Hormonal acne: Accutane or spironolactone?

[ston]

I’ve dealt with acne on and off for about 12 years (25 now). I tried everything before I was put on roaccutane at age 17. I had severe acne everywhere on my face then and it did clear the majority of it up. I hardly ever get spots on my cheeks or forehead now… just left with awful scarring.

A few months after I stopped taking roaccutane I started to get acne around my chin. I’ve been on a battle with this acne on and off since being off roaccutane. I’ve lost count of the amount of times I’ve been on lymecycline/doxycycline. I’m currently on doxycycline and feel I must have antibiotic resistance by now.

My skin has not been this bad in years and years. I have been through a stressful period in my life and started antidepressants a few months ago. Not sure if the stress / lack of sleep im having is causing my hormones to fluctuate? I have also been drinking alcohol most weekends.

A positive is that I do have a NHS derm appointment on Wednesday which I got referred to in October 2019. I’ve been waiting over 2 years for this. So in wondering whether I should go for roaccutane round 2 (deal with the horrible side effects for 6 months) or spironolactone which I would have to probably be on for years, and can still have side effects like headaches, fainting and hair loss etc.

I've had three courses of Roaccutane in my life (now 45). I was always acne free for a few months afterwards then it would creep back. I don't think it's done my overall health much good, but it would have been worth it if it had been a cure, which I think it can be for some people. My final course was a low dose for one year, instead of the short course on high dose, and was the best for me in terms of side effects. Could that be an option for you?

Spironolactone was effective for me and I had no side effects except for very sore, lumpy breasts, which worried me as I'm in my forties and breast cancer is in my family. I actually took it for hair loss, and it was great for both skin and hair. It's much kinder to the body than Roaccutane.

But the very best overall was Dianette, or another anti-androgenic contraceptive pill. I was on it for years and it was amazing. There are several options for different pills.

I now only use topicals (currently Epiduo at night and benzoyl peroxide in the morning). I take a multivitamin with zinc. I don't really have acne if I stick to that regime, but as soon I stop it comes back.

I also had some very good laser treatment (NLite) about 15 years ago. That worked very well for a year or two. And helped with scarring too. It's expensive though.

It's been lifelong management for me - as you can see I've been around the block!

One of my roaccutane nurses said she’s taken it 3 times and she had lovely skin.

All acne’s hormonal, you only get it at puberty because your sex hormones encourage oil production. I’ve been incredibly stressed (dh seriously ill) since July 20th 2019 and no acne.

I’d do the roaccutane again.

Spironolactone has changed my life. After a couple of weeks of breast tenderness I was just left with spotless skin.

I was on Dianette for 15 years and they stopped prescribing it to me because it's considered too high a risk. The BNF (Meds bible for Drs) says only to prescribe it for Acne for 6 months so most Drs won't prescribe it long term.

Spiro plus conjunction with Yasmin mimics the chemical composition of Dianette and Drs are happier to prescribe it. There's a Randomised Controlled Trial (gold standard evidence) detailing the research and prescribing recommendations for it which I took to my Dr and she was happy to prescribe it.

I guess you could try either and if one doesn't work, just try the next.

Nothing worked for my acne, ever. It was horrific.

Then, when I was 25, I went on the contraceptive pill Yasmin (not for my skin, for its primary purpose of contraception) and to my shock, surprise, amazement, awe .. within 3 months my skin was completely clear. I used to look at myself in the mirror and cry.

The best thing is though, I have now been off the pill for 2 years and although I get a couple of spots just before my period, my skin is still clear on the whole. I was scared that it would go back to the way it was once I stopped, but it never did :).

I haven't used either of those. I've suffered with consistent mild-moderate acne for 20 years. Lymecycline antibiotics are quite good for me. I take them on and off for a few months at a time.

The only miracle cure was Dianette contraceptive pill. Would that be an option? I can't take it now as I'm over 35 and it's one of the more risky pills once you're older.

I've spent a lot of time, as I'm sure you have, researching cures and things to help. There have been times in my life it has been all I've thought about and I haven't wanted to go out as I've been so ashamed of my skin. I've also found a lot of GPs aren't sympathetic about it as it isn't an 'illness' as such.

I really hope you get some good advice from the Derm. I would take whatever advice they offer but I have heard great things about Roaccutane, as long as you're aware of the potentially serious side effects.

All the best.

I'm another who was on dianette for years back when that was allowed. Yasmin didn't work as well - but if spiro + yasmin combo is similar to dianette think I'd be tempted to try that rather than go through side effects of roaccutane if the results aren't long lasting for you. (I never used that, though my sister did and couldn't tolerate it - blood tests showed kidneys were not handling it).

Now I use one of the online skincare prescription sites and skin is as good as it's ever been. Main active is tretinonin.

Roaccutane side effects aren’t that bad. I’d have taken capsules of powdered dog shit if the drs said it was a cure by the time I took it.

I was tired and had dry lips but that was it.

Yes I was put on Yasmin after the Dianette actually, and that was quite good for my skin, forgot about that. Once I reached 35 I was put on a not very well known pill called Gedarel 30/150 which was also good. Once I reached 40 they changed it to one with lower hormones called Gedarel 20/150. It's not quite as good but lower risk. I'm 43 now and have 5-6 medium sized spots most of the time which I can live with.

These are a few other things that help me a little:-

• gentle skincare such as ph neutral face wash and jojoba oil to moisturise. Other acne treatments are too harsh now I'm older.
• supplements - krill oil, evening primrose oil, vitamin d, vitamin c, potassium, zinc.
• good make up for confidence, I like Ester Lauder double wear which has good coverage
• eating healthily and drinking lots of water
• dairy doesn't affect me like it does some people, but sugar definitely does make mine worse
• I know it isn't a good thing but being in the sun definitely makes my skin better

Yes after I came off Dianette, then came off Yasmin and Spiro my skin didn't relapse. Nowadays I only have bad skin when I eat a shit ton of whatever I want (holidays...) Which is inevitably huge amounts of fat and sugar.

Just resurrecting this thread to see how you got on @ston ?
My daughter started spiro last month at a very low dose 25g I think. It worked well for a few weeks then the acne broke out again. We're going to ask the dermatologist to increase the dose to 50mg. She can't take roaccutane so this is all that's left. Her acne is definitely worse since having the Mirena but she was having constant bleeding so how to control it all???