Acne comes in many different forms.  For example, acne with just blackheads and whiteheads, which are technically called comedones, is referred to as comedonal acne whereas the presence of very large, deep breakouts filled with pus is referred to as cystic acne.

Another particular form of acne that occurs in women usually in their 20s and 30s is referred to as hormonal acne. The best treatment for each type of acne can be different. In this post, we discuss the best treatment for hormonal acne and compare the two most effective options, Accutane and spironolactone.

Hormonal acne is a pattern of breakouts that tends to occur on the lower face and along the jaw lines and upper neck areas of women. Although all forms of acne can be traced back to hormones, the hormonal acne label is given to a particular pattern of breakouts that can be readily identified due to its common occurrence in young women with a tendency to worsen with each monthly menstrual cycle.

Hormonal acne is a very stubborn type of acne breakout that frustrates many women because it seems to resist any treatment that is tried.  By the time hormonal acne sufferers seek help from a dermatologist they have typically tried a variety of topical prescription treatments as well as oral antibiotic pills, none of which seem to help at all.  Desperation sets in and they are usually ready to try something much stronger as a last resort.

Effective control of hormonal acne usually involves more than the common or first-line acne treatments.  Patients often visit multiple dermatologists and receive variations of the same treatments. Topical acne medications are usually prescribed but are typically very ineffective.

Many patients with hormonal acne have often tried multiple topical prescriptions and various combinations of topical therapies without achieving much improvement.  Adding an oral antibiotic to their regimen is likewise usually not very helpful but is often prescribed.

Some women opt to use a birth control pill containing acne-friendly hormones to counteract the acne-causing hormones in hopes of fighting fire with fire. While this strategy can sometimes be effective, it is often not strong enough to produce satisfactory improvement.

The time it takes for hormonal acne sufferers to try these different methods can be months or years before realizing that something more effective is needed.  The significant time and effort expended to try these unsuccessful therapies can often lead to more frustration and anxiety.  While some patients resign themselves to learn to live with their relentless breakouts, others continue their quest to find an effective treatment.

Spironolactone

One of the most successful therapies for hormonal pattern acne is a medication called spironolactone.  This oral medicine was originally developed many years ago as a blood pressure pill and is still used as such today.  However, it turns out that spironolactone also has the ability to block the very hormones that are responsible for causing acne to form.  This is why spironolactone can be a very effective and successful treatment for hormonal acne.

The side effects of this medication are typically mild in most women who take it making it a desirable choice for women who are reluctant to use something more aggressive.  Unfortunately, not all providers are skilled in using spironolactone to its greatest effect.  This can result in dashed hopes in women who were treated with spironolactone and who were expecting an effective result only to once again encounter the disappointment of yet another failed treatment.

There are many reasons that this unexpected outcome can occur, such as using an insufficient dose or not using it for a long enough time.  This can often be fixed by an experienced acne expert skilled in the use of spironolactone.  But even in the hands of an expert, spironolactone is not always effective and prompts the need for something more aggressive.

Isotretinoin (Accutane)

The most effective treatment for hormonal pattern acne is isotretinoin, often known by its original brand name of Accutane.  Accutane works by “shrinking” or deactivating the oil gland in acne-prone pores thereby preventing the overactivity of the oil glands that is necessary for acne to develop.   Although Accutane can be a very effective option, it is a more aggressive treatment and has various requirements for women who take it.

For example, one of the most important aspects of Accutane in women is the need to prevent any risk of pregnancy.  This is because Accutane can cause severe birth defects if taken while pregnant.  Therefore, women are required to comply with a governmental registration program called the iPledge Program which monitors pregnancy tests during treatment and necessitates compliance with pregnancy prevention requirements.  Various additional information covering potential secondary effects of Accutane is also important to understand before starting treatment with this prescription medication.

Which treatment is the best for hormonal acne?

So which treatment is best for hormonal acne, spironolactone or Accutane?  Well, the answer is…it depends.  For some women, the response to spironolactone can be very good, often leading to completely clear skin.  Because of its effectiveness, many women come to rely on spironolactone to maintain their clear complexion for extended periods of time.  Remember, spironolactone was originally developed as a blood pressure medication so there is precedent for taking it for a very long time.  Also, since the side effect profile for spironolactone is fairly mild relative to Accutane, many women prefer to use it as their initial treatment of choice.

However, spironolactone isn’t always effective for every woman who takes it.  Also, the need to continue to take it in order to maintain its effects is a turn-off for many women who prefer a more definitive treatment that has a defined endpoint.   For these women, Accutane is more appealing. In addition, for women who start with spironolactone and do not experience satisfactory results, they often transition to Accutane as their treatment of last resort.

While spironolactone is very effective and preferred by many, Accutane treatment remains the gold standard in the treatment of most forms of acne, including hormonal acne.  Almost all women have very effective results.  The treatment can be life-changing for women who have long suffered with hormonal acne and have been unable to find relief.  This is why many women accept the greater intensity and more aggressive nature of Accutane treatment and ultimately opt for Accutane therapy.

Ultimately when deciding which option is best, some want to jump directly to the most effective treatment and choose Accutane while others are more comfortable starting with spironolactone as the next step and will only decide on Accutane once all other options have been exhausted.  Ultimately, there is no right or wrong decision when it comes to which choice of medications is the best. Both medicines can be very effective and can be chosen based on comfort level with risks and benefits for each.