more as an adult than you did as a teenager, we feel your pain. Not only can adult acne be worse than adolescent acne—it can be more nodular and really scar and discolor skin—but you can also spend a fortune on products and treatments trying to find a magical solution to no avail. We’re not saying that there aren’t things out there that will help to clear up your skin, because there definitely are, but after everything we’ve tried and tested, nothing works to resolve adult acne once and for all like spironolactone.
You may have heard of spironolactone before, or maybe this is the first time you’re reading about it. Anyhow, it’s one of the best-kept anti-acne secrets out there. I know firsthand because I’ve seen the wonders it’s done for my own skin. In less than one month of being on a prescription, my skin totally cleared up—breakouts were something I’ve dealt with since my early 20s—and they rarely, if ever, pop up now.
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Technically, spironolactone is a diuretic blood pressure medication that’s used to treat high blood pressure, but once doctors noticed the unintended side effect of clearer skin, it began being prescribed off-label to treat adult acne. “Spironolactone has an aldosterone antagonist, which means it can regulate from hormonal and endocrine functions. Women with hyper androgen issues often have adult acne. And, because female acne is often hormonally influenced, this is why spironolactone helps,” says New York dermatologist Gervaise Gerstner, MD.
The typical high blood pressure patient will take about 200 mg of spironolactone to level out their blood pressure to a safe level; for anti-acne purposes, you can expect to be put on a lower dose. “It takes less of a dose to suppress hormone effect on the sebaceous gland, as opposed to affecting blood pressure. A recent large meta-analysis of the use of this medication for acne showed that doses of 100 mg or less daily are sufficient in most women,” says Charlotte, NC, dermatologist Gilly Munavalli, MD.
So here comes the meat of it: how it really works. As Dr. Munavalli explains, “Spironolactone is an anti-androgen, meaning that it controls the effects that androgen (male sex hormones) has on the body specifically increased sebum production. It has been shown in studies to decrease androgen-stimulated sebocyte (oil gland) growth in vitro, which means that spironolactone cannot be used in men and is typically only prescribed for adult women.” Because the drug works to control the effects of androgen and sebum production in the body, overactive sebaceous glands, which give way to more breakouts around the mouth, chin and jaw area where bacteria can easily grow, are essentially kept under wraps.
It’s not uncommon for dermatologist to prescribe antibiotics and/or Accutane (isotretinoin) to treat acne, and Dr. Munavalli says one of the many benefits of spironolactone is that there are no issues with developing bacterial resistance or the irritated, flaky, dry skin that comes along with Accutane.
Going on a prescription for spironolactone doesn’t mean you have to alter your skin care routine all that much either. “It works best in combination with a good topical regimen, as well as birth control, but it can be used instead of birth control for hormonal acne, too,” says Dr. Gerstner. But, you will need to get your potassium levels monitored yearly to make sure they don’t spike.
Once your skin starts to make a turn for the clear path, Dr. Munavalli says it typically takes a few months before major improvements in acne are seen. Although many of his patients have reported appreciable changes within just a few weeks, you’ll want to stick with what you’re doing and keep on taking the medication. And when you get to the point where you’re finally happy with your skin, you’ll need to continue with the prescription in order to keep it looking that way—it’s all totally worth it.
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