This Pill (Not *the* Pill) Helps to Banish Hormonal Acne—Here’s What to Know

Photo: Stocksy/Leandro Crespi
If I could swallow a pill and it would magically rid me of a single skin affliction, I'd choose hormonal acne. This breed of breakouts is particularly fickle, as it starts with those unseeable chemicals in the body that are difficult to control. Yes, there are topical skin-care treatments (I'm looking at you, retinol), anti-inflammatory diets, and certain supplements that can help—but sometimes they're just not enough to stop the cyclical pimples in their tracks.

But then I discovered that such a pill does actually exist, by way of prescription from one's doctor. As someone who's tried every hormonal acne treatment under the sun, I'd pretty much given up hope that my skin could ever be clear—until I was introduced to Spironolactone. It's a prescription that regulates your hormones to stop these breakouts from happening. Fast forward six months, and I literally don't get acne anymore. At all.

How long does the morning after pill last?
Photo: Getty Images/Maskot

How Spironolactone works

Here's how it works: "Spironolactone is popular for female cycle acne, the kind that happens every couple of weeks and is associated with a menstrual cycle," says Purvisha Patel, MD, a board-certified dermatologist and founder of Visha Skincare. "Progesterone and testosterone surges cause oil glands to increase production at these times, and Spironolactone binds to the same hormone receptors to decrease oil production during these same times."

It's interesting because it's also used for other things that are unrelated to acne. "It's a blood pressure medicine that has a side effect of blocking androgen hormones like testosterone," explains Tony Nakhla, MD, a board-certified dermatologist and founder of Eighth Day Skincare.  And Dr. Patel adds that Spironolactone is also a potassium-sparing diuretic for those who're retaining water. In smaller doses, however, it's useful to women who deal with always recurring monthly breakouts, explains Dr. Nakhla.

Basically, Spironolactone blocks androgen receptors and reduces the production of oil in the sebaceous glands, according to him. "With hormonal acne, androgen hormones (like testosterone) are elevated and can cause skin problems like oily skin, clogged pores, and acne around the neck and jawline," he says. And that is how the miracle is performed.

What to know ahead of taking it

First things first: You know how they say patience is a virtue? Yeah, that definitely applies with this medication. While Dr. Nakhla says that results can be seen in as little as a month, he tells me that the full effects usually take longer: around three to six months. Personally, I didn't see my skin clear up until about four months in.

The frustration can be real. While most derms say your skin usually won't get worse before it gets better on Spironolactone (you know, in the dreaded purging period), that definitely wasn't the case for me. My skin freaked out at first, with breakouts bubbling up all over, and then it cleared. "That can happen with any acne med," says Mona Gohara, MD, a Connecticut-based, board-certified dermatologist.

If you stick it out, however, dermatologists agree that's very effective. The thing is, if it works for you, you might want to take it long-term. "If you stop taking the medication, your oil glands will become hormone responsive again, and pimples may recur," says Dr. Patel (Dr. Nakhla says that hormonal acne has a tendency to burn itself out, though). The good news is that this is safe. "I have patients on this medicine for many years," notes Dr. Nakhla. "There is no time limit."

There are a few things to take notice of, of course. "You should have a pregnancy test before starting the medicine, and should use strict birth control while on it," says Dr. Nakhla. "It is a category C medicine and can cause severe birth defects." Also, since it affects your potassium levels, this is something to monitor. "It's important to measure blood potassium levels with use and stop if too high," says Dr. Patel. "The side effects do include increased potassium levels and low blood pressure or dizziness, which is why your doctor will check your blood pressure before starting the medication." So lay off of too many bananas.

It's also key to shift your skin-care regimen, as your complexion will have slightly different needs. Goal number one? Stay hydrated. "It's a good idea to avoid over-drying the skin," says Dr. Patel, who recommends avoiding prescription tretinoin or benzoyl peroxide as your skin can get extra dry, peel, or become irritated, as well as oil-absorbing products like charcoal masks, which can lead to an over-drying of the complexion. "Your moisturizers should say comedogenic or non-pore clogging so that your pores can stay clear when using," she says.

The best part of it all, I've gotta say, is that (if it works for you, as it does for so many people) you can get your hormonal acne under control once and for all. And that is why I look forward to taking the pill everyday.

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