Spironolactone to treat acne: Month by month diary

Back in January, I wrote a blog about how I managed to treat my cystic acne using spironolactone – and it’s been my most popular blog post to date! I was even interviewed by PopSugar and Alluremental, right?

But, to be honest, I’m not surprised it’s been my most popular post. I know from experience how utterly crap acne can make a person feel, how it can lead to a total loss of confidence and how it can make you want to hide away from the entire world. Everyone who once felt like me is desperate to find a treatment to kick their acne to the curb – and there’s definitely somewhat of a hype around spironolactone and acne right now because of that.

I felt like I made it out to be a miracle pill in my first blog post — and to be honest, in some ways, that’s true. No other treatment has worked so well for my acne. However, it’s not something you should take lightly – and I want to be open about the negatives as well as the positives, so I can create a useful resource for those wanting to try it.

[Just a little heads up that this post is from my old blog and was written around 3 years ago. A lot has changed since then, and I’ve since gone off spironolactone and successfully cleared my acne using Accutane (and seriously improved my writing skills). Still, it might be worth a read if you’re considering using spiro as an acne treatment.]

Why I used spironolactone to treat acne

I don’t want to go too much into the original story as I’ll just be repeating myself. You can read my full spironolactone for acne story here. Long story short, I’ve had acne since I was 10 and I’ve tried every topical prescribed treatment under the sun — numerous antibiotics, numerous contraceptive pills, loads of expensive skincare regimes, diet and lifestyle changes, food elimination diets and tons more. I was in Vietnam and my skin got absolutely out of control.

Close-up of girl's cheeks with hormonal acne

As you can probably understand from the photo, the acne making me feel terrible. I felt I had to try either Accutane or spironolactone as soon as possible for the sake of my mental health. My self-esteem was extremely low and at one point didn’t leave the house (and barely even my bed) for 2 weeks.

I decided to go the spironolactone route and after speaking to a dermatologist in Vietnam, I started taking 50mg spiro.

What is spironolactone?

I’m definitely not qualified to medically explain the medication, so here’s what Very Well Health say about spironolactone and how it works to clear acne. They’re referring to it as Aldactone, the generic form of spiro.

“Aldactone is in a group of drugs called as anti-androgens. Hormones, specifically androgens, have been linked to the development of acne. Aldactone works by limiting hormonal fluctuations that can trigger breakout development. Androgen hormones, like testosterone, are typically thought of as male hormones. But androgens are also present in the female body, although in lower levels. Some women produce more androgen hormones than needed. Anti-androgens like Aldactone block androgen receptors in the body, preventing cells from absorbing androgen hormones. Simply, Aldactone limits specific hormonal fluctuations that can contribute to acne breakouts. Because of the way Aldactone works, only women whose acne is greatly influenced by hormonal fluctuations will see results with this medication. But for those women who have hormonal acne, the drug can do a good job in helping to manage breakouts.”

It’s also worth noting that spironolactone isn’t normally used for its anti-androgenic properties. It’s most commonly prescribed for high blood pressure and heart disease. It’s not FDA approved for acne in the UK but does seem to be more commonly prescribed by doctors for PCOS specifically.

Although spiro isn’t FDA approved for acne in the UK, they can still technically prescribe it to you — it’s just considered ‘off-label use’.  If you’re experiencing acne past your teens and you’ve exhausted all your options, it’s worth chatting to your doctor about spiro – although I obviously can’t guarantee they’ll prescribe it to you.

Girl after 10 months of spironolactone to treat acne

Using spironolactone to treat acne: Month by month

Month 1

I started spironolactone with the most severe acne I’ve ever had. And I’m not going to lie — it got even worse before it got better!

The first month was absolutely horrific. I don’t actually have any photos (which I regret now) as I was so down on myself and didn’t want to go anywhere near a camera. I started breaking out in places I’d never broken out before about a week after starting the medication. I remember getting a really strange cyst right under my eyebrow and clusters of cysts on my outer cheeks.

My skin also started drying out very quickly, which was weird for me, as I’ve literally always had very oily skin. If there’s one thing that’s worse than acne, it’s dry, flaky, itchy acne. Yep, it wasn’t a pretty situation!

I got eczema on my neck and arms and cracked lips. Spironolactone is a diuretic, which means it makes you lose water – ya, basically it makes you wee a lot! I wasn’t upping my water intake enough at first, so my body was quite literally drying out. If you’re not someone who likes to drink water, spiro probably isn’t for you. I have to drink loads – and hangovers are 10x worse!

Month 2

My skin continued to break out in weird places and my skin was significantly less oily than it was before I started spironolactone. My acne was very clustered, crusty and red (I know, ew) because it was an unfortunate mix of inflammatory acne and the driest of dry skin.

I was unknowingly making this worse though! I continued using the Effaclar Duo by La Roche Posay, which contains salicylic acid. I swear by this product for keeping acne at bay, but when your skin is dry, it’s not gonna help the situation.

I eventually got some Avene repair cream, which I applied at night, and my skin became way more manageable. At the end of month 2, I started taking 100mg a day rather than 50.

Month 2.5 – 3

I saw a subtle improvement in my skin at this point. My family had come out to see me in Vietnam — and about a week into that, my skin started to slowly clear.

I still think it’s such a coincidence. I was so happy to see them. It made me realise that my mood and general happiness probably has a bigger effect on my skin and body than I’d thought. I can be a huge over-thinker and worrier – and most of the time, I just pretend I’m alright and don’t talk to anyone about it. Was I worrying less because my family were there who I know, love, and trust? Did that help my skin clear, along with the spiro? I think so – I really think stress and anxiety plays a part in my acne, so I’m trying to change that.

So, in conclusion, I finally saw some serious improvement at about 2 and a half months in — and even more so towards the end of month 3.

Month 4 – 5

I was travelling around Asia with my sister and boyfriend at this point and quite literally having the time of my life! My acne seemed to dramatically improve — quite rapidly, actually. I’d gone from having 20 or so painful cysts to just a couple of minor spots.

I was out in the sun and swimming in the sea, however, so I do think that may have helped speed up the process too. The sun has always done wonders for my acne, but I obviously can’t rely on that as a cure.

Month 6 – 8

When I got back to the UK, my skin was perfect! I was barely wearing makeup and felt so confident in my skin. It was literally amazing for me. However, the next task was getting the medication prescribed to me by a British doctor.

I was running out of spiro rapidly and had to wait a while for a doctor’s appointment – and so, I dropped down to 50mg. Guess what? My acne came back! It was nowhere near as severe as it had been, but the change in dose definitely provoked a change in my skin. In fact, every time I’ve changed my spironolactone dose, my acne has worsened. It seems to take a while for hormones to settle to a new dose.

Anyway, thankfully, my GP prescribed the spiro to me after seeing photos of my skin before I’d started taking spiro. She prescribed me 100mg/day with blood tests every 3 months.

Month 9 – 10

This is where I am now! After going back up to 100mg/day, I’ve had a few breakouts here and there. I don’t think I’ll ever be acne free, even on spiro.

I tend to get a nasty breakout monthly. However, I can definitely take a few spots once a month (yep, hormonal) in comparison to 20 spots at any one time. It’s 100% made my acne more manageable and often non-existent. Here’s a recent (July 2018) picture of me with just concealer on my scarring and under-eyes. Far from perfect, but I feel so much better!

Girl after taking spironolactone to treat adult acne

Side effects of spironolactone to treat acne

I quickly want to mention the side effects I have personally experienced whilst using spironolactone to treat my acne, though I do plan to write a longer blog about all the possible side effects. As with any medication, the side effects I experience will be different to others – everyone reacts differently to medication, so do keep that in mind.

I have experienced dry skin, increased thirst and the need to wee a lot (haha, TMI?) as it’s a diuretic. It hasn’t bothered me too much, but I do have to make sure I’m drinking lots of water. Plus, I’m the lame friend on a night out who has to ask for a glass of water between every drink – I just can’t do it otherwise! 

As I said earlier, if you don’t think you could get into the habit of drinking a lot of water, spiro probably isn’t a healthy option for you. When I forget to drink enough water, I get headaches.

The dry skin thing was really just a matter of adjusting my skincare routine. I thought I was getting wrinkles (ah!) but they were just dehydration lines as my skin has lost most of its oiliness on spiro. This is all fine now that I’m using oils, serums, and richer moisturisers, rather than following my old skincare routine which was tailored towards acne-prone, oily skin.

Since starting spiro, I’ve also noticed that my hair has thickened out — which is a great side effect! I had thin hair around my hairline and couldn’t wear my hair up without it looking like I had huge bald patches. As spiro regulates hormones and lowers testosterone, you might find that your hair grows back if you had a problem with hair loss before.

Although I have my concerns about being on a strong medication long-term, I’m so grateful that it’s given me my self-esteem and confidence back somewhat.

It might seem silly to those who haven’t experienced it, but acne can genuinely make you feel awful and make you hate yourself. Nowadays, there’s such pressure to look a certain way and that really took its toll on me when I had acne. I’ve always felt the need to have perfect skin – which is stupid. My skin will never be as perfect as I’d like it to be after my years of acne – but I’ve stopped searching for perfection now.

If your acne is bothering you, there is a treatment out there and you should get to your doctor ASAP to see how they can help you. Remember that you’re not alone, too – there’s an amazing community online, especially on Instagram, of girls struggling with acne. Try and connect with us! It’s helped me so much. As always, I’ll always reply to any messages or emails about acne and I’m always willing to have a chat with you, no matter how down or crap you’re feeling about it.

Girl after taking spironolactone to treat acne

I hope this blog has answered some of your questions if you’re considering taking spironolactone to treat your acne. If you have any questions or just need a lil rant about your acne journey (I’ve been there), feel free to message me on Instagram.

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5 responses to “Spironolactone to treat acne: Month by month diary”

  1. Sofia says:

    Hi Alice,

    Your blog above helped me to understand better and confident that the Spiro will work on my hormones especially the acne issues. I am actually taking Spiro of 50mg last Tuesday and in two weeks I will get 100mg. The doctor did tell me that it takes months to be fully effective :). I have question what products did you used or if you are still currently using the routine products for your face. Like Cleaner, Moisturizer, etc. Did you used any oils? Serum? Your input will be much appreciated. I am trying to make new routine of products for my dry skin with acne’s at the same time.


    • alicelang says:

      Hey Sofia!

      Thanks so much for your comment. I’m glad to hear it helped you understand Spiro more! I’ve got my fingers crossed for you that Spiro will help you to get your acne under control. As you said, it can definitely take some time – so hang on in there! I’m 100% sure you look great anyways 🙂

      When I was on spiro, I kept my skincare quite simple. I used micellar water to remove makeup and followed with a gentle face wash (I’d recommend Simple Skincare or Cetaphil). I used The Ordinary products for moisturisation, namely their Hyaluronic Acid and Argan Oil, and followed up with the Science of Skin Rescue No.One cream: https://www.scienceofskin.com/product/rescue to help with my scarring too. This is a bit of a pricey product but really did work for me!

      I should mention that I also used treclin gel whilst I was on spiro, but you’ll need a prescription for that.

      Obviously different products will work for everyone, but I’d recommend using gentle products and making sure to keep your face moisturised and hydrated, as that will help your skin and scars to heal.

      Lots of love to you and good luck!

      Alice x

  2. Valeria Ortega says:

    Hi! This entire post has been very helpful and informative. I started taking spironolactone (100mg) about 3 months ago. I just started on my dosage for the third month. However, as you mentioned my skin became worse after the first month and it’s still bad. I am losing hope and thinking of giving up because I continue seeing posts about spironolactone and how it should start working after 2-3 months. What are your thoughts on this? Was it still as bad in the beginning of the third month? Should I just stick to it and wait it out? Thank you!

    • Alice says:

      Hey Valeria, how’re you? Glad you enjoyed my post. From what I’ve read, it’s quite normal for spiro to take some time to ‘kick in’ – I’d stick with it for now, but if it doesn’t start to improve in the next month or so, perhaps book an appointment with your doctor or derm. Wishing you all the best with it!

  3. Victoria says:

    Hi Alice!

    This is a great read. It’s very helpful, but I’ve yet to experience the same results. I’ve been on spiro for about three months now and I don’t see any improvements at all. If anything, I’ve experienced more frequent and painful cysts. It seems like once one cyst clears, another cyst “pops up” the very next day. I never have completely clear skin and it’s all concentrated on my lower cheeks and jawline.

    Is this normal? Is it possible that I could be part of the population who sees improvements in 4-5 months? Or could it just not be working for me?

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