Thank you so much for posting this. I'm almost 40 years old, but only began getting cystic acne on my chin, upper lip, and back this last year. I've been using Differin for over a decade (which used to keep everything at bay) and then this last year I was put on Doxycycline for the new cysts I was developing. But, my Derm doesn't want me to continue taking an oral antibiotic for such a long period of time and yesterday mentioned Spironolactone. Is there a definitive test to see if it is indeed 'hormonal acne'? Or is it just an educated guess? Also, did you notice that it got worse before it got better? If so, how far into the treatment did that occur? Does it also help with body acne?

I'm planning a big 40th birthday bash in Las Vegas in May, and I'm debating putting off the Spiro until afterward, if that means my face will be a wreck in two months.

Thanks!

~Mandy

Hey, Mandy!

Unfortunately, there is no lab test or medical test that can show that you have hormonal acne. You could, however, test for high testosterone levels since Spiro reduces testosterone levels in the body and blocks the androgen receptors. High testosterone levels in and of itself would not prove that hormones were causing acne, but it would definitely support the possibility. Also, if your testosterone levels are normal, it could still mean that another hormone is screwing up your system. Honestly, I attribute most adult acne (in women only) to be hormonal. If you have acne consistently (cystic or otherwise) after puberty, it is most likely a hormone imbalance. I'm basing this off the knowledge I've acquired after YEARS of personal research and my BA in Biology.

I figured out that I had hormonal acne because of several things... most of them found by deductive reasoning. Simply, what didn't work... But instead of just tossing aside something after it didn't work, I tried to figure out WHY it didn't work, so that I could come closer to the source.

While there are plenty of other causes besides these two, I tried to tackle what I saw as the 2 main causes of acne. Each one has a DIFFERENT method of treatment... specific regimens and medications that will treat each kind. It was possible that my acne was caused by something else, but there are a lot of different causes within each category, so I had to start somewhere.

1) what you put on your face/in your body (I believe that these types of acne are helped most my medicines like BP, Differin, etc... topical creams and careful facial regimens, and lifestyle/diet changes)--> could also include gluten, lactose, or anything that you could be allergic to. Gluten can cause cystic acne if you are allergic (and you can develop a sensitivity to it) but I had tried all kinds of diets, cutting things out and introducing things back in... and it didn't hurt or hinder. Also, the kind of makeup or wash didn't didn't really seem to have an effect. In fact, except for a few medicines that had short term effects, nothing that I put ON my face seemed to even phase my skin. A pro and con, I guess... no severe reaction or disaster. But it just made me think, if I don't get even a negative result from these topical treatments, why would anything positive come from them? I decided it wasn't sensitive skin, or a topical or food allergy.

2) Hormones or some other imbalance in your body--> this is a very broad category but an important distinction between different causes of acne. I noticed that whatever topical treatment I put on my face didn't seem to prevent the acne very well. At least not the cystic acne. While I was having breakouts all the time, I was consistently having the worst and most painful breakouts on a schedule- every 25 to 30 days. Not necessarily when I was on my period (which makes sense when you know how hormones in the female body work), but just consistently. I could prepare for the worst and expect it. It always happened. I always broke out when I was expecting it to. THAT was the biggest clue that it was hormonal. My acne was on a cycle, like the hormones in my body fluctuated. Also, I had always had severe PMS- painful awful cramps (to the point of vomiting), severe body aches, depression (sometimes leaving me unable to function), and migraines.

Now that I'm on Spiro, I have NONE of those symptoms including my acne. My boobs are 2 sizes bigger, and the hair on my body is reduced (it wasn't bad before but still a plus ). Just the symptoms I had before the medicine, and my body's positive reaction all around afterwards, is evidence to me that I definitely have (or had) hormonal acne.

It did get a little worse before it got better. But not unbearably so... I started out with 25mg and every few months bumped it up by 25mg. Every time I had that increase, I broke a little for a week, and then it was better than it was before the breakout. I HAVE heard of people who had just terrible breakouts initially, but I've also found that most often those are the people who start out with a higher dosage. Of course your body is going to have an adverse reaction when you immediately introduce something that messes with your hormones! I think sometimes people forget that while this medicine will hopefully solve a problem (acne), if you are having hormonal acne, there are probably other problems in your body because of hormones, too. You need to give your body a chance to catch up and adjust.

If you want to start taking the medicine, but were afraid of a really bad initial breakout, maybe take 25mg and then increase it to 50mg after the party? I'm not a doctor (yet), so you could ask your physician what he thinks. Some doctors aren't familiar with this medicine being used for acne. I think it's more commonly used for hyperaldosteronism, and fluid retention from things like heart or liver disease.

The breakouts that did occur happened about a week or so after every dosage increase. From my research, that seems to be a pretty standard reaction. Some people breakout more severely than others (I think based on the initial dosage and the size of increase) since some work up to 200mg in the time that others work up to 50mg or 75mg. Also, I'd recommend Finacea... a topical cream. It's definitely helped my skin before I was ever on Spiro.... it just wasn't enough. And the good thing about Finacea is that it is SO gentle, no breakouts, and it just improves the overall condition of your skin.

I did have body acne, but that (somehow) seemed to clear up on its own years ago (from I think a few months of oral antibiotics). So I don't know how it would react to this medicine. You could search the boards and see if others have experienced a reduction in body acne on this medicine.

Sorry this is such a long post... I hope I answered your questions! The downside to Spiro (and Finacea actually) is that it just takes a while to work to its full extent. I'm finally experiencing that after 8 months of being on it. However, I did notice it helping before that (around 4 months). It's so worth it, but you have to be really patient.

Thank you SO much for your detailed response. This is much more helpful than the very brief explanation my Dermatologist gave me. I did have my hormones tested, and my Testosterone levels are normal. But they found I am actually quite low in Progesterone and morning Cortisol. My Dermatologist said that would not necessarily contribute to acne. But, everything I've read online said it can. Regardless, after reading everything you've said, I am going to give Spiro a chance! One last question: Is Spiro something you can take for a very long period of time? Or is it like Antibiotics, and something that should only be used short-term?

Again. Thank you!!!

~Mandy

Glad to help! Your body won't ever adjust to Spiro and stop working in the way it could to antibiotics. The only way that it would maybe not do what it was supposed to, would be if you have changes in your hormone levels NOT because of the medicine. Sprio works with the hormone levels that your body has naturally, and if those "baseline" hormone levels change, that could mess up the balance you have with the medication. Does that make sense? I might have been a little confusing... Also, if you want to get pregnant, you unfortunately can't stay on Spiro.

You can't be on spiro if you are on birth control?

Also, have you ever taken Accutane and Spiro? My derm mentioned there is a "less harsh" version of Accutane that is "brand new." Has anyone heard of this? I can't seem to find anything with a google search.

I actually did some research, and you CAN be on Spiro while on birth control. But you can't be on Spiro when you're pregnant... so that was my mistake. In fact, some doctors require you to be on birth control if you are Spiro.

I have heard that Sprio is called a "less harsh" version of Accutane. I don't really know why it's called that though unless they are simply referring to the side effects. Spiro and Accutane work for completely different reasons. Those reasons are exactly why I chose Spiro over Accutane. Spiro blocks androgen receptors and testosterone production- people (usually women) who have hormonal acne would see results if their hormones are off balance. Accutane is a chemotherapy (in that it reduces cellular proliferation of the sebaceous glands). The reason that Accutane has so many side effects is because like chemotherapy for cancer, this doesn't just stop one kind of cell, it will stop production of other cells, too. I'm not saying people shouldn't be on Accutane at all, I'm just explaining that people should expect adverse side effects because it's not leveling hormones like Spiro but stopping cell production throughout the body.

I actually haven't heard anything about this new Accutane. I'll have to look into it.

I just started 25 mg twice a day of spiro and 100 mg of doxy.. I never had bad acne until I got on birth control. I was on it for two weeks and stopped taking it because it made my face horrible. I've only been on spiro since Friday. I'm scared of the initial break out everyone is talking about. did you have one? and is the other medicine you're using topical? I just retin A and benzacline.

I did have an initial breakout, and it seemed to mostly be along my jawline. I'm not gonna lie, it was pretty bad... BUT there were no cysts, and it healed up within a week which I was not used to happening. That's something that I've noticed after starting on Spiro as I was healing- my breakouts healed much faster, and those breakouts were mostly just small whiteheads. Also, just a heads up... if you increase the dosage later, you will most likely have some kind of breakout (no where NEAR as bad as the initial). I've researched and experienced a breakout with every dosage increase.

The only other medication I'm on is Finacea which is topical. I know that was what helped my existing acne and has improved my skin condition over all (no oily skin, no more blackheads, etc). However, Finacea did NOTHING for the cysts since the cause of my acne was deeper than my skin's surface.

Don't let the initial breakout scare you. The medicine is worth it if you have hormonal acne and are willing to stick with it.

Okay thank you!