With all of the acne treatments on the market, deciding on which one to use can be a pain. While some may opt for natural remedies or over-the-counter creams and washes, others choose to go with prescription medications like antibiotics.
The problem? Long-term use of oral antibiotics can result in serious chronic conditions, including antibiotic resistance, lupus and inflammatory bowel disease. Because of the delicate bacterial balance in our bodies such as on our external layer of skin and in our colon, long-term antibiotic use can also negatively affect our body’s pH balance, which can lead to other conditions like rosacea and eczema, according to Dr. Rachel Nazarian, a board-certified dermatologist and Fellow of the American Academy of Dermatology.
The downsides to long-term antibiotic use have led doctors to advise patients to seek alternative acne relief that has fewer risks involved. One of these options is the diuretic drug spironolactone, which has gained popularity as an acne treatment as more becomes known about antibiotics’ affects on the body. A study published this month showed its promise as an alternative acne treatment.
How It Works
Recent research published by the University of Pennsylvania School of Medicine found that spironolactone may be just as effective as antibiotics in the treatment of hormonal acne, with similar rates of patients sticking with each treatment over a year.
“Taking spironolactone avoids all of these risks, is safe for long-term use, and is without the risk of building resistance,” said Nazarian, who wasn’t affiliated with the study.
Spironolactone works by blocking the effect of androgen hormones on the sebaceous glands, which are the glands underneath the skin that secrete oil into the hair follicles for lubrication (a process that can lead to acne if there’s an overproduction of oil). The diuretic’s anti-hormonal effects make it an appealing option for preventing acne outbreaks. It comes in the form of a pill, but you can also request it in liquid form. The medication is only available with a prescription from your doctor, according to the Mayo Clinic.
The Small Catch
As with every supposed “miracle product,” there are limitations with spironolactone ― the main one being that it’s only effective in treating women’s acne. This is partially due to the fact that spironolactone, primarily used to treat high blood pressure and heart failure, also prevents testosterone production. As such, the drug can cause unwanted side effects in men like increased breast tissue, said Nazarian.
Dr. Angela Lamb, a board-certified dermatologist and director of the Westside Mount Sinai Dermatology Faculty Practice in New York, told HuffPost that she would not prescribe spironolactone to men due to its hormone-blocking properties. This includes androgen, which, if found in high levels in women, may contribute to the development of cystic acne, Lamb said.
Though androgen is, by definition, a male sex hormone, it can be found in both women and men. Androgens just more present at much higher levels in men, resulting in the development of male traits and reproductive functions.
In women, androgens are produced in the ovaries, adrenal glands and fat cells. They play a role in regulating pubic hair growth and underarm hair growth during puberty. When women have high levels of androgen in their bodies, with it comes issues including excessive hair growth in unwanted places and, yes, acne.
For the guys who do not want to take antibiotics to treat their acne conditions, Nazarian suggested taking isotretinoin, which she described as a “high dose form of vitamin A,” and can give a sometimes permanent improvement in acne. Both Nazarian and Lamb also recommended trying other oral medications if topical treatments like retinoids or other creams appear to not be working.
Both women and men can also make lifestyle changes, like removing dairy and processed sugar, or cutting back on wearing makeup every day, to help with skin issues.
What You Should Know
As with all medications, use with caution. Taking spironolactone could bring about some unwanted side effects including dizziness, upset stomach, lightheadedness, diarrhea and other gastrointestinal problems.
While spironolactone isn’t recommended for men, “in women, it typically works very well by improving hair growth on the scalp and decreased hair growth on the chin and neck and improving acne flares,” said Nazarian. So, along with treating acne, this also means no more surprise guest appearances from random hairs that you have to shave every two days.
In women, it typically works very well by improving hair growth on the scalp and decreased hair growth on the chin and neck, and improving acne flares. Rachel Nazarian
Taking spironolactone is safe for most women, except for pregnant women, women who are trying to become pregnant, women who are breastfeeding and women who are currently using blood pressure medication.
It is important to consider that spironolactone is not FDA-approved to treat acne, so doctors typically recommend this medication for “off-label” use. But this doesn’t mean the medication is necessarily dangerous to use. Doctors prescribe off-label medications for use if there is an overwhelming consensus that using it will be beneficial to patients, and using spironolactone for acne treatment has been been backed by data to suggest it is effective. However, you should always consult with your doctor before trying any new medication.
“I recommend a professional evaluation by a dermatologist,” Nazarian said. “Be realistic with your plan: If you don’t have time for applying creams and topical medication, you may be more successful going on an oral medication.”
It’s also a good thing to keep in mind that no matter what type of treatment you use to treat your acne, you most likely won’t see results overnight.