43. Females only - The best treatment for hormonal acne

Hi there. Doctor Jacob here today, and we're talking about the best treatment for hormonal acne.

If you haven't had the chance to catch the last episode, go back and catch the previous episode because it will explain all about why certain women develop hormonal acne. Now let's talk about treatment.

Birth control pills are a great treatment for hormonal acne, but there is a more effective treatment out there. It's called spironolactone. It's an oral medication, a pill which has been out for decades and decades. It's not a birth control pill, and it's not a hormone. It's actually an anti-hormone, meaning it blocks the receptors for hormones on the oil glands within the skin, preventing the hormones from binding to their receptors, hence preventing their effects.

Spironolactone can be used in combination with birth control pills, in combination with Accutane (isotretinoin), as well as in combination with oral antibiotics if needed. However, this drug can certainly be used alone as monotherapy, or in combination with topical therapy.

The first thing to know about this drug is that it is for women only; men should not take this drug. Secondly, women taking this drug should never become pregnant while taking it, because of the risk of birth defects. After a few weeks of being off of the drug it is safe to conceive.

Most women taking spironolactone experience no side effects at all. However, about a third of women taking this drug may experience an increased urinary frequency, meaning urinating one extra time a day. This happens because the drug is a weak diuretic. Also, approximately one out of five women who take this medicine can experience spotting in-between menstrual periods, as well as breast tenderness.

Use of birth control pills along with spironolactone will prevent these two side effects. Rarely nausea can occur if spironolactone is taken on an empty stomach. This medication can also lower the blood pressure, but it only usually lowers it a tiny amount. If the patient's blood pressure already runs low or if a patient has preexisting blood pressure issues, symptoms such as dizziness or weakness, especially when standing up rapidly from a reclining position can occur.

This should be obvious, but women who use spironolactone who are sexually active with men should use birth control to prevent the risk of birth defects.

In terms of effectiveness, spironolactone is more effective than birth control pills in treating hormonal acne, however severe cases sometimes require the combination of an acne-friendly birth control pill with spironolactone. Many dermatologists prefer to prescribe spironolactone only to women who are already on birth control pills, because birth control pills 1) provide contraception, and 2) can mitigate some of the side effects, for example the breast tenderness and the spotting in-between periods, which can occur with spironolactone. Those side effects essentially do not occur if patients take concomitant birth control while on this drug.

Additionally, spironolactone can be used to treat other conditions, including female-pattern hair loss, as well as excessive body hair in women. So if you have either of those two conditions and you take spironolactone from acne, you will likely see some extra benefits. Be sure to tell your doctor if you have certain kidney diseases or take medication for high blood pressure in combination with spironolactone.

Some doctors or other healthcare professionals recommend checking a blood test called potassium while you take spironolactone, as this medication can sometimes raise the potassium level. This becomes more important in patients with pre-existing kidney disease, or for patients who take medication to treat high blood pressure. If this doesn't apply to you, routine testing of potassium is generally not indicated for young, healthy women who take spironolactone.
I do recommend that potassium be monitored if the patient has kidney disease, heart disease, or takes other medications that can raise potassium. Symptoms of rising potassium can include a pins and needles sensation, muscle fatigue and weakness, or a slow heartbeat.

Because spironolactone is somewhat of an anti-hormone, meaning it blocks the hormone receptors, it can be used as a counter-medicine to treat acne cause by birth control that's causing acne, if that makes sense. For example, if a patient has a hormone-releasing intrauterine device, for example Mirena, which releases an androgenic progestin called levonorgestrel, this goes into the blood and hits the hormones in the face, in the oil glands, which are hormone-responsive in the beard area and triggers hormonal acne. However, if a patient takes some spironolactone, this can block those hormone receptors, treating the hormonal acne without mandating the removal of the intrauterine device. Sometimes it's a bit complicated, and many patients find it simpler to remove the intrauterine device and take acne-friendly birth control, rather than adding on spironolactone. However, some patients prefer to add on spironolactone to treat this problem.

For most patients taking spironolactone, I start at a dose of 50 mg twice a day, unless the patient is very heavyset, in which case I may start at a higher dose. The maximum dose if 100 mg twice a day, and a minimum effective dose would be 50 mg once a day. I recommend taking this medication with food, since food enhances its absorption. It takes approximately 8 to 12 weeks to see the effects of spironolactone at any given dose. Therefore, I typically see my patients back in follow-up approximately 8 weeks after starting this medication.

That's all for today. I am Doctor Jacob, we'll see you next time.