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Based on All Available Studies
Strength of Evidence
Side Effects
Antiandrogen’s Real World Take
“Spiro” has been shown to work in a real and noticeable way most of the time. However, messing with hormones is messing with hormones and it’s best to proceed with caution.
How to Get It
Have a dermatologist? Make an appointment to get this medication. Don't have a dermatologist? See The American Academy of Dermatology Physician Database to find one.
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August 31, 2023
Spironolactone – worked wonders for us!
Spironolactone- my 15yo daughter had severe cystic acne. She had tried lots of skin remedies and medications including doxycycline and the pill (Brenda) with no results. We then went to a dermatologist and were prescribed spironolactone, which started to work after about 2 to 3 weeks, and now 3 to 4 months later, her skin is 90% improved. She really only has the acne scarring left now which is also getting better over time. She started on 25 mg, then went up to 50 mg after six weeks and has been on 75 mg for the last six weeks or so. It’s been a very effective treatment for her and we are super happy with it. She hasn’t had a period since commencing the medication though so we will bring this up with the dermatologist at the next appointment. Highly recommend!
February 16, 2021
THE cure for hormonal/adult acne (but it takes 4 months)

It cured me COMPLETELY after 5 or 6 months (cleared 90% my skin after 4 months; 50% after 3 months, I think...). My acne was no joke, I had a lot of internal pimples, clogged pores, the whole combo, and as everyone here, I tried everything under the sun, except to Isotretinoin. It TAKES at least 3 months to have effect, no matter the case, no less than that, I saw that information once in a medical presentation. BUT after 2 months I was seeing VERY good and solid results. Your acne will, at first, slowly decrease, and then QUICKLY decrease, and one day you will wake up with no new acne, and cured of the past one and be amazed with your new skin. My skin is SO smooth right now, I can't believe it's my real skin, no more clogged stuff under it. I used Epiduo also as a treatment (and of course sunscreen). In the end of this review I will list everything I use now, and explain why I think I found the best minimal skincare regimen to support that pill treatment. 

That thing is so magical that I don't even use Epiduo anymore! I finally have a skincare routine of a normal person.

I never had any side-effects by the way. See a doctor to keep track of your health ok? There ARE side effects that can happen, so you have to keep an eye on that...

And you H.A.V.E. TO DRINK AT LEAST 2 LITERS OF WATER, ok? Break it into 500ml turns, or you will lost count...

 I use Pfizer's 100mg (my dermatologist said it was the minimum amount to have effect... after a while she said I can slow the dose). And yeah, she said I would have to use it for a long time. I asked "forever?" and she said that acne triggers don't go forever, so after some years I can slowly stop (she said at least 1 years of full dose)... But anyway, I gladly take my magic revolutionary pill every morning (on a empty estomach, and it doesn't hurt anything!). 

I didn't had an hormonal problem apparently, all my hormones were normal, but damn, everytime I ovulated or had my period, there they were, new internal pimples... So yeah, you can call my acne "hormonal". I used everything (except Isotretinoin) for 10 years, Epiduo, the regimen, etc etc, and they helped in some phases, in some years, but they never cured anything even if I did exactly what aaaall the doctors said). They help if there aren't new pimples coming, but every 15 days, bang, all the work were lost with new acne arriving in my poor face. 

About hormonal disbalance: my recent dermatologist said that most people that have hormonal acne don't have any disbalance of hormones, the problem is that our skin is more SENSITIVE to the ups and down of a month's cicle. 

SKINCARE REGIMEN (HOT HOT TIPS coming from 10 years of mistakes):

Sunscreen: you just HAVE to use it, especially if you use something to treat acne (usually things that make your skin super sensitive to sunlight). If you skip this you are screwed BUY JAPANESE BRANDS like Biore or Hadalabo (Rohto), they have real tested standards, not like USA where the worst sunscreen are made (because there's no rule for UVA protection there). Go with the japanese. I use the Biore Aqua Rich because my skin is super dry (the forehead is super oily, so I use a translucent powder on it), but they have great options for oily skin, in fact, the best options out there. I've used La Roche Posay and Vichy's sunscreens for years, they are awful for sensitive skin, but can be an ok plan B if you don't find the japaneses.

>>> I use the HadaLabo Gokugyun Lotion and I freaking LOVE it, you can really feel the water being replaced in your skin, I will never let go of this powerful and yet light liquid lotion. My skin is very sensitive, and this baby is gentle as it can be, seriously. My skin is super dry by the way, I had a difficult time until I found this one, NOTHING seemed to give me enough hydration until this one. I use it a few times a day, after 3h you will see your skin is not sooo hydrated as before, so a refil is always welcome. I believe this is a very important step of my cure, you can't have a healthy skin without a proper skin barrier, and today I see I was not taking enough care of this water reposition in my skin (all dermatologists used to give me gelly creams with salicylic acid, but man, RUNNN from this kind of cream, all they do is irritate your already damaged skin). Run from CeraVe and Cetaphil if your skin is very sensitive, my assss they are for sensitive skin, maybe in the past they were, but not now.  

>>> I lock all the hydration above with Aquaphor around my eyes and mouth at night, and even at day time, since I use a faceshield in my work so my face will be blurry behind it anyway. I intend to do this at night forever, there's no better way to lock all the water in, and those areas are the most sensitive and the susceptible to damage and wrinkles. The formula is pretty minimal by the way, it's like, 4 ingredients, awesome. 

>>> I wash my face with La Roche Effaclar or Vichy Normaderm liquid "soap".

>>> If you use makeup or some kinds of sunscreen, you HAVE to use some Cleansing Oil, I like the Hadalabo one. Oil removes oil, so that is not only the best way to remove your makeup COMPLETELY (and without using cotton, that irritates skin), it will also melt aaaall the superficial sebum of your pores. The Aqua Rich sunscreen I use don't need this, but the others Biore sunscreen do. For years I used those sunscreens that requires a "double-cleasing" and I skipped that part out of ignorance, today I know that played a big part in my acne. Efficient and GENTLE cleaning is a big important part.

>>> Epiduo: DON'T use everyday! No, your skin wont get used to it if your skin is slightly sensitive, I tried it (before starting Spironolactone) and it didn't helped my acne that much to be worth all the pain it causes if used everything... I did peelings and one session of laser, and let me tell yah, they didn't make my skin as sensitive as Epiduo, I almost cried when I had to apply makeup everyday to go to work... Use every other day or skip two and the results will be the same.  IT HELPS ACNE A LOT, yes, because it unclogs pores and make it change the cells quickly, but if you don't wear sunscreen like a vampire you will gain another problem, an awful skin full of spots, been there done that (when I was 20, 10 years ago). So don't be dumb to use this thing without using sunscreen, even to be inside, just near windows. If you don't you will be destroying your skin. Again: japanese sunscreens! 

Obs: I used the Treatment and their product was less irritating than Epiduo, I was able to use it everyday with no problem.. My dermatologist said it was less effective but they seemed to have the same effect to me (they help but not cure anything for hormonal acne)... The game changer, as I said, is the Spironolactone. That shit is the bomb. Freaking miracle. 

Extra stuff I use but are not necessary:

- Ordinary Niacinamide (100% pure powder), I mix with the Hadalabo Lotion. I SWEAR it makes the moisturizing feeling feel  a lot longer, and I think it made my skin less sensitive... Scientists say it's awesome to fade away scars and yellowness of the skin and make the skin barrier a lot stronger;

- La Roche Posay eye cream for dark eye circles (that shit works!);

- Melano CC Vitamin C serum (this formula is safe for acne). 


That's it girlsss, I hope you can use all my tips to have a miracle in your lives too. Don't forget: 2 litres of water or more a day and a good (japanese!) sunscreen are just as important as Spironolactone to have a healthy and beautiful skin. 

This Was Helpful

2 user(s) found this helpful

December 21, 2023
Thank you 😊 What an incredibly detailed explanation 🫶❤️‍🔥
February 6, 2021
Starting Spiro

I’ve been on spiro for almost 6 weeks. The texture of my skin has improved but i’m still breaking out every day. My chin is covered with cysts which i’m confused about because i’ve never had issues with acne on my chin. I have many white heads also on my cheeks. I just feel really disheartened and not sure if any one else has experienced the same. I’m trying to give it more time but I don’t know how much longer to wait. 

January 2, 2021
Cleared my skin

Brief background: I started getting painful hormonal acne when I was about 18/19. Had minor acne before that. It got pretty bad and caused what would now be considered pretty minor scarring (that does make me self conscious), thanks to retin-A. I finally went to a dermatologist, who prescribed antibiotics and retin-A. These took months to work but they cleared my skin and the retin-A helped minimize the scars over a period of two years. I started Apri birth control and stopped the other prescriptions and my skin stayed completely clear, but the pill also way lowered my sex drive. 


Last year, after I turned 28, my new doc changed my OCP from Apri to a lower estrogen pill. After another 6-8 months, my skin started getting more blackheads and small spots. Manageable but annoying. Finally, during lockdown, especially with increased mask usage and the heat/humidity of summer, my jawline started getting constant large painful spots. I immediately asked for spironolactone, which I hadn’t used before but had heard about. Started with 25mg, then bumped up to 25 mg x2 a day after a couple weeks. Stopped getting large painful spots after about 3 weeks. Largely cleared up after 3 months but still have some spots here and there. Slightly worse around period/withdrawal bleed, and have to be careful with my skincare. But mostly I’m just so happy my skin is basically ok now. I asked to be upped to 100mg a day and have only been on that dose less than a week so I’ll see if it helps even more over time. On all the doses, I’ve had minimal if any side effects. Maybe using the bathroom more, but even that isn’t that noticeable or problematic. 

I definitely recommended giving this a shot, it can make a substantial difference even if it doesn’t make your skin absolutely perfect. It also comes with minimal health risks, unless you’re a man or worried about the effects on hormones. 

November 5, 2020
Glad I gave this a second shot

I am so pleased with the results of this medication. I was actually prescribed this about two years ago but stopped after two weeks because I found the medication made me super lethargic the first time (100 mg). I think the issue is it was too high to start out on. 

I recently went back on this in September because my jaw acne was getting bad again. I have tried everything under the sun over the years (been dealing with acne on and off for 14+ years), and I had never given this a good go. I've tried diet changes (cutting dairy did NOTHING for me; cutting sugar didn't help much, I've tried retin a which works awesome for surface whiteheads! and I still use it 2x a week; I've tried antibiotics, creams, birth control etc....). My friend was on spiro and raved about it, so I tried it. I'm nearing two months and I am so pleased with my skin. I used to have OILY OILY skin, like blotting 4x a day type, and always shiny. Hated it. Since taking this, I blot about 1x a day which is amazing. My skin is smooth and very soft. I have 1 active bump right now, the rest of my skin is clear. Working on clearing the hyperpigmentation up after the last breakout in August/September. Wow, this stuffs amazing for those of us who have acne along the jaw/cheek area. I never thought I had hormonal acne because I never broke out around that "time" of month, I just broke out consistently. However, it was in the area of the beard. I've always suspected I may have PCOS though because I do have some dark hairs that pop out on my chin and around my nipples actually, and occasionally I can feel pain during ovulation. Anyways, I'm still not diagnosed, but the fact that this medication is really helping says something about acne being related to my hormones. I was very hesitant to go on this because it does make me nervous to "play" with hormones. But for crying out loud, I'm so tired of feeling uncomfortable in my own skin. Acne has really affected my confidence over the years and more importantly, its caused scarring that I will never ben able to fully treat. For this reason alone, I think it's import to have it under control because scarring is not easily fixed. 

I started at 50mg for the first week, and I've been on 75mg since September. Next week is 2 months on this stuff. I would say I cleared up by week 5/6. My acne didn't get "worse"/ no purge, but it kind of stayed the same for the first month. I am so happy with this. I still get tiny pimples on my upper neck sometimes, so I have been thinking about going up to 100mg. This makes me pee more, but 75mg is not super high. When I originally went on 100mg the headaches were pretty bad and I felt tired all the time. This dose, I feel pretty normal, occasional headaches I guess. I was tired for the first 3 weeks but its gotten much better over time. 



I wanted to do a quick update. This is still the best stuff I've taken for my acne. Anything topical never truly "treated" the issue, I find taken something internally does the trick. This has reduced my jaw and cheek acne by 90 percent. I still get a couple here or there when very stressed but that's life. far better than before. I take 50mg a day, enough to keep things under control but skin is still a bit oily. The higher you go the less oil you will get. Problem I found on this med, is if I go above 50mg my anxiety can be out of control. When I started taken this med I noticed increased anxiety, heart flutters and general butterflies for minor things. This definitely worsened which is why I have to remain at 50mg. It still aggravates my anxiety and depression but I am going on an anti depressant to counter those because I can't go back to having a full face of acne (that's a whole other depression in itself). I will say, this medication DRASTICALLY reduces my appetite due to increased anxiety, so I can go a whole day with only one meal sometimes. This isn't good as I am already underweight for an adult. hence keeping a low dose. would be awesome for someone looking to lose pounds though! I dont drink near enough water on this, not healthy, make sure you do and I think because its a diuretic not drinking enough water can really create an electrolyte imbalance. make sure you drink gatorades and stuff at the gym to keep those balanced while on this. 

April 30, 2020
Don't Give Up!

I would give 5 stars, but I have just entered the "clearing" phase, so I want to make sure this continues and I will update later. I am 27 years old and started getting pretty bad hormonal acne two years ago on my jawline, neck, chest, and back. Jawline and back being the worst areas. I haven't been on birth control for years so it has nothing to do with this. I would get moderate cysts (I've never had super severe acne), but they were deep enough to stay a week or so, and leave a scar behind. I haven't felt confident enough to wear a low cut shirt or tank top in years, and I always have to wear makeup with the exception of one week after my period when I seem more clear on my face. 

I started Spironalactone 50mg (25 am and 25pm) a little over two months ago. I will say I was one of the unlucky people who had a dramatic initial breakout. I got about 10 hard cysts on my neck in places I have never gotten them before, and they stayed there for about 3 weeks. Nothing helped I tried tons of spot treatments. My chest and back also got worse. I have a new guy I'm seeing and I was so embarrassed to be around him. I was so discouraged by this initial breakout and it felt like it was going to last forever. Because I wasn't seeing improvement, I asked for a topical and I was put on Aczone. This seemed to dry out newer smaller pimples, but not the cystic ones. I also just started curology in order to simplify my skincare. Surprisingly since starting curology my skin has improved leaps and bounds and it did not make me break out. My cysts are 90% gone and I have only been on it a week. The struggle is knowing whether this was just convenient timing and the Spiro is starting to work, or if the curology has accelerated the process. Either way, I am going to stick to this regimen because my skin is GLOWING and I am finally at a place where I don't need to wear makeup. I still don't have a fully clear back or chest, but it's getting there. I was told to use Zinc soap to help with this and I've noticed a difference since using this as well. I ONLY use this on my body.

Anyway my point is that as difficult as it was to push through the initial breakout, I now see why everyone says to be patient. I am well on my way to perfect skin- I can tell. I am starting 75mg tomorrow and will let you know how i progress. Please don't give up! I am rooting for all of us to get our confidence back. No side effects besides frequent urination and some bowel issues the first week. Feel a little more tired, but it's manageable. 

April 6, 2020
Starting Spiro

I have struggled with moderate acne both on my face and my back since I was about 13, and I'm now 19. I started spironolactone 2.5 weeks ago, and I take 50 mg every night. I've rated it 3 stars because I have no side effects but I also haven't noticed much of a difference in acne.

Week 1: I noticed a decrease in oil production at the end of week 1. I haven't noticed serious side effects, but there were a few days when I felt anxiety which resolved as soon as I drank more water and electrolytes. 

Week 2: My acne improved at the beginning of Week 2, but it worsened slightly at the end of week 2. I've seen an improvement of acne along my jawline, but I still get some small bumps on my cheeks (not full cysts though). Back acne has improved slightly and the frequency of new cysts has decreased a little.

Week 3: I'm now about halfway through week 3. I noticed some small bumps on my chest and stomach that are not itchy like hives, but they have a red appearance similar to hives. I don't know if these are related to the medication or if they're due to a new allergy. If they don't resolve soon, I'm going to see my derm again. My derm also recommended moving up to 100mg after two weeks, but I've stayed at 50 mg because I'm a little concerned about new side effects. My acne has improved slightly, but I still have new pimples. My hair is noticeably less oily.

End of week 3: The weird red bumps on my chest and stomach have diminished but they are still noticeable. The acne on my face has definitely improved but the past breakouts are still healing. The acne on my back has improved somewhat but I'm still getting some new pimples. I'll update the rating at the end of 4 weeks. I'm also going to call my derm to see whether I should still move up to 100 mg, but I'm optimistic that staying on 50 mg will help since I'm beginning to see an improvement.

End of Week 4: I have noticed an improvement in my back acne, but it is not clear yet. I'm not sure what the red bumps were, but those disappeared. I tried going up to 100mg (50mg in AM and PM) and noticed severe side effects, such as numbness and tingling in my hands and feet. I'm back to 50 mg in the PM now. Can't yet tell if my face has improved much.

March 5, 2020

I will update as I go along.

I'm 44 and have suffered from cystic acne on and off for the last 10 years.  I've been on all the different antibiotics but all stop working after around 6 months.  I've also been on all of the topicals. Epiduo being the most effective but still not preventing the cystic acne in the first place.

End of week 1 - 2 x 50mg per day.  My skin is noticeably less oily. No new acne, existing acne little difference, some small acne which was already under the skin coming up but no more than usual.  Days 5-7 terrible terrible diarrhea.  I have had to reduce to 2 x 25mg per day as I have been unable to leave the house and am in the bathroom every other hour including throughout the night.  No other side affects.  Am hoping the reduction in dosage will make it more tolerable.

End of week 2 - reducing the dosage thankfully sorted the diarrhea problem!  Since dropping from 100 to 50mg per day I have noticed a slight increase in oil in my skin again, and the acne which was already under the skin is still coming out. I have a few new ones, but its the week before my period so its hard to tell if this would have happened anyway - at the minute I wouldn't say I have had a Spiro related outbreak.  

End of week 3 - increased dosage to 75mg per day due to oil increase when dropped from 100 to 50.  Seem to be able to cope with this, with occasional but controllable bowel issues (tmi!). Skin looks good.  No new breakouts so far. No weight loss.  Boobs same size.  Potentially a little bit of weight gain but hard to tell as we are all housebound due to COVID19 lockdown so not getting any exercise.  We will see.  No emotional changes.

End of week 4 - still on 75mg, stomach issues under control. Skin generally quite good though have had a couple of new cystics.  No weight loss.  Boobs tender but same size, very minor weight gain but could be to do with social isolation. No emotional changes. All in all pleased with results so far.  Certainly not "clear" yet but seems to be making a difference, skin definitely less oily and its good not to be on antibiotics having been on them for years.  Unless anything drastic changes I will report back after month 2.

End of week 8 - very much the same as week 4. No further stomach issues, skin is generally good - I had an outbreak of 3 cystics on my jawline around week 6 which I was a bit disheartened about as it was the first real set back, but they didn't seem to last as long as normal, they are now pretty much gone with some minor colouration all that is left. They weren't as painful or as "angry" as usual so I'm seeing this as a good sign.  Boobs still tender, have gained a few pounds but have also eaten a lot of cakes.  I know that 3 months is when most people see the most benefits so I'm holding on in there.  Am due the results of my first set of bloods next week so I will update again then. No problems with periods or mood swings etc. Am hoping the weight gain is more about the cakes than the pills.

April 9, 2020

Hey RG001, 


how's it going now 8 weeks on? I have just started on 50, might go up to 75, nice to hear from someone on similar dose!

April 29, 2020

Hey a91, hows it going for you? Have just updated post week 8. The outbreak at week 6 did feel like a set back but it wasn't as bad as usual and I seem to have escaped significant side effects. I might consider going up to 100mg if my bloods are OK but I don't know.... and I don't think I would want to go higher than 100mg.

March 3, 2020
Is itchiness a normal reaction?

Does this make anyone else extremely itchy? Is this a symptom that will go away with time? My skin itches- then when I scratch it- it welts. Is this something normal to push through- or am I having a bad reaction. It didn’t bother me the first 2 weeks of taking and now for the last week I am super itchy. I’m only taking25 mg. 

November 5, 2020

Yes, it made me a bit itchy but rarely. not extremely. If you are very itchy you may be allergic. Check with your doc

August 27, 2019
Broke me out - Not just an "IB"

I went to my dermatologist for something non-acne related and she noticed I had 1-2 pimples. She asked me if this was typical for me. I told her that I usually only get 1-2 pimples around my cycle and she told me that spironolactone would be perfect for me - that it would clear the hormonal "acne" I was suffering from during my cycle. I don't usually jump on the pharmaceutical bandwagon, but I was getting annoyed at the monthly pimples so I figured I'd give it a shot. I had heard a lot of good things about spiro, and I even have a good friend who has benefited from taking it.

The first two weeks were great. After that, my entire face was breaking out in all kinds of ways. Deep, cystic pimples, whiteheads, blackheads, etc etc. I had acne in places I've never had acne before. It was awful and lasted weeks, if not months after I stopped using the spiro. I had persistent flesh-colored non-poppable bumps covering my entire forehead for a long time after. I also blame the spiro for a few other medical things that happened to me after that. Overall, really regretted trying this. Glad it works for other people, just didn't work for me.

Finding a Doctor

The right dermatologist can make a big difference to your patient experience and the success of your acne treatment plan. Here are the steps to find a dermatologist who is a good fit:

  1. Use the search feature on the American Academy of Dermatology website to look for board-certified dermatologists in your area, and filter the search results for doctors with a special interest in treating acne.
  2. Read online patient reviews of any dermatologists you are considering and ask people you know whether they have any experience with these dermatologists.
  3. Do your research and go to your first appointment with questions prepared.
  4. Listen to what your gut feeling tells you once you see a dermatologist in person. If you are not completely comfortable, try a different dermatologist.

Finding a Doctor

Only a select few plastic surgeons specialize in acne scar revision surgery. Be certain to find a provider who specializes in acne scar repair and who is passionate and experienced in this area.

Be sure to:

  • Look at before and after photos, the more the better, especially patients with similar scarring to your own.
  • Be realistic about results. Look for improvement, not a cure.

Questions to ask a potential scar revision specialist:

  • Are you board certified? Be certain that they are board certified.
  • How long have you been performing these procedures? Normally, the more experience the better, however, some younger surgeons may be more on top of the latest procedures.
  • Can I speak to some of your other patients? Ask for references for several patients who had similar scarring and speak to them about the process and their satisfaction with results.

Red flags:

  • Their story changes: As you discuss different treatment options, if they tend to change their mind easily, or agree with whatever you say, consider this a red flag. A confident, experienced surgeon will possess strong, unwavering opinions.
  • Your gut tells you "no": Trust your gut. If you just don't feel that the doctor is the right fit, trust that and move on. On the other hand, if you feel they are the perfect specialist for you, trust that feeling.