Everything You Need to Know About the Acne Medication Spironolactone

Updated 10/05/19
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In recent years, the rise in cases of adult acne has been likened to an epidemic. More and more adults (mostly thanks to stress wreaking havoc with hormones) are having to deal with teenage skin long after blowing out the candles on that 19th birthday cake. Whether you’ve tried tweaking your diet (have you tried giving up dairy yet?) or switching up your skincare routine, it’s a really tricky skin issue to fix because the causes and fixes vary so wildly from person to person. In short, when it comes to acne, we’re still after some miracle cure. So when we heard that highly-respected dermatologists recommended the same spot-fighting ingredient within weeks of each other, our ears perked up. Besides, who could forget a catchy name like spironolactone?

Type of ingredient: Medication

Main benefits: Regulates oil production, blocks androgen receptors, and reduces the length of hormonal breakouts.

Who should use it: In general, women with hormonal acne or women who have been resistant to other acne treatments in the past. It is not recommended for men or for women who are looking to become pregnant.

How much you should use it? Consult a dermatologist.

Works well with: Generally, it works well with all topical treatments.

Don't use with: Check for interactions with other medications.

What Is Spironolactone?

One of the reasons this ingredient has been lying low is because it can’t be applied topically. In fact, it’s an oral form of medication that was initially used to treat mild blood pressure and water retention. However, women with combination skin taking the drug for those aforementioned reasons soon found that one of the side effects was better skin—in particular, fewer spots and breakouts.

It’s been dished out in the United States for years to treat adult acne. Nick Lowe, MD, consultant dermatologist and clinical professor, practices out of the US and England and says this is because prescribing spironolactone for acne is essentially “off-label,” meaning it wasn’t designed to treat hormonal acne, so it doesn’t sit neatly under that category.

That being said, dermatologists, gynecologists, and endocrinologists have been using it for women suffering from PCOS for a while. “It’s not actually licensed for treating acne in absence of the full syndrome, but consultant dermatologists can prescribe the drug on an off-label basis for women who have a hormonal pattern to their spots and whose acne hasn’t responded to first-line therapies such as prescription creams, antibiotics, and even Roaccutane,” explains Justine Kluk, MD, dermatologist and acne specialist.

So, when women experiencing hormonal acne get wind of a treatment that works without any irritation to the skin or other nasty side effects (some lightheadedness can occur if you have low blood pressure), they might be quick to jump in. Which is why it’s now starting to gain traction as a treatment for women who have severe hormonal acne.

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Benefits Of Spironolactone For Skin

It’s the impact spironolactone has on the hormones that give it its superpowers. That’s because it blocks the effect that androgens (hormones like testosterone) have on the body. Those effects include increased sebum production and bacterial growth. Once you stop those, the acne glands and hair follicles won’t get overloaded, thus reducing the likeliness of pimples.

The trouble is that androgens are notoriously tricky to target, which is why spironolactone doesn’t perform very well as a topical treatment. “Studies show it’s the same concept as Roaccutane in that it works when ingested via the mouth, but not when applied as a gel,” Lowe says.

The good news? The more people are talking about it and the more studies proving it’s worth on complexion clearing, the more likely it will start to become a go-to for dermatologists and doctors—especially when cases of adult acne are on the up.

Side Effects Of Spironolactone

Because the drug tampers with hormone levels and testosterone, it’s recommended for use by women only (it could potentially cause men to suffer from gynecomastia, enlarged breast tissue, and tenderness). It also can’t be prescribed for those who are trying to get pregnant, so bear this in mind if you’re planning to conceive any time soon.

Dr. David Colbert, MD, and founder of the New York Dermatology Group, also recommends that people taking spironolactone stay hydrated, as it is a diuretic. "Also, it can alter your blood potassium levels, therefore people with kidney disease should not take it," he says.

How Does It Work?

Like most skincare products, topical or oral, you have to give it time to work. Kluk says it takes around three months to see results. The good thing is that there’s no time limit to how long you can take the drug, unlike the antibiotics that are often be prescribed for acne.

Having said that, some dermatologists advise taking antibiotics at the same time, including Lowe. “If someone keeps coming back for acne because other treatments aren’t working, I’ll prescribe a low-dose antibiotic along with spironolactone, but that will soon be withdrawn and then they can remain on the spironolactone for long-term periods,” he adds. If you do find yourself on antibiotics, be sure to bolster your gut bacteria (it can be adversely affected by antibiotics) with a probiotic like Symprove.

Lowe describes it as an “old medicine that’s been rediscovered for new uses,” so if you’ve tried everything from AHAs to giving up dairy and regular facials to prevent pustules, then this could be the ingestible answer you’ve been looking for. But, as always, remember: "Acne comes with bacteria and hormones, if [spironolactone] isn't working, speak to a doctor to see if they add something topical/oral," Colbert says.

Shop our favorite acne-fighting products.

CeraVe Hydrating Cleanser
CeraVe Hydrating Cleanser $13
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This no-frills cleanser will whisk away dirt and makeup without stripping the skin or exacerbating your acne. It's great for those with sensitive skin.

IS Clinical Active Serum
iS Clinical Active Serum $135
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Whether you already have zits or feel them coming on, this exfoliating serum is a winning formula that makes light work of preventing and fighting blemishes—no matter how stubborn or angry they may be.

The Ordinary Salicylic Acid 2%
The Ordinary Salicylic Acid 2% $5
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Stubborn under-the-skin acne and blocked pores? Salicylic acid gets in the pores and gently exfoliates the inside of them to loosen and remove anything trapped inside.

Paula’s Choice 10% Niacinamide Booster
Paula’s Choice 10% Niacinamide Booster $44
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Not only does niacinamide bolster your skin’s barrier function, but it is also anti-inflammatory, so it calms any inflamed, angry blemishes you may have. Layer this with other serums or add a couple of drops to your day cream.

La Roche-Posay Hyalu B5 Serum
La Roche-Posay Hyalu B5 Hyaluronic Acid Serum $30
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Dehydration can contribute to blemishes and blocked pores, so make sure your skin is sufficiently hydrated by adding in a lightweight hyaluronic acid-based serum.

La Roche-Posay Effaclar Duo
La Roche-Posay Effaclar Duo $30
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Containing niacinamide, glycerin, and salicylic acid, this lightweight, hydrating lotion will calm blemishes and hydrate the skin. It’s an acne-fighting must-have.

Avène Cleanance Mask-Scrub
Avène Cleanance Mask-Scrub $24
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This multitasking scrub mask contains AHAs (glycolic and lactic), salicylic acid to exfoliate, and cellulose beads to slough away dead skin. Soft kaolin clay mops up excess oil, too.

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