Acne is one of the most commonly reported skin conditions in the United States, affecting up to 50 million Americans annually.

It can cause scarring, disfigurement, and significant emotional consequences including loss of self-esteem, low self-confidence and social withdrawal.  Fortunately, it is a treatable condition.

Upon seeking medical treatment, acne sufferers are typically treated with a variety of over-the-counter and prescription topical therapies with or without oral antibiotic pills.  However, these common “first-line” treatments are often ineffective and can prolong the frustration and emotional consequences experienced by acne sufferers.  This can ultimately lead to feelings of hopelessness and resignation that there is no effective solution to be found.  At the Advanced Acne Institute, we often receive new patients to our practice who had been treated elsewhere with ineffective therapies.

Fortunately, there are effective solutions for almost any form of acne.  For example, women who suffer with “hormonal pattern acne” characterized by persistent breakouts mostly on the lower face and along the jaw lines usually are very resistant to the standard treatments of topical prescriptions and oil antibiotics.  For these women, a less commonly prescribed pill called spironolactone can be a game changer.

What Is Hormonal Acne?

The truth is, all acne is traced back to hormones.  However, we arbitrarily and loosely label a subset of women, usually in their 30s with persistent breakouts affecting the lower face areas, the jaw lines and the upper neck, as having “hormonal acne.”  By attaching this label to this group of female acne sufferers, it helps acne specialists understand and share effective treatment plans more readily.  For example, we have learned that this subset of acne sufferers tends to be less responsive to certain treatments and more likely to reposed well to medicines the work to block acne-causing hormones.

Another thing to understand is that women who have this “hormonal pattern” of acne breakouts don’t necessarily have abnormal hormone levels.  Their hormones could be perfectly normal but the acne-prone pores may be more sensitive to the acne-causing effects of the hormones.  That’s just one example of how hormones might cause acne breakouts but it is important to understand that acne can actually result from many different factors that could be somewhat different for each person.

While Hormonal acne typically refers to a subtype of acne in women, acne breakouts in men are also caused by the same hormones called androgens.  These hormones, like testosterone, normally activate the skin pores to produce an oily substance called sebum which lubricates our skin.  When oil production becomes excessive and when the linings of the pores begin to become overgrown and sticky, acne breakouts can follow.     Whether there is a type of acne in men that resembles hormonal acne in women, however, is not known.  Furthermore, since it is the male hormones that are the principle acne-causing hormones, we have to be very careful in men if we use a medication that interferes with the function of male hormones as this could lead to various unwanted side effects.

Is There an Effective Treatment for Hormonal Acne?

Thankfully, yes — a highly effective drug called Spironolactone can be used to treat hormonal pattern acne in women. It provides an excellent alternative to a medication called Accutane, which is a much more aggressive treatment method.

Originally developed as a blood pressure medication, Spironolactone is a proven and effective treatment for acne in women. Relatively speaking, it exerts minimal side effects and can typically lead to completely clear skin.

And it is not a new drug; the safety of long-term use of Spironolactone is well established, and this drug has been approved by the U.S. Food and Drug Administration (FDA) since 1960.

How Does Spironolactone Work?

In simple terms, Spironolactone reduces the activity of androgens (acne-causing hormones mentioned earlier) so that oil-producing glands in the hair follicles produce less oil and become less active overall. Less activity in the oil glands means fewer clogged pores — and less acne.

Spironolactone has proven to be effective for treating active red pimples as well as clogged pores, which lead to blackheads and whiteheads, known as comedones, and can be used to clear up breakouts on the face as well as the body.

Unlike Accutane, however, there is no end point for treatment, meaning it generally must be taken continuously to be effective. This is often a deciding factor when making the decision between spironolactone snd Accutane.  Some patients prefer to use Accutane since it is only taken for a specified period of time.  Other patients, however, choose to take spironolactone because it is a less aggressive treatment than Accutane.

How Do I Take It?

Your doctor will determine the ideal prescription for you.  The dose of spironolactone depends on various factors including the speficis of your acne as well as other individualized considerations.   Spironolactone comes in tablet form, which is taken orally.

Spironolactone Is Used Exclusively to Treat Acne in Women

Because spironolactone reduces the activity of male hormones, it can cause men to experience unwanted effects such as enlargement and tenderness of the breasts.

And because it affects male hormones, pregnant women should not take Spironolactone since it can cause birth defects, especially in the case of a developing male fetus.

How Long Does It Take to Work?

Using Spironolactone can lead to clear skin in as early as one month but sometimes can take two or three months to show good results. Patience is key when setting your expectations for efficacy.

Remember, everyone’s body is different, and so your response to Spironolactone may be different than others.

Some Side Effects and Precautions

Spironolactone can cause breast tenderness and irregular menstrual cycles, and so it is frequently prescribed together with birth control pills which can help prevent some of these side effects.

Elevated Potassium Levels

In some cases, spironolactone can cause elevated potassium levels in the blood, but usually this side effect is a risk mainly in patients with abnormal kidney function. Because of this risk, your provider will likely order some blood tests prior to treatment to make sure your potassium is in normal range and your kidneys are working normally Your doctor may repeat your potassium tests at regular intervals while you’re taking Spironolactone. It should be noted, however, that when used by young, healthy patients, Spironolactone is far less likely to cause elevated potassium levels.

Use of Anti-Inflammatory Drugs

Use of anti-inflammatory drugs called NSAIDs (Non Steroidal Anti Inflammatory Drugs) such as ibuprefen or aspirin, are not recommended because of their effect on kidney function when used with Spironolactone.


Spironolactone also functions as a water pill, which can lead to more frequent urination. Because of this, it’s important to be mindful hydrating consistently, especially if doing vigorous exercise in the hot sun, which can cause dehydration.


Using Spironolactone can cause dizziness in some patients, usually at the start of treatment, but usually resolves itself within one or two days.  Patients experiencing dizziness should not drive or engage in dangerous activities.

When you discuss taking Spironolactone with your doctor, he or she will review your personal medical history with you to assess whether it’s safe for you to use this drug.

Patients with Baseline Low Blood Pressure

Spironolactone should be used with significant caution in patients with baseline low blood pressure and may require frequent blood pressure monitoring in the early stages of treatment.

Consult with an Expert

If you think you are experiencing hormonal pattern acne and wish to consider treatment with spironolactone, the Advanced Acne Institute can help.  We use spironolactone in regimens designed for rapid clearing of acne breakouts and maintenance of an acne-free complexion.  Our patients are very happy with their results. Spironolactone can be life changing for many women who have struggled with non-stop acne breakouts that have not improved with other treatments.

At the Advanced Acne Institute is to help our patients achieve clear skin. And unlike general dermatologists, we exclusively treat patients with acne.

Our innovative therapies are tailored to each patient’s unique situation. We treat mild, moderate, and severe acne, and we listen to our patients who may have felt their symptoms were dismissed by other doctors.

If you’re suffering from hormonal acne, we’re ready and waiting to hear your story so we can design a treatment plan that will result in clear skin at last. Why not make an appointment with us today?

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