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The Surprise Medical Treatment That Also Clears Up Acne

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Illustrated by Elliot Salazar.
When we talk about acne, we tend to gravitate towards a few buzzwords: salicylic acid, benzoyl peroxide, Accutane, and maybe even Retin-A. Recently, some dermatologists have been prescribing another method to deal with acne that unexpectedly appears in women in their early 20's. Spironolactone is an oral medication that's been around since the 1960's, but dermatologists have used it to treat acne since at least the 1980's.
Since isotretinoin — better known as Accutane — involves abstinence from drinking, requires the use of hormonal birth control, and has been loosely linked to depression, a lot of young women are hesitant to try it out. That's why spironolactone has been increasing in popularity recently — so much that you or your friends are probably using it already.
Spironolactone is actually a diuretic and has been traditionally used to treat high blood pressure, congestive heart failure, and other diseases that cause the body to retain fluid. But, its anti-androgen effects can counter the hormones that promote the development of acne.
Androgens stimulate oil glands and alter the growth of skin cells that line hair follicles. Although most women with adult acne don’t have increased androgen levels in their blood, some studies have shown women with increased androgen levels in their skin tissue. It's also possible that some women may just be more sensitive to the normal level of androgens in their bodies.
If you're a woman who has adult-onset acne or acne that has persisted since your teens, you might consider giving spironolactone a try. One reason dermatologists reach for spironolactone in women with adult acne is that traditional acne treatments often fail for this group, and they may respond better to anti-androgenic treatments.
It’s important to note that spironolactone as an acne treatment is considered an “off-label” use, which means it's not FDA-approved. Doctors often prescribe medication for an off-label use if they feel the overall benefit is worthwhile, and there's enough data that suggests women with adult acne benefit can from spironolactone.
Like any other medication, spironolactone does have potential side effects. The most common ones are increased urination, menstrual irregularities, and breast tenderness. It can also raise your potassium levels and lower your blood pressure, so it's important for your doctor to be monitoring both. The potential for spironolactone to cause estrogen-dependent cancers — such as breast cancer — remains controversial, but available data suggests there is no definitive association in humans. If you have a family or personal history of estrogen-dependent cancers, be sure to mention it to your dermatologist. Long-term use of spironolactone has also been found to be safe.
The effective dose of spironolactone varies based on the individual, so it may take some time to determine the best dosage for you. This trial period may impact the efficiency of the medication, and it can take up to 12 weeks to see an improvement. It's important to be patient and consistent. As a board-certified dermatologist, I can attest to the efficacy of spironolactone and recommend that you talk to your doctor if you are experiencing recurrent acne that's resistant to over-the-counter treatments. By finding an option that's right for you, clear skin is within your reach.
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