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Spironolactone Might Be the Miracle Acne Treatment You’ve Been Looking For

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Sometimes the best inventions happen when another invention goes awry. You’ve probably heard the story about how chewing gum was invented: that is, while trying to make rubber! Over in the skincare and dermatology worlds, retinoids were used for the treatment of acne, before someone realized that they happened to seriously smooth out lines and wrinkles, too.

Nowadays, there’s a lot of hype about spironolactone, a blood pressure medication that just so happens to be extremely effective in treating hormonal acne—one of the trickier forms of acne (common around the jawline) to pin down. Read on for everything you need to know about spiro, straight from dermatologists who write scripts for it everyday.


About the Experts:

Joshua Zeichner, MD, is the director of cosmetic & clinical research in dermatology at Mount Sinai Hospital in New York City.
Rachel Nazarian, MD, is a dermatologist at Schweiger Dermatology Group in New York City and a faculty member at Mount Sinai Medical Center’s department of dermatology.

First, what exactly is spironolactone?

Like we mentioned, spironolactone has been used for decades to treat high blood pressure. “Specifically, it’s a potassium-sparing diuretic,” says Dr. Zeichner, meaning the pill encourages your body to pass more urine without losing too much potassium in the process. Wondering how acne fits into all of this? Well, to treat cases of hormonal acne and persistent pimples, dermatologists have increasingly been prescribing spironolactone off-label over the years.

How does it treat hormonal acne?

“We use spironolactone to treat acne because of one of its side effects, which is blocking your hormones from binding to oil glands in the skin,” says Dr. Zeichner. Before you freak over the mention of hormones—many of us are only too familiar with the often not-so-great side effects of birth control—know this: “Spironolactone doesn’t affect the hormone levels themselves, but rather serves as a roadblock between your hormones and oil glands,” says Dr. Zeichner. “And because your oil glands are not activated as they normally would be, your body won’t make as much oil.” The result? Less shiny skin, fewer clogged pores, and ultimately, fewer acne breakouts.

How long does it take to work?

Like most good things in life, spironolactone requires some patience. “Results are typically seen between six and twelve weeks, so be diligent about taking the medication to see improvement, and continue even after you’re improving to maintain results,” says Dr. Nazarian. You’ll also want to factor in the time it may take to get on the correct dose for you, which can range from a low dose of 50 mg to a high dose of 200 mg a day.

How long will I be on it?

By the way, spiro isn’t like Accutane, which you’re on for several months only. “Patients can be on it for years, and the results only last as long as you are on it,” says Dr. Zeichner. So if you’re hesitant to add a pill to your daily routine long-term, you might want to pass on this one.

“We often recommend that patients consider titrating down their dose every once in a while to determine if they still require it for acne,” adds Dr. Nazarian. “Oftentimes hormonal acne will resolve within a few years, no longer necessitating oral medication.”

Does spironolactone have any side effects?

First things first: This medication is for adult women only, as it can lead to breast development in men. But overall, spiro is a very safe and well-tolerated medication, according to Dr. Nazarian.

Still, as with any medication, there are potential side effects. “Because spironolactone can decrease your blood pressure, let your physician know if you are experiencing lightheadedness or weakness, which may often be an indication of low pressure,” says Dr. Nazarian. “Patients are also advised to decrease potassium intake since spironolactone has a risk of increasing potassium levels.”

At higher doses, patients may also experience hormonal issues, like breast tenderness, hair growth or hair loss, or irregular menstrual cycles, but going on an oral contraceptive, like birth control, usually offsets these side effects. “However, you should stop taking spironolactone if you are planning to conceive,” says Dr. Zeichner. (This medication can impact hormones that are essential to making a baby.)

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About the author
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Kate Foster Kaplove
Kate is a freelance beauty editor in Brooklyn. She was previously a beauty editor at ELLE, Cosmopolitan, Women's Health, and Seventeen. Her favorite topics to write about are skincare and fragrance, especially as they relate to art, culture, & politics.
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Article Last Updated August 21, 2020 12:00 AM