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I've been lurking around here reading as much as I can about skin purging and acne treatments, specifically Spironolactone.
I started spiro a little more than 2 weeks ago. before treatment, my skin was super oily and I'd have mild acne constantly. The only thing that ever worked for me accutane when I had cystic acne as a teenager, and bactrim (weaned off of bactrim and things were still good) when I started breaking out again a few years later. things were great until I got off if birth control, started breaking out again then starting up the SAME bcp I was on beforehand to fix it and that made everything worse.
Anyway, I was convinced my acne was hormonal. Right off the bat I thought spiro was working great, 50mg a day along with my bcp ortho tri cyclen lo, and duac. My skin became less oily, mild acne was still there but it was ok.
Mid through, my 2nd week, I woke up one morning with itchy bumps all along my jawline, hairline by ears, and around mouth. Most we're really small, but things progressed to worse. Some of these bumps have gotten bigger and turned to regular pimples and small cyst like ones.
And I'm not sure why they itch. (I have a log in the personal log category)
Now, I read that skin purging is a myth and spiro does not scientifically cause skin purging (like accutane and retinoids) because it blocks the androgens, doesn't mess with the oil glands directly.
So what could this be if not skin purging? I've never broke out all over all at once like this, even pre-accutane. When starting accutane, I did breakout similarly with cysts all on my right jawline at once ( but this isn't bad like that)
What is going on here? Does this mean spiro will not work for me? I was better off without spiro! I went from mild acne to moderate in a day!
The purge may have to do with your body initially trying to adjust with synthetic hormones being added into your system. It might see it as a toxin and flush it out, and in the process flush out all "toxins", including acne. This is only a theory I think, I'm not incredibly sure about that purging process. However, I think purging is a normal sign for most acne treatments - many successful users (even on this forum) can attest to initial breakouts that subside with time. I do think there is a line that you can draw between purging and just a bad reaction, but that's something you sort of have to figure out.
There are lots of opinions with regards to acne treatments I find. Even depending on the doctor they'll tell you different stuff based on their own understanding. With most "scientific articles", I usually read them with a grain of salt or at least cross reference a few times and get the general consensus. And, most importantly, it all varies from person to person, which is a terribly vague and the answer that I hate the most. But if acne was so easily treatable, there wouldn't be so many of us on this forum complaining. 
Spironolactone isn't a synthetic hormone. It's is a mineralocorticoid receptor antagonist - meaning it blocks the effects of mineralocorticoids, most importantly aldosterone. It's a medicine that works mainly on the kidneys, causing mild diuresis and increasing the secretion of sodium (and calcium) in the urine while decreasing the the secretion of potassium. And as a side-effect it blocks the 5 alpha reductase enzyme that converts testosterone into more active DHT in tissues, thus having feminizing effects. But mostly it's used in combination with other (stronger, potassium-wasting) diuretics to treat conditions such as heart failure. The most serious risk with spiro is getting hyperkalemia, the risk being higher for patients with kidney failure. Hyperkalemia can be a life-threatening condition at worst, and although this must be a very very low risk overall for someone taking spiro for acne, it might be better to avoid getting too much potassium in the diet just to be on the safe side.
I'm sorry this is fairly irrelevant to the topic, I just happened to learn about spiro at school very recently, and have a bad habit of wanting to correct misinformation I see online. I'm fairly curious about the purging effect as well, since technically hormonal treatments should (based on my logic) just decrease oil and stop new acne from forming. Maybe it's got something to do with bacterial imbalances, while the skin flora adjusts to new conditions? Or inflammation increasing temporarily while the body adjusts? I don't know.
That's interesting. Maybe it's the bacteria adjusting because they can't thrive on the oil anymore since it's no longer there? I went from an oil slick to bone dry in 2 weeks, it's so dry it feels tight to talk, so I'm trying to adjust to it as well and changing up my skin care regime to something more gentle. I wonder if it could be using duac simultaneously? The derm prescribed that and I've read it's best to comine spiro with a topical.
It's possible for the duac to possibly do that, but I've been on that before with no problems.
I highly doubt it's ortho lo all of a sudden, I've been on that for 5 months
Yes I know it's the obvious / easy conclusion...except that because you've now changed your hormones with spironolactone, it is very very possible that OTC Lo's balance of hormones no longer works for you.
It's possible for the duac to possibly do that, but I've been on that before with no problems.
I highly doubt it's ortho lo all of a sudden, I've been on that for 5 months
Yes I know it's the obvious / easy conclusion...except that because you've now changed your hormones with spironolactone, it is very very possible that OTC Lo's balance of hormones no longer works for you.
I see what you're saying.
However, I think jump from bc to bc type will make things even worse. I don't want my body to constantly keep having to readjust.