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Skinbeginner

Spironolactone story and advice?

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Ok so I started having hormonal acne that has been getting worse and worse around my chin when I hit about 26. I have never had issues with acne even when I was in high school but it was a huge blow so I went to a derm. She put me on 50 my Spironolactone and Tretinoin cream. It made my acne much much worse and after a month she bumped me up to 100 mg. Again continued to make acne worse and now currently I'm on 150 and doing Tretinoin and clindamycin gel which I have been on for a week. My skin is the worst it's even been in my whole life. I am suffering from extreme depression and I don't want to leave the house because I have at least 3-4 new pimples pop up a day and at least 3 active whiteheads at any given time. I have been on some dose or form of Spironolactone and Treitinoin since August. I just need some help. My dermatologist is wonderful but I don't think she understands how devastated I feel and how depressed this makes me. I'm starting to wonder if I should go off everything and just go back to the way I was originally. I wasn't happy before I started all of these and my acne make me sad, but it at least was manageable and it wasn't nearly as awful as it is right now. I'm also getting cystic acne since starting the higher dose which I never got in my life prior to starting these meds. Any advice or help?

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Firstly....hang in there.  I remember when i started Spiro and my acne got so much worse for the first few months.  I didn't see consistent improvement until well after a year.  Spiro ended up not being my solution but for others, it can be a miracle worker.  Retinoids are known for irritating skin so maybe your derm can put you on the lowest possible concentration and form (ex: differin).  As much as you want to stop, give it at least 6 months so you can cross it off your list.  Prior to this treatment, what else have you tried?

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@leelowe1 I've done oral antibiotics, metronidazole gel and used to use curology as well as really diminishing my skin care routine down to the basics that are non comedogenic. When I asked her what next steps are if the 150 dose and addition of Clindamycin don't work she said we would try isotretinoin, but I've read topics on that too saying that it's the worse thing people have ever done. It's just so frustrating because I was unhappy with my skin prior to this, but it was manageable, but since starting the Spiro it just feels out of control.

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Spiro takes a longgggg time to work.  I started to see very very slight improvement after a couple months but didn’t see a noticeable improvement until six months. And it was actually at 12 months that my skin really improved to almost perfect. Hang in there! Also, what generic Spiro are you on? Because I have noticed a difference based on which generic the pharmacy puts me on. 
 if you have not seen any improvement after four months maybe you could try a different generic. 
 I had to be on at least 100 mg to see a difference, 150 mg my skin was perfection but it messed up my period too bad so I am back to 100. 

 another thing you might want to think about is caffeine. Not sure if you drink any… But if so cut it out. Caffeine is huge for me! Even on spironolactone, if I have caffeine specifically coffee is the worst, I will start to get a couple cysts. 
 Caffine messes with your stress hormones which in turn can jack up the rest of your reproductive hormones.  Just something to think about if you are looking for a missing link.
 Hang in there I understand how frustrating it is.
Also FWIW Retin-A DESTROYS  my skin, I cannot handle retinoids in anyway… I have cystic hormonal acne and it did nothing but make it worse. It was not purging either it literally made my face 10 times worse and never got better so I will never touch another retinoid. 
 I had much better success with consistent Clindamycin gel and BP.  I also SA peels regularly ( 10% ) - you can get them on the Internet and I specifically use ASDM Beverly Hills   and wash with Ceravefoaming cleanser. 
so I still take good care of my skin but the main thing that makes a difference is spironolactone. Besides Yaz birth control it has been the only thing that has ever helped my hormonal acne. I did not want to be on birth control because of the health risks, so I stick with spironolactone.  It’s the only thing I’m on and the only thing that has made a difference. I would definitely ride it out for at least eight months. And like I said, no caffeine and check your generic. 

Edited by 363085_1443950141

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You have to give Spiro time to work. After a few minor bumps in the road like the purging at the beginning, I'm really happy I stuck with Spiro. I've been on it for ~8 months at a low dose of 50 mg and it's working great. I'm not 100% acne-free, I still break out a little on my chin but overall my face is now not oily, no clogged pores, and my pores have tightened up and gotten smaller. I'm pretty sure I would be at 100% clear if I upped the dosage, but I just don't want to risk any side effects and I'm managing the minor acne with salicylic/mandelic acid peels, which helped tremendously to get rid of any superficial scarring/post-inflammatory hyper pigmentation.

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