November 18, 2015

Adult Acne: Does Spironolactone Work?

I just want to put this on the table: acne sucks.

I am in awe of all of the men and women who are confident enough to not care about acne. And in the grand scheme of things, I know that acne is so, so far down on the "things that matter" list.

But it still sucks. Which brings me to this post about the bastard.

You might remember this acne post a while ago, where I told you that I had tried minocycline (an antibiotic which worked, but isn't something I wanted to take long term) and was just starting to try a prescription retinoid.

My Experience with Retinoids

I ended up using the retinoid for a very uncomfortable three months. Like, stepping on a lego in the middle of the night uncomfortable. Or sitting next to a couple making out in the movie theater painful.

You see, even using the lowest strength cream (0.025%) every other day, I couldn't get rid of the "I forgot sunscreen on a boat" look. And being a light shade of cherry Kool-Aid wasn't the worst of it; I also could not run or work out (even indoors) for more than 15 minutes before my face stung to the point of stopping. And the worst part was the sun; even with spf 50, ten minutes outside was enough to start burning my sad, abused face.

I'm not sure if my skin would have eventually adjusted but in the end, although the retinoid did make my pores noticeably less clogged, I didn't want to deal with the no working out, vampire lifestyle anymore.

At that time, I was also about a month into taking an oral medication called spironolactone (or "spiro," if all those letters annoy you), so I stopped using the retinoid and prayed to the acne gods that spiro worked.


Spiro is a medication that was originally prescribed for high blood pressure, but has also been prescribed off-label for over 20 years to treat all sorts of hormonal related issues.

You're probably wondering how a high blood pressure medicine can also affect hormones. And the answer is simple: science.

But seriously, doctors learned a lot about spiro when it was used to treat high blood pressure in women who were also diagnosed with polycystic ovary syndrome (PCOS). PCOS is a syndrome which, among other things, is associated with a high level of androgens (i.e., "male hormones") in women. Although women normally produce some level of androgens, too much can do some pretty effed up things. For example, too much androgens can cause unwanted hair growth, sebum production, and a messed up menstrual cycle, all of which are symptoms of the syndrome doctors call PCOS.

The doctors found that spiro was pretty efficient at inhibiting androgens, meaning that it stopped the male hormones from doing that unwanted shiz.

In my case, I didn't have any symptoms of PCOS or an unbalanced level of androgens except that my skin and hair was incredibly oily. When I broke out, it also looked like a "classic" case of primarily hormone-related acne: very inflamed, very deep, and painful pimples on my cheeks and chin that would last for weeks.

So I decided to give spiro a shot.

I've been taking spiro for a little over six months now. I also switched birth control pill brands again about three months ago to see if that helped as well. I don't want to do any jinxing but so far, it seems like it's been helping a lot. I'm still trying to figure out a good skin care routine and I still don't have close to perfect skin, but I also would recommend asking your doctor about spiro if you think your acne is mostly hormonal related.

Spironolactone: The Downsides

I don't feel like I can post this without at least some sort of disclaimer about the downsides of spiro. Because even though it sounds like spiro is pretty safe for long term use, I still have to be careful taking it because:

1. It's a diuretic. Basically, it makes you have to pee a lot, which can lead to dehydration if you're not careful.

2. It's potassium-sparing. This one is the biggest one: potassium-sparing diuretics like spiro can make you pee a lot, and also make you excrete less than normal amounts of potassium while you do so. This means that if you have a kidney problem or eat an unnecessary amount of bananas, you could be at risk for hyperkalemia (high levels of potassium in the blood). I'll let Google explain why that's bad.

3. It's used to treat high blood pressure. Which means that if you already have low blood pressure, it could lower it even more, sometimes to dangerous levels.

4. You can't use it while you're pregnant.

For the sake of not getting sued, I also thought I should add that I'm not a doctor. This isn't a medical journal; this is the experience of one random person online. Don't buy drugs online because you read about them on a blog. Don't confuse my advice with legit medical advice. Don't be stupid. 

Anyway, hopefully this was helpful. Or interesting. Or at least better than stepping on a lego.

And to be clear: this is just an update, not an "end of the story" type post. I don't know if this is a long term solution, and I don't know if in a month, I'll be saying that spiro made me grow a third boob.

But I'm saying a silent prayer and keeping my fingers crossed that for the love of God, I stay acne and third boob free