Hormonal acne looks just like non-hormonal acne, it’s caused by the same basic factors, but it has a few unique treatment options, like spironolactone for acne. Spironolactone is a medication originally produced to treat hypertension, but in the last decade or two, doctors have found that it can significantly reduce acne as well. This is because it suppresses androgens, a class of hormones generally associated with hormonal acne. But before you ask your dermatologist about starting spironolactone for acne, make sure you know how it works and that your acne really is caused by hormones.
Hormones Cause Acne When They Fluctuate
We all know that hormones can play a major role in acne, but why is that? We all have an array of hormones keeping our body functioning at all times, so when do they cause acne? Hormonal acne is the result of hormonal fluctuations. Our natural hormone levels rarely cause acne on their own; it’s only when we deviate from our own personal norm in specific ways that acne can result.
Generally speaking, increases in androgens, like testosterone, can lead to increased acne because when androgens increase, oil production also increases. This contributes to all kinds of acne, from blackheads to cysts. It’s important to note though, that testosterone by itself does not lead to more acne. Men and some intersex folks typically produce more testosterone than women and other intersex folks, but they are no more prone to hormonal acne. That’s because hormonal acne is caused by changes in hormone levels. Regardless of how much testosterone you normally produce, if that amount increases, acne could be the result. It’s also possible to have “relative increases” in testosterone when the hormones that typically balance out testosterone, like estrogen, decrease. When there’s less estrogen to balance out the testosterone, it’s like testosterone levels have increased, even though there was no change in testosterone itself.
Spironolactone for acne can help stabilize these changes by suppressing androgen production. But we’ll explore what that means and how it works in a minute. First, it’s important to understand why suppressing androgens can help, and determine if your acne is in fact caused by hormones.
How Increased Oil Production Leads to All Kinds of Acne
When our hormone levels shift and change to create an increase in androgens, either literally or in relation to other hormones, our bodies produce more oil. This can be a big problem for acne because oil production is one of the three main causes of acne, and it contributes to bacteria growth, one of the other main causes.
On its own, excess oil causes acne because it clogs pores. Typically, we produce a small amount of oil in our oil production glands which then travels through our pores to the surface of our skin to protect it from irritation. When these oil glands start producing too much oil, there’s nowhere for all the extra oil to go once it reaches the surface, so it gets backed up in the pore and causes a clog. This leads to whiteheads and blackheads. Whiteheads form if the pore is closed, and blackheads form if the pore is open.
But excess oil does more than just clog pores. It can also lead to an increase in acne-causing bacteria, also known as p. acnes. These bacteria always live on the surface of our skin and are relatively harmless on their own, but if they get trapped in a pore or if their numbers grow significantly, they can lead to pimples and cysts. Excess oil production can help their numbers grow exponentially because p. acnes’ main food source is oil. When we produce more oil than necessary, the bacteria have extra food and they multiply rapidly. Because there are more of them, p. acnes are more likely to get trapped in pores, where they multiply some more and generate the minor infection that leads to pimples, or the more serious infection that causes cysts.
Is My Acne Hormonal?
Spironolactone for acne will only help if your acne is caused by the androgens that spironolactone can help control, so how can you tell if your acne is hormonal? There are three classic signs of hormonal acne:
1. You have increased acne when you know your hormones are fluctuating.
The easiest way to tell if hormones could play a role in your acne is by paying attention to when your acne flares up. If you menstruate, you may see a relative increase in acne during the week before your period because that’s when estrogen levels start to drop off. If you notice that your acne is worse during the week before your period, then your acne may be hormonal and spironolactone for acne could be a good solution. Although menstruation, pregnancy, and menopause are times of significant hormonal fluctuation, recent studies show that people who don’t menstruate also experience regular, cyclical hormone fluctuations. These may be harder to spot without the clear cycle of menstruation, however.
2. Your skin is oily.
Hormonal fluctuations lead to increased oil production, so if your acne is hormonal, you will probably notice that your skin is oilier than normal before major breakouts. If your acne appears when your skin is dry or normal, then your acne may be caused by other factors, like bacteria or irritation.
3. You have all types of acne.
Excess oil can clog pores and provide food for acne-causing bacteria, meaning it can create blackheads, whiteheads, pimples, and cysts. If your acne is hormonal, there’s a good chance you’ll have a variety of all of these kinds of acne. If you have mainly one type of acne, hormones could still be to blame, but it is less likely.
How Spironolactone for Acne Works
So you’ve determined that your acne is definitely hormonal and now you’re ready to find the best acne treatment for you. Could spironolactone be right for you? Unlike many topical treatments, spironolactone doesn’t try to get rid of acne you already have. It tries to prevent acne from forming in the first place by suppressing the androgens that often cause hormonal acne.
Spironolactone was originally created to treat hypertension by suppressing the production of aldosterone, a hormone involved in the absorption of potassium and sodium, and doctors later found that it was also useful in treating congestive heart failure. Hypertension and congestive heart failure are obviously very different from acne, so you may be wondering how this medication could possible address all of these conditions.
It turns out that when spironolactone suppresses aldosterone, it also suppresses the creation of some androgens as well. Like we said at the beginning, androgens like testosterone don’t cause acne all on their own, they only cause acne when they increase or when balancing hormones like estrogen decrease. But if androgen levels are generally lowered, then it becomes more difficult for the androgens to rise back up to a level that would cause increased oil production.
Side Effects Worth Considering
Although many people see significant improvement in their acne while taking spironolactone, there are some side effects and risk factors that should be considered. The biggest one goes back to what the drug was originally invented for: if you have low blood pressure or any kidney conditions, spironolactone for acne may not be a good idea. The hormones it blocks could worsen your condition.
You may also be hesitant to use of spironolactone for acne if you identify as male. Androgens play a large part in generating masculine features, so when you take a medication designed to suppress those hormones, the result is an increase in more feminine features, such as breast enlargement or a decrease in facial hair. In some cases, spironolactone has led to a decreased libido and erectile dysfunction as well.
If you identify as female, these may be less of an issue, but there are still general side effects anyone who takes spironolactone for acne needs to consider. For instance, if you are able to get pregnant, it’s important to know that spironolactone must be taken along with oral contraceptives because of its high risk for birth defects. Oral contraceptives come with their own list of possible side effects to consider, like weight gain, anxiety, and brain fog, among others.
Spironolactone also has a black-box warning label, the most serious warning label the FDA assigns to any drug. This particular warning was issued because spironolactone could cause tumors. However, the study that determined spironolactone could cause tumors is nearly 60 years old now, and it studied spironolactone in doses almost 500 times higher than what is prescribed now. No studies conducted in the last ten years have found that modern dosages cause tumors, but it is still a warning you should be aware of.
Other Treatment Options
If spironolactone for acne doesn’t sound like the right fit for you, that doesn’t mean you’re doomed to have hormonal acne forever. Although some medications can prevent hormones from causing increased acne in the first place, there are other treatments that can treat and prevent acne in non-hormonal ways.
Retinoids are one of the most popular types of acne treatment prescribed at dermatologist offices right now. This type of acne treatment works by regulating the life cycle of skin cells. By making sure your skin cells are being produced and dying at the right pace, retinoids help prevent clogged pores and clear away excess oil. This makes them relatively effective in treating hormonal acne specifically, since it is driven by excess oil.
Traditionally, retinoids have only been available as prescriptions, but that’s been changing recently. Retinoids like Retin-A, Tazorac, or isotretinoin (Accutane) are still only available through a dermatologist, but new retinoids like Differin are starting to become available over-the-counter.
If you’re looking for a natural remedy for your acne, we strongly recommend honey because it has antibacterial properties, anti-inflammatory properties, and it can help absorb excess oil. However, make sure you use pure honey; honey with added ingredients, even just water or fructose, will not be as effective in treating acne. However, this doesn’t mean you need to buy the most expensive honey on the shelf. Many simple clover honeys are pure honey, while other organic, pricey brands have added ingredients that dilute honey’s acne-fighting powers. Some studies show that Manuka honey, a particular type of honey made using nectar from the tea tree plants that grow in New Zealand, may be even more effective in treating acne, but regular honey can still help reduce acne.
You can apply honey to your skin on its own, or you can create your own DIY face mask. If you have primarily blackheads and whiteheads, add a small amount of freshly squeezed lemon juice to the honey to help exfoliate the skin. If you have pimples or cystic acne, try adding a dash of cinnamon. Like honey, cinnamon has antibacterial properties that can help fight the p. acnes infections involved in pimples and cysts. If you have sensitive skin, we recommend combining aloe vera with honey, to help protect and hydrate your skin.
A Consistent Skin Care Routine:
The best treatment for any kind of acne is a gentle skin care routine. Even if you are controlling the hormones causing your acne with spironolactone or oral contraceptives, it’s important to take care of your skin directly. Many acne treatment systems address the two main causes of acne we’ve already discussed, oil production and bacteria, but they fail to address the third: inflammation. In their efforts to prevent oil buildup and bacteria growth, some acne treatments are far too harsh on the skin, and this leads to inflammation. The skin tries to protect itself from the harsh products through the inflammation response, which swells the skin slightly and constricts the pores, leading to clogged pores and increased acne.
At Exposed Skin Care, we know the most important part of acne treatment is to keep your skin healthy, which means treating it gently. That’s why we combine acne-fighting ingredients and soothing ingredients in all of our products. We utilize green tea extract and aloe vera to protect your skin, and we include ingredients like salicylic acid and tea tree oil to reduce acne. Together, our products take care of your skin and your acne at the same time.