If you have acne and don’t want to take antibiotics or other medications, talk to your dermatologist about spironolactone. This medication has been used for over 30 years to treat acne and can help reduce a cystic outbreak.

The drug is also prescribed to female patients who have cystic breakouts that tend to flare up with their menstrual cycle or ovulation (mid-cycle). Spironolactone can be combined with other hormonal therapy such as oral contraceptives to enhance its effects.

What is spironolactone?

Spironolactone is a potassium-sparing diuretic (water pill) used to treat hyperaldosteronism, heart failure, high blood pressure and hypokalemia (low potassium levels in the blood). It’s also sometimes prescribed off label to women with stubborn acne to help clear skin.

It works by blocking androgen hormones, which can cause sebum to build up in your pores and trigger acne breakouts. It can be a great option for women who have tried topical and oral treatments without seeing results.

Oral spironolactone is an effective treatment for women who have persistent hormonal acne and haven’t responded well to other therapies. It can be taken alongside other medications or as a stand-alone acne treatment.

It’s important to discuss spironolactone with your dermatologist before starting it. Your doctor may need to order a blood test and a consultation, so they can monitor your progress.

How does spironolactone work?

Unlike other acne medications like antibiotics and isotretinoin, which have short-term effects, spironolactone can be taken for a long time. This can be very beneficial if you have ongoing hormonal acne because it will prevent new breakouts from forming by preventing clogged pores and inflammation (Charney et al, 2015).

Spironolactone is an oral medication that is typically taken at least once daily. It is a diuretic, so you will likely need to drink more water than usual when taking it.

If you have kidney or heart disease, speak with your doctor before taking spironolactone. This medication can affect your potassium levels and hormones, so you may need to monitor these closely.

Some patients experience side effects when taking spironolactone, such as irregular periods and breast tenderness or enlargement. These are known as spironolactone adverse events.

How long does spironolactone take to work?

If you’re taking spironolactone for acne, you may not notice results immediately. It can take several weeks to see a difference in your skin.

Spironolactone slows the production of hormones that cause acne, including testosterone (the “male” sex hormone). It also blocks these hormones from binding to hormone receptors in the skin.

When these hormones are too high, your oil glands produce too much sebum (oil) and clog pores, leading to pimples and other breakouts.

To treat acne, spironolactone is usually taken by mouth, once daily. Your doctor will prescribe a dose that’s right for you.

It’s also a potassium-sparing diuretic, which prevents your body from absorbing too much salt and keeps your potassium levels from getting too low. You should not use spironolactone if you have kidney problems, Addison’s disease, or if you’re unable to urinate. This medication also can cause weight gain in some people. If you’re taking spironolactone and you want to lose weight, talk to your doctor about other options.

What are the side effects of spironolactone?

If you’re thinking about trying spironolactone to treat your acne, it’s important to understand what you may be getting into. The side effects of spironolactone can range from mild to serious, depending on the dose and your body’s reaction to it.

It’s also important to note that it can raise your potassium levels (a condition known as hyperkalemia) and can cause breast tenderness. You should let your doctor know if you have kidney problems or any other health conditions that affect the level of potassium in your body.

In general, spironolactone is a good choice for women who have stubborn acne that hasn’t responded to other treatments. However, it’s not for everyone and should be a last resort, rather than a first line of treatment.