While hormonal acne is often thought to be just for teens, it's perfectly normal (and extremely common) to experience hormonal acne as an adult. Whether you’ve tried tweaking your diet or have seen a dermatologist about prescription acne medications like tretinoin, sometimes these small adjustments just aren't enough to clear tough breakouts.
Typically, when topical ingredients aren't cutting it, your dermatologist might recommend a medication called Spironolactone—an oral blood pressure medication that can be prescribed off-label to treat hormonal acne. And when used as directed, it's actually quite effective (you might find that your skin is completely clear after 3-6 months of use).
So who is a candidate for using Spironolactone for acne, and how does it work? Ahead, dermatologists share everything you need to know.
Meet the Expert
- Nick Lowe, MD, is a consultant dermatologist and clinical professor, based between the U.S. and England.
- Susan Raffy is a California-based cosmetic chemist and the president of Susan Raffy Consulting.
- Justine Kluk, MD, is a dermatologist and acne specialist.
- David Colbert, MD, is a dermatologist and the founder of the New York Dermatology Group.
Type of ingredient: Oral 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. You must have a prescription to use Spironolactone.
How often should you use it? Consult a dermatologist.
Works well with: Generally, it works well with all topical treatments.
Don't use with: Check with your physician for interactions with other medications.
What Is Spironolactone?
Spironolactone is an oral form of medication that was initially developed to treat mild blood pressure irregularities and water retention. However, women with combination skin taking the drug for those aforementioned reasons soon found that one of the side effects was improved skin—in particular, fewer spots and breakouts. Physicians soon found that Spironolactone could regulate oil production, block acne-causing androgen receptors, and reduce the intensity and lifespan of hormonal breakouts. Soon after this discovery (and plenty of clinical studies), dermatologists began prescribing Spironolactone off-label to treat difficult hormonal acne cases in women.
Board-certified dermatologist Dr. Justine Kluk clarifies what is meant by "off-label" use: “It’s not actually specifically licensed for treating acne in absence of a syndrome like PCOS, but 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 Accutane."
How Does It Work?
It’s the impact Spironolactone has on the hormones that give it its acne-clearing superpowers. It works by blocking the effect that androgens (hormones like testosterone) have on the body. Increased androgens can increase sebum production, which leads to clogged pores and acne flare-ups. So essentially, Spironolactone gets to the root of the cause by blocking the hormones at the root of the problem, which means the acne glands and hair follicles won’t get overloaded, thus reducing the likelihood of developing pimples.
And like most skincare products, topical or oral, you have to give Spironolactone some time to work. Kluk says it takes around three months to see results. And just how promising are those results? In one study, 85 percent of patients saw an improvement in their acne, and 55 percent were completely clear of acne after taking Spironolactone. The good thing is that there’s no time limit to how long you can take the drug, unlike the antibiotics that are often prescribed for acne. But Kluk says that many patients see improvement after just two "rounds" of treatment and find that they don't have to continue taking their medication.
Benefits of Spironolactone
- Effective at Clearing Stubborn Hormonal Acne: While topical ingredients can certainly be effective for many people dealing with hormonal acne, Spironolactone can prevent blemishes from even developing in the first place by blocking the androgens that stimulate sebum production. Many women dealing with stubborn hormonal acne that's resistant to topical treatments find success in using Spironolactone.
- Can Treat Hair Loss in Women: Due to its impact on hormone regulation, the drug has recently been prescribed for women experiencing hair loss. It hasn't been found to have the same impact on men, however.
- All-in-One Treatment: Because of the efficacy of Spironolactone, you may no longer need to use drying topicals to treat your acne.
Spironolactone Side Effects and Safety Considerations
Spironolactone is a prescription medication that should only be used under the direct supervision of a physician. Because the drug tampers with hormone levels and testosterone, it’s recommended for use by women only. 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. Colbert also notes that in some cases, spironolactone "may alter blood potassium levels, therefore, people with kidney disease should not take it," he says.
Otherwise, the negative side effects associated with taking oral doses of Spironolactone include "electrolyte imbalance, breast tenderness, irregular periods, and increased urination," says Raffy. Colbert recommends that patients stay well-hydrated and carry a water bottle while taking Spironolactone to minimize dehydration from the dieretic effect.
Who can and can't use Spironolactone?
In general, dermatologists tend to recommend Spironolactone to women with persistent 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.
Can Spironolactone cause weight gain?
While some individuals have reported experiencing weight gain while taking Spironolactone, there is little evidence to support this. Weight gain is not considered a formal side effect of Spironolactone and it is not listed as a side effect on the packaging of the medication.
Are there alternatives to Spironolactone?
If you're dealing with hormonal acne, talk to your dermatologist. They may recommend a specific birth control or prescription topical before resorting to Spironolactone.
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