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[lazy1980]

Hi All,

I'm a long time lurker, first time poster. Apologies for the length of my post. I'm posting to share a strategy for those having trouble getting spiro prescribed - the strategy is to say straight out you think your acne is hormonal, bring research studies in with you, and keep going for more opinions, don't give up.

I'm 28 and have had moderate-severe acne since puberty along with very oily skin. Like little oil dots on my nose 30mins after washing, makeup sliding off, blotting papers went everywhere with me. I went on Diane 35 in my early 20s after little success with topical antibiotics/BP,etc. It worked wonders on acne and oil but took 12 months. I was fully clear for 3 years before my skin started to get oily again and I broke out around my periods. Nothing as horrible as before mind you, but still annoying to always have two/three deep pimples, some healing scars plus oily skin. Embarrassing when you work in a professional field.

I went to a derm and he put me on topical antibiotics and Retin-A, this helped initially with the acne but became less effective over a year and started to really really irritate my skin. Red, bumpy, flaky. I tried Differin because it's supposed to be less harsh but I had the same issues. Finally bummed out and reading this board I read about spiro and thought it would help, given that my acne is hormonal. I went to a GP since I had just moved to a new city and was without a derm. The GP thought I was wrong about my acne's cause and suggested trying to work up my resistance to Retin-A. I tried another GP to get their opinion. His attitude when I mentioned spiro was so hurtful. He looked at me like I was crazy for wanting to be acne-free at my age, said spiro was only for people with purple cysts all over their face, and that I should be glad that all I have to deal with is breakouts around my period and very oily skin. Would not even refer me to a derm.

The next time I went to see a GP who specialised in acne, but armed with more studies. I ended up on 25 mg/day, which is measly compared to some people, but in my case it's all I've needed so far in combination with Diane 35 to keep me free of breakouts and a nice reduction in oil. If you're starting from severe acne obviously you will need a different approach.

The use of spiro for acne is relatively new and off-label. Most doctors understandably are scared to prescribe something off-label they are not familiar with. If any are familiar with spiro it may only be the studies which show adverse side-effects at high doses used to treat women with severe hirsutism or PCOS. Show them recent studies by Dr James C. Shaw, his studies show that spiro can be used to safely to treat adult acne hormonal in cause, and is effective in low doses (w/ less side effects) when combined with a birth control pill.

To get his studies go to PubMed, www.pubmed.gov. It's an index of medical journal articles all doctors should know about and use. Copy and paste this into the search box "Shaw JC"[Author] and acne . to get a list of his articles. You can't get the full articles themselves without going to a university library that subscribes to these journals, but that won't be a problem - just bring in the the summaries that are in PubMed. The doc can easily get the whole article themselves if they are open to learning more about spiro from what you've brought them. Here are just two that are useful:

Long-term safety of spironolactone in acne: results of an 8-year followup study.
Shaw JC, White LE. J Cutan Med Surg. 2002 Nov-Dec;6(6):541-5.

CONCLUSIONS: After 200 person-years of exposure to spironolactone and 506 person-years of followup over 8 years, no serious illnesses thought to be attributed to spironolactone were reported. The long-term use of spironolactone in the treatment of acne in women appears to be safe. Side effects, however, are common, although not usually a cause for stopping the drug.

Low-dose adjunctive spironolactone in the treatment of acne in women: a retrospective analysis of 85 consecutively treated patients.Shaw JC. J Am Acad Dermatol. 2000 Sep;43(3):498-502

CONCLUSION: Spironolactone can be used in low doses as a single drug or as an adjunct to standard acne therapies in women with adult acne. When used in this fashion, treatment outcomes are favorable, and the drug is well tolerated.

Anyways for any older ladies out there still suffering with acne, moderate or more serious, don't give up if you think spiro can help you. Keep trying to find a GP or a derm who will listen, empathizes that at a certain age even moderate acne can be very very hard psychologically, and show them some studies. Doctors are trained to make decisions based on medical evidence - ask them to review the articles by Dr. Shaw and they may be more open to spiro- he publishes in respected scholarly medical journals and is a researcher at the University of Toronto. His opinion should carry some weight in your doctor's eyes even if yours don't!

Attitude is key when presenting research to a doctor- don't act like you know more than them (you don't) or that they must be ignorant because they haven't read the articles you have. Don't expect the doc to read the articles during your appt and prescribe- ask that they take a look at some studies you have that are favorable to spiro treatment and to get back to you if they change their mind. Avoid putting them on the spot, that can make anyone feel defensive. Obviously they may still shut you down because of their own beliefs about acne treatments and what level of acne you should just deal with, but for me it was worth a try.

Good luck and thanks to all the more regular posters. Your stories have helped me a lot.