If you have hormonal acne, you'll know that managing your skin day to day is no mean feat. Some weeks your complexion can be crystal clear and others it is congested with blackheads, painful cystic spots (often along the jawline) and red or flesh-coloured bumps under the skin. Your skincare regime might consist of all the right acne-busting ingredients, such as AHAs, BHAs and retinol, but when hormones are the underlying cause, it's still pretty difficult to keep breakouts under control. So where do you go from there?
Oral medications such as antibiotics (popular prescriptions include tetracycline, erythromycin, trimethoprim) work by killing excess bacteria on the skin, while isotretinoin, also known as Roaccutane, is usually reserved for severe, recurring acne or acne that is leaving marks or scars on the skin. But if your issue is predominantly hormonal, there's another pill that can potentially help, and you might not have heard of it until now. Enter: spironolactone.
"Spironolactone is an 'off-label' drug which means it is not licensed in the UK for the treatment of acne," explains Dr Anjali Mahto, consultant dermatologist and author of The Skincare Bible: Your No-Nonsense Guide To Great Skin. According to experts, the drug was initially developed for blood pressure and heart failure, but Dr Mahto explains that it seems to work on adult acne in women, as it takes action on hormones, namely testosterone, which is responsible for excess oil production and therefore breakouts.
"Spironolactone is used more widely in North America and produces good clinical results, especially for female adult acne or acne in the context of PCOS (polycystic ovary syndrome)," adds Dr Mahto, who often prescribes the drug in clinic. But you can't just get it anywhere. "Spironolactone should only be prescribed by those who are familiar with the use of the drug in this context, i.e. ideally a consultant dermatologist."
While the drug is still quite under-the-radar in the UK, the research presenting positive results speaks for itself. After being prescribed spironolactone by Dr Mahto in 2017, I've seen a vast improvement in my own skin and often consult the medication when my complexion flares up. Here's everything you need to know before taking spironolactone to treat your hormonal acne.
There are side-effects
Like most medication, doses of spironolactone vary. If you're a spiro beginner, skin specialists will most likely start you on a low, daily dose of 25mg and graduate you to 50mg, then potentially 100mg or higher depending on how you react to the drug. Like all medication, there are side-effects of spironolactone. Firstly, it's a diuretic (or water tablet), which means it'll make you pee more than usual. For this reason, Dr Mahto recommends taking it in the morning, rather than at night. Other common side-effects can include irregular periods and breast tenderness around the time of your period.
After increasing my own dose to 100mg, I found myself feeling a little sick and dizzy, so I looked to Dr Mahto for advice. "This is not a particularly common side-effect but certainly possible," she explains. "Often splitting the dose, for example, taking 50mg twice daily (half in the morning and the other half in the evening) instead of 100mg in one go may help."
It could take a while for spironolactone to work
Similar to other acne medications, spironolactone isn't usually instant. It took just over a week for me to see positive results in my own skin, but it can take anywhere between six and 12 weeks for any skin changes to take place at all, so being consistent with your daily dose is important.
It pays to combine spironolactone with a solid skincare routine
Experts recommend pairing spironolactone with proven acne-fighting ingredients. These include: benzoyl peroxide (a topical, over the counter treatment which works by killing acne-causing bacteria), azelaic acid, glycolic acid, salicylic acid for exfoliation and retinoids. If you're using any of the above in cleansers, serums, moisturisers or as targeted topical treatments, it's important to wear a daily SPF, as they can make your skin sensitive to UV.
Your GP might be reluctant to prescribe spironolactone to you
Spironolactone is usually used to treat high blood pressure and heart conditions. For this reason, GPs may be reluctant to prescribe it to you, and that's why it pays to visit a skin specialist who can properly assess your skin concerns and determine whether you're the right candidate for the drug. "The drug is 'off-label' so doctors should not be prescribing outside their area of expertise," adds Dr Mahto. "I wouldn’t expect a GP to necessarily prescribe the drug for acne. Their experience comes from using it as a diuretic in heart conditions, which is a totally different population group. Spironolactone also hasn’t gained that much popularity in use yet in the UK, so even many dermatologists aren’t prescribing it routinely at this current time."
Repeat prescriptions of spironolactone can be expensive
If your skin is seeing an improvement while taking spironolactone, you'll probably want to stockpile it. But depending on the dose and how much your specialist thinks you need, prescriptions might not be cheap. Three months' worth of tablets in varying doses cost me over £50, and that's on top of skincare products. "I suspect different tablet sizes may also vary in price," adds Dr Mahto. In my experience, the price of private prescriptions varies from pharmacy to pharmacy. Shopping around with your prescription is most likely to get you the best deal.
Your acne can come back after taking spironolactone
Spironolactone is not a cure-all pill and won't rid you of acne forever. It is prescribed to be taken daily but according to Dr Mahto, acne can return when it is discontinued. "Spironolactone can be safely taken for many years if necessary," she adds. "A reason to stop taking the drug would be if pregnancy is under consideration."
"Women with PCOS tend to have two different types of hair problems," explained Dr Mahto. "They often suffer with excess facial or body hair (often in a similar pattern to men and also known as hirsutism) but may also notice shedding of scalp hair around the crown and temples." Spironolactone works to block the male hormones responsible for excess hair, making it a potentially effective drug for treating these symptoms. "In this context it should only be prescribed by a consultant dermatologist with experience in its use as it is an unlicensed treatment," stresses Dr Mahto.