Spironolactone for Acne


95 reviews

85% would repurchase

Package Quality: 4.1

Price: $$

Package Quality: 4.1

Price: $$


Age: 25-29

Skin: Other, Fair-Medium, Not Sure

Hair: Brunette, Other, Other

Eyes: Blue

I would have given this a 1.0 but my case is a little unusual and I don't want to unfairly judge this medication. Unlike most users here, I took high dose (200mg/day) Spironolactone for 4.5 years, so I can give some insight into what this drug can do *for* you and *to* you in the long term.

Background: As a teen I had severe, recalcitrant acne AND rosacea that was only controlled by a course of Accutane. In addition to super oily skin I also had hirstuitism. Wee! So post-Accutane, I wanted to try something hormone-based, and strong in an effort to knock out my residual Rosacea and body hair.

Well, 200 mg/day of Spiro *is* certainly strong, although it wasn't at all effective at controlling my Rosacea papules (did control my "pustules" though). It was also not very effective at treating my hirstuitism. I was still darn hairy while I was on it--and again, I was on it for a cumulative 4.5 years.

What it *did* do was dramatically reduce my oil production, and make me dehydrated. I got frequent headaches and my previously oily skin became a dry, red desert. I have tons of small wrinkles on my face that weren't there before (I'm 25, btw). My eyes were also frequently dry and irritated. Was this because my protective oil barrier was repressed, or due to the diuretic effect? I'm unsure. Probably a little of both.

The diuretic effect does not let up, btw. Expect to pee about 8-10 times a day, every day.

What happens when you take Spironolactone long term is much more concerning than dry skin. Aldactone, the active ingredient in Spiro, steadily raises your cortisol levels. It has both anti-cortisol and pro-cortisol effects, but ultimately you get a rather significant net gain in cortisol.

Elevated cortisol levels can create sleep and mood disturbances. I'm going to talk about what Spiro did to my sleep. This is not a happy story.

I noticed the insomnia gradually. I went from getting 8-10 hours a night to 7, then to 6, then to 4-5. Depression and panic attacks crept in. Eventually I could only clock about 2 hours of sleep a night. Despite improving my sleep hygiene and using all sort of prescription meds (Ambien, clonazepam, clonodine, hydroxizine, gabapentin, to name a few), my sleep was shit--and only a few years prior I was known for being a heavy sleeper. As mentioned, I had become increasingly depressed and anxious, which was exacerbated by the insomnia.

It was bad. This was 2.5 years into Spiro, btw. I quit the drug on the chance that it may have been causing my sleep problems--and a week later my ability to sleep began to improve. Full improvement took several months. My depression also lifted. I was doing okay again.

Gradually, after about a year off the drug, some pustules began to return. Not a lot, but to me any was too much. I decided to give the Spiro another go. I thought maybe I was wrong to attribute my insomnia to this drug--maybe it was a coincidence. My doctor wrote a new scrip for 200mg/day and off I was again.

Two years later, I was in the same place I was before. Anxiety, panic attacks, depression, dry skin, and of course: incurable, unremitting insomnia. I have (probably) permanently worsened the dark circles under my eyes, both from the chronic dehydration and from not getting enough sleep.

I stopped Spiro in February, and will never go back. And guess what? Sleep and mood improved.

Low dose Spiro (25-50mg/day) for acne is effective and safe, although you need to be drinking a lot of water while you're on it. I would also recommend periodically getting your cortisol levels checked.

High-dose, long term Spiro, however, was disastrous for me. I cannot begin to express how significantly my mood and sleep quality changed on this drug. My skin is also still bone-dry and wrinkly nearly six months after stopping (not purely Spiro's fault, I'm sure, since I do still have rosacea and irritation can cause dryness). Be cautious, do your research, and get your cortisol levels checked if something feels fishy.

2 out of 2 people found this review helpful.

on 7/2/2015 11:21:00 AM

Age: 25-29

Skin: Acne-prone, Medium, Warm

Hair: Black, Wavy, Medium

Eyes: Brown

I have been on spironolactone for about two months. As I write this, I have one small spot on my face that is almost totally healed up. That is it.

This, to be clear, is insane and something that sort of makes me want to cry with happiness.

I have had serious acne since turning 22 and everything on my face going to heck. That's four years now. I'm talking constantly having at least two (usually more) deep, painful spots on my cheeks. I have tried just about everything short of Accutane and while some things, like Epiduo, definitely helped, they weren't making it go away. Finally, two months ago, I went to a new dermatologist who took a look at my face and the prescription topicals I was on and said "Yeah, these will help clear the spots up faster, but they aren't going to stop them from coming in, because topicals can only do so much for hormonal acne." (To which I have to say, WHY DID IT TAKE SO LONG FOR SOMEONE TO TELL ME THIS, PREVIOUS DERMS?!) She sent me in for a blood test and then prescribed 50 mg a day of spironolactone for me.

I take a pill once a day with a glass of water. It is $8 for a months worth of pills with my insurance (as opposed to the hundreds of dollars I've spent on OTC treatments - oh, and Epiduo's legitimately insane pre-coupon pricetag of $900). My biggest piece of advice on this is do your research. Read all of the MakeupAlley and acne.org reviews so that you know the cycle that you're in for, because spiro definitely has a crazy initial outbreak period for most people and is going to likely take weeks, if not months, to be effective. My IB started at the end of my first week and lasted about two and a half weeks. I don't want to sugarcoat this. It was awful - and I was lucky in that it was only a couple of weeks. I had more spots on my face than I'd seen in a very, very long time - at least 6-7. They were huge, red, and painful. They would heal up quickly, but it felt like 2 would pop up every time 1 went away.

And then it just stopped. I began noticing that the skin between the spots actually looked really good - when you have serious acne, everything is always clogged and you can always see that something is brewing under there. My pores looked smaller and my face was less oily. And then the spots healed up and went away - this was about a month in. A week later, I got my period, and 2-3 spots showed up (I usually have a big breakout right before my period), but they were significantly smaller than normal and went away quickly. For the past month, I have had maybe 2-3 spots in total. The one currently on my face is the only one that popped up for my period this week. My face is otherwise smooth and clear. I camped at a music festival two weeks ago, an experience that would have normally taken a month for my skin to recover from, but literally experienced no issues with the fact that my skin regimen was out the window for four days. (I have actually turned down social things like this before, out of fear of what my skin would do.)

Spiro does have some weird side effects, since it messes with your hormone levels. My doctor had me take a blood test in the beginning, once after I had been taking it for a week, and then I'll have to get blood tests once every year. This is to check on my potassium levels - I haven't had any issues with this. My breasts definitely hurt for about three weeks when I started taking it, and they got bigger, but seem to have gone back to their normal size since then. It's definitely a diuretic at first, so I was extremely careful about getting enough water (dehydration causes the dizziness associated with it). I haven't noticed anything happening with my body hair. Should I manage to find myself in a situation where I could get pregnant, I'm going to be extra cautious (for some reason, this does not come with the same crazy DO NOT GET PREGNANT materials as Accutane, which makes me a little uncomfortable because it really should). I don't like the fact that this is a pill that I'm just going to have to be on every day, but honestly, my self esteem reached such a rock bottom that this is a trade-off that I am 100% okay with making.

I cannot tell you how important the results of this medication are to me and my life. I have struggled with acne for four years. I have not walked out of my house without makeup on in that time, and have had mental breakdowns whenever I've gone on trips or the like and forgotten my concealer. This thing is life-changing for me - no exaggeration.

If you have hormonal acne, I highly recommend at least starting the conversation about this with your doctor. I wish I'd done so sooner.

2 out of 2 people found this review helpful.

on 6/9/2015 12:25:00 AM

Age: 25-29

Skin: Acne-prone, Medium, Not Sure

Hair: Black, Straight, Fine

Eyes: Brown

A God send. I was suffering from deep cystic hormonal acne on my jaw, neck, cheeks and shoulders. It was so painful and embarrassing. I had previously been on retin-a micro for about 6 years. Retain-a worked up until I hit 26, at which point it seemed suddenly ineffective. I attribute the changes to age-related hormone shifts. I'm on 50mg a day and take it once a day in the late afternoon since it's a diuretic and makes me go up to go to the bathroom way too many times during working hours.

Benefits to having taken this medication:
1. no HORMONAL acne!
2. decrease in sebum production (I went from blotting 3x's a day to not needing to at ALL)
3. decrease in sebum production also means I don't have to wash my hair as often, yay!
4. I don't have to shave my legs as often- hair doesn't grow on my legs as quickly)
5. My period went from 10 days (abnormal) to 3-4 days (crazy, I know).

I also use this in conjunction with epiduo, which is a benzoyl peroxide/retinoid gel, I use this 3x's a week to clear up congested pores (blackheads/filaments/clogged pores). This combo has made my face radiant, thank the heavens!

1 out of 1 people found this review helpful.

on 5/29/2015 12:49:00 PM

Age: 36-43

Skin: Combination, Fair, Neutral

Hair: Red, Straight, Fine

Eyes: Grey

it worked.
25-100 mg a day
watch your potassium
its feminizing so i got prettier lol
skin was glowy and softer... less oily
its made from mint so also the spearmint tea works the same way :)
so look that up too
somehow i was very depressed on it after a while
like a clinical depression so i stopped it and went for Accutane
i don't know if it was the spiro but i was a dark kind of sad.
even though i looked great haha
even my hair was better
i didn't gain any weight
ive always had oily skin/high free testosterone levels for a female
it also helps if you have any facial hair i read. ive never had facial hair so just sharing.
my main concern is oily skin.even in my 40's now.
i recommend this product

on 4/23/2015 8:07:00 AM

Age: 19-24

Skin: Acne-prone, Medium, Not Sure

Hair: Brown, Other, Other

Eyes: Other

Well I'll start out by saying Spiro has made my life LOTS easier!! I have been on Spiro for probably close to 2+ years, as prescribed by my dermatologist. I previously and sometimes still have hormonal acne. My previous dermatologist had me on antibiotics, creams, etc. and nothing seemed to do the trick. I finally went for a 2nd opinion with another dermatologist. He prescribed me Spiro 25mg, take 2 pills twice daily. Unlike the previous antibiotics I was prescribed, Spiro is okay to be on long-term, from what my dermatologist told me. As far as side effects go, this may alter your menstrual cycle...but from what I understand this is normal. And, honestly, I'll take that over acne any day. Secondly, I did not notice any weight gain....if anything I would say I have lost weight since taking Spiro. Also, I had oily skin...like to the point I had to use those oil blotting sheets daily. But the Spiro has REALLY helped with that. Like I really don't have problems with oiliness anymore. The Spiro did significantly help my acne. It is wonderful. However, I do feel like I noticed better results when I first started taking it. I think I have taken it so long that maybe my body has gotten used to it. But I'm not complaining because I am still a faithful about taking my Spiro daily. I don't have perfect skin now. I do still notice a breakout or two around the time of my menstrual cycle but I usually just treat with a salicylic acid or benzyl peroxide spot treatment. So don't expect to never have another breakout but to sum it all up Spiro has significantly helped my face...with both acne and oiliness. I hope to use it as long as possible!

on 3/23/2015 10:00:00 AM

Age: 25-29

Skin: Oily, Olive, Warm

Hair: Brunette, Straight, Medium

Eyes: Grey

I asked for this from my doctor specifically because I have both genetic high blood pressure and hormonal acne. He only gave me 25mg because I guess it's a little dangerous? I've been taking it regularly and tried doubling up, but I think less is more in this case. He warned me not to eat bananas while taking it, but I did anyway and it made me super lethargic. Avoid potassium, because this works by saving your body's potassium. (I am no doctor, but this is what I hear.) I asked if I could just eat more potassium but I don't think that is how this pill works...

Anyway I feel my blood pressure has gone down!!! Also I have noticed, even though it has only been three weeks I don't have any (new) cysts!

I probably wouldn't take this if it weren't for my blood pressure, but I am very hopeful so far. This is nothing like Accutane, I feel like it's resetting a glitch in my body that needed to be reset.

Update: it's 7/7/2015 and I just threw the rest of my Spiro away. It works really well, my skin is so pretty now. I also modified my diet for good skin (lots of greens and veggies, no coffee, no cheese or milk...). However, I wasnt on the pill and became upset at the thought of this potentially causing birth defects. Apparently this can cause males to develop abnormally if used during pregnancy. Also after a while I started experincing a lot of symptoms related to high estrogen levels, like breast tenderness and pain. As I said I just threw mine out and I am planning on going on Vitex next to combat the acne. Wish me luck please c:

on 2/1/2015 12:31:00 PM

Age: 25-29

Skin: Acne-prone, Fair, Not Sure

Hair: Brunette, Other, Other

Eyes: Blue

Before using this I had been using Acne.org's system on and off for six years. I had good results from it, but got tired of my skin constantly being dry and of the time it takes to put on two full pumps of benzoyl peroxide on your face every morning and evening. Also, my dermatologist had recommended Retin A Micro for acne and anti aging benefits and trying to alternate it with benzoyl peroxide had my skin so dry and chapped it was unmanageable. I stopped using the Acne.org system in April of last year and had a bit of a honeymoon period after where my skin did not break out too terribly. Of course, it caught up to me and I started breaking out a little bit that summer. I asked my dermatologist about Spironolactone and she recommended trying a couple of antibiotics first. I think I tried Tetracycline, Doxycycline and one other that I cannot remember and none had great results. She also prescribed Aczone to apply topically, which I suppose may have helped but the results were so slow going that I ended up getting lazy with it and stopping.

Eventually in early August my acne had reached a boiling point and gotten so bad I considered asking for accutane. I had never considered that before because of all of the side effects, but I was that desperate. My dermatologist decided to finally try Spironolactone and said if that didn't work we could try accutane. She thought Spironolactone might benefit me because my acne was mostly on my chin and jawline, which is usually hormonal. She asked me to go back on birth control, because I had been off it at the time. She said that she wanted me on two forms of birth control at all times because Spironolactone can feminize male fetuses if you get pregnant while on it. She also had me get my blood tested before she put the prescription through and warned me that I cannot have much potassium, so I avoid bananas and coconut water.

She started me at a dose of 50 mg per day and had me get my blood checked every single month while slowly increasing the dosage. I didn't get results for the first several months and kept asking about accutane instead. She told me to be persistent and wait, which I did. I am now at 150 mg and my skin has been clear for the last few months. It is the clearest my skin has ever been and it is amazing. I can actually touch my face without having to worry about getting a breakout. I still have some hyper pigmentation leftover on one cheek from my horrible breakout last summer and cannot believe how long it is taking to fade. However, I've gotten maybe three small whiteheads that I can only see if I am leaning in super close to the mirror and they usually come after I pick at my skin. I still have some blackheads on my nose that haven't gone away, but they don't bother me that much. I'm really taking advantage of the clear skin while I can, but I know I'm switching my health insurance this July so I'm not sure if I'll be able to keep using this or not.

Now I'll mention some of my concerns with the prescription. First, like I said I was not on birth control until right when I started this prescription and I started taking birth control on the first day of my period. When I've started the pill this way before my period has always stopped. However, while taking Spironolactone, my period went on in a spotty fashion for ELEVEN days. This has obviously never happened to me before, but I haven't had any problems with it since taking the pill regularly.

My second concern may be totally unrelated to the pill, but I thought it was curious. I've been a vegetarian for thirteen years and my cholesterol has always been very, very low. I happened to give blood a few months after starting this prescription and when I got the thank you note in the mail a few weeks later I was shocked to see that my cholesterol was above the normal range. I haven't started eating more dairy or eggs, so I don't know why my cholesterol would have been raised and the only thing that has changed is this prescription. However, my dermatologist said that this wouldn't cause that so I don't know what to make of it.

My last concern is with the safety of taking this long term. My dermatologist said that this is only a short term treatment, so I don't know what I'm supposed to turn to if my acne returns when I stop taking this. Also, I started reading Anticancer recently and am worrying about how the effects of this drug on my hormones might affect my body long term. I think when I stop taking this I may try giving up sugar because I've read about great results in getting rid of acne as well as reducing your cancer risk. That would be incredibly hard for me, so I'm not looking forward to it. If anyone has any suggestions, please let me know!

2 out of 2 people found this review helpful.

on 1/22/2015 2:22:00 PM

Age: 30-35

Skin: Acne-prone, Olive, Not Sure

Hair: Red, Other, Other

Eyes: Brown

To Sageraye‼️‼️.. I've been on it for two weeks and have noticed the breakouts being worse.. My Derm Doc, said it can often GET WORSE , BEFORE BETTER IN SOME PEOPLE. I'm as well holding out hope for improvement over time

Age: 30-35

Skin: Acne-prone, Olive, Not Sure

Hair: Brown, Other, Other

Eyes: Brown

I was on spirinolactone from 2012 to February 2014. I was getting frustrated with a resurgence in papular and cystic acne after a sweet spot free 2 years thanks to Accutane. It was actually my OBGYN that recommended it and not my derm. While I was happy with Accutane even though the results were temporary and despite cost and side effects, I wish I'd been aware of spironalctone first to try as I'd consider this treatment less intense and almost as effective. Keep in mind that I was still instructed to use birth control and avoid pregnancy while using spiro and advised about all the possible side effect, none of which I recall experiencing.

My OBGYN started me off on 50 mg daily and this worked until stress triggered a major cystic acne flare in August 2012, then I was increased to 100mg daily. My skin was mostly clear after that until another major cystic acne flare in March 2013. At this point it was my derm treating me with spiro and she suggested combining it with Solodyn (minocycline). By July 2013 my skin was pretty much at the level of flawless that I got with Accutane using the spironolactone 100 mg/minocycline 100 mg combinations every day. That sweet period lasted until I finally decided to self taper and discontinue the spiro in March 2014 to flush it from my system so I could try to have a baby. I subsequently stopped my birth control in May. Within two months of discontinuance of both, I'm validated that my acne is off the chain hormonal since my face has been an inflammatory mess of cystic acne flare ups from then up to present day. I continued the minocycline 100mg help me manage it, but it only takes the inflammation down and doesn't help eliminate the flare ups. If it weren't for my personal goal, I'd be back on that spirowagon in no time.

2 out of 2 people found this review helpful.

on 9/18/2014 6:46:00 PM

Age: 19-24

Skin: Acne-prone, Fair-Medium, Warm

Hair: Brunette, Wavy, Medium

Eyes: Brown

Amazing, amazing, amazing.

I've been having a hormonal acne breakout that was attributed to coming off the pill...but this 'breakout' lasted a whole year. It just got worse and worse, and finally I got my OB-GYN to run some bloodwork. It turned out my testosterone was high though I was otherwise healthy, and she put me on 50mg spiro twice a day.

She told me it usually takes about 3 months to really see an improvement.

One month in, and about 90% of my body breakouts are GONE. My face is probably about 40% less oily, as is my scalp, and I only had two cystic breakouts during my period this month. My skin is SIGNIFICANTLY better, I'd say about 40-50% reduce in breakouts.
I still have trouble with clogged pores and small bumps, though.

Cons are: my hair, lips and hands are MUCH drier. I use a humidifier at night now because the dry air from the AC hurts when I breathe it in through my nose. My cuticles and lips crack when I don't apply Vaseline regularly.
I do find myself peeing more than I did before so I can't take my nightly dosage before I go to the movies, and if I know I'm going to be on a long drive I take my second dose AFTER I get back.
When I don't drink enough water, my muscles begin to ache and I get really, really tired... My libido is also way, way down.

Note -- I started out on 50mg ONCE a day (half the dosage prescribed to me) for the first week to get adjusted to the diuretic effect. Then after a week I increased the dosage to 50 mg twice a day as prescribed.This helped me a lot in getting used to the side effects.

I haven't noticed weight gain, but I've been trying to lose weight for awhile now so we'll have to see. But it's really, really helped my skin and I am extremely thankful for that.

I will update this review once I've hit the 3-month mark. :)

EDIT, 11/25/14: I got sick for two weeks and I wasn't taking my Spiro... sigh, I guess it's a good thing it doesn't stick around for long in the body, but in terms of oiliness I'm right back where I started. I also started to break out on my chin and a few spots on my back/chest. So note to self and others, take this as religiously as you'd take any other Rx! On the plus side, I can jump right back into the full dosage and not feel particularly dehydrated or dizzy like I did before.

3 out of 3 people found this review helpful.

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