Adult acne  cases are spiralling: according to a survey of 92 dermatology clinics in the UK in 2015, cases have risen by over 200 per cent, with more than 80 per cent of adult acne diagnosis occurring in women according to the NHS. It’s no wonder that so many of us are desperate to seek a cure for pernicious, painful and confidence sapping acne that can plague us into our 30s, 40s, 50s and beyond- acne is certainly no longer the teenage rite of passage it was once dismissed as.

As anyone who’s ever experienced a tenacious breakout will agree, acne is very often tricky to treat, and many strong prescription treatments such as roaccutane , while mightily effective for some, involve serious side-effects or aren’t suitable for longer term use. Which is where an acne medication that you may not have heard of comes in. Here’s what Dr Sam Bunting  has to say about spironolactone, and why she thinks it deserves a positive rep in the realm of acne treatments.

It’s especially suitable for adult women with hormonal acne

Spironolactone is a drug originally designed to treat hypertension that has an anti-androgen effect, meaning that it helps to block the production of male hormones that are often responsible for excess oiliness and acne. For this reason, Dr Sam highlights that it’s particularly effective for managing the kind of active hormonal acne  that appears on the lower half of the face- jawline, cheeks and chin. If you’re acne has responded well to anti-androgen contraceptive pills such as Yasmin and Dianette, but you’re no longer taking them, your prognosis on spironolactone is likely bright.

It’s not a first line treatment

In the UK, spironolactone can only be prescribed by a dermatologist, generally after acne has failed to clear up after topical treatment and a course of antibiotics. Dr Sam might prescribe spironolactone if a patient’s skincare and makeup regime has been tailored to treat acne and a three to six month course of ‘stabiliser’ oral antibiotics has shown little to no improvement in acne symptoms. If you’ve taken roaccutane and the results haven’t been as you’d hope, Dr Sam reports that switching to spironolactone could be a game changer as far as clear skin is concerned. Basically, if you’re skin is extremely oily and acne is either persisting or “peaking and troughing”, it could be for you. Dr Sam also cites recent studies that suggest that spironolactone is almost as effective in treating acne as oral antibiotics, which is good news because…

It’s a safe long-term option

The use of antibiotics for acne  is a growing area of concern owing to increased  antibiotic resistance , and Dr Sam highlights that the World Health Organisation are keen to restrict prescriptions for antibiotics. As such, long term antibiotic treatment for acne isn’t recommended, which means that, if antibiotics worked for you but when not taking them your acne returns, you can feel pretty stuck between a rock and a hard place. Which is where spironolactone could come in, as it’s safe to take long-term. That said…

It’s a slow burner

Don’t expect a miraculous clear-up- Dr Sam reports that it can take up to three months for acne to show an improvement, although you should notice that you’re far less oily after about six weeks.

It works best when combined with other treatments

Spironolactone is a team player- combine treatment with a non-comedogenic skincare and makeup  routine, a  topical retinoid  if suitable and anti-inflammatory clarifying treatments such as benzoyl peroxide and salicylic acid .

Doses can be tailored

Dr Sam particularly rates spironolactone as you can adjust dosage to suit your unique needs over the course of treatment. The ideal is to be taking the lowest dose possible, but the fact that it’s relatively low risk means that your prescription can be higher or lower depending on your needs. Just bear the following in mind…

It’s best taken in the morning

Spironolactone is a diuretic formulated to regulate the body’s fluid levels. In fit women, it shouldn’t interfere with your fluid load, however, it can make you want to pee more, which is why taking it before bed could be pretty disruptive. The drug can also elevate the body’s potassium levels, and for this reason Dr Sam monitors patients’ bloods and salt balance, and advises them to adjust their diet accordingly…

Lay off the bananas and coconut water

As spironolactone can cause an increase in potassium, it’s advisable to limit high potassium foods such as bananas and coconut water while you’re taking it.

It’s not for everyone

As with all treatments on earth, spironolactone has its contraindications. Dr Sam states that those with a strong family history of breast cancer may be advised not to take it, and if you’re looking to conceive, it’s not a good option as it can have a feminising effect on a male foetus. Otherwise, there are no major side-effects, although some women experience period irregularities and breast tenderness. If you don’t fit into these groups and have tried everything under the sun to keep deep-seated spots at bay, spironolactone could be ‘the one’- make an appointment with your GP or dermatologist to assess whether it’s right for you.

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