You know those commercials for new medications that spend half the ad time racing through a scary-sounding list of side effects, like dizziness and shortness of breath? Well, the blood pressure medication spironolactone is pretty much the opposite of that. Originally intended to balance high blood pressure, it’s actually more well-known for its main (glorious) side effect: eradicating hormonal acne. The once-daily pill is now a staple of modern dermatology, and many patients now turn to spironolactone for acne, even if they boast totally normal blood pressure stats.
“We take advantage of one of spironolactone’s side effects, which is its ability to block the effect of hormones on your oil glands,” Dr. Joshua Zeichner, a dermatologist at Zeichner Dermatology in New York City, tells The Zoe Report. “It prevents your hormones from binding to your oil glands; less oil means less shine and fewer blockages within the pores, which clinically translates to fewer pimples.”
The medication, known in the industry as “spiro” for short, actually decreases the amount of testosterone in your system. “Testosterone fuels oil glands to produce oil,” Dr. Jennifer Herrmann, a dermatologist based in Beverly Hills, explains to The Zoe Report. “Spiro lessens overall oil production, which decreases clogging, bacterial proliferation, and the development of acne bumps and cysts.” Because of this, spiro is specifically prescribed to women suffering from hormonal acne — the kind that typically presents along the lower third of the face (jawline, chin, cheeks) and flares up just before your period, thanks to the level of testosterone coursing through the body at that time of the month.
Those who’ve noticed skin disruptions from starting or stopping the Pill, or implanting or removing an IUD, are ideal candidates for the medication as well. “I started taking spiro about three years ago,” Devan Jesmer, a beauty blogger known as @devsday, tells TZR. “I've always suffered from cystic acne, mostly around my mouth and chin. Birth control had kept it at bay for a good chunk of my 20s, but I hated all of the other side effects of being on birth control, and the IUD didn't work for me either.” After reading about spiro online, she asked her dermatologist about the medication — and it was a natural fit.
Three years later, Jesmer says her skin is far less oily and less congested all over. "I haven't had a deep cystic pimple in two and a half years,” she raves. “I will occasionally get a small whitehead, usually around my period, but it comes to a head, and goes away in a couple days versus weeks.”
Spiro isn’t exactly an instant miracle cure, though. “It takes about three months for it to start to exert its effect,” Dr. Zeichner says — so patience is key. “I generally have patients on this medication for long periods of time, as it only works so long as you are on it.” As soon as you stop taking spiro, your skin will probably revert back to its previous state; most patients don’t have an issue with long-term use, though. “Spironolactone is in general very safe,” Dr. Herrmann tells TZR. “It doesn’t risk resistance and gut disruption like many oral antibiotics or leave the skin overly dry and irritated like many topicals.”
“It is prescribed at a very low dose for acne, so it does not affect your blood pressure,” Dr. Zeichner clarifies. Dermatologists will usually start patients at a lower dosage, about 25 to 50 milligrams, before gradually increasing up to 150 mg if needed.
Jesmer’s dosage followed this pattern. She started at 50 mg, before increasing to 100 mg then 150 mg — but ultimately, she decided to work her way back down. “During the few months of the higher dosage, I noticed I needed to urinate more — I was warned about this side effect because the drug is a diuretic,” she says, a point that Dr. Herrmann confirms. “I honestly would rather have to pee more any day than deal with cystic acne that took months to heal,” Jesmer laughs.
The beauty blogger also noticed mild hair loss. “I was never warned that potential hair loss could be a side effect, but I've talked to a lot of people who experienced the same thing, and there are [online] forums of women who have, too,” Jesmer says. In addition, Jesmer experienced an irregular menstrual cycle for about five months before things went back to normal.
“At higher doses, it can cause breast tenderness and irregular periods,” Dr. Zeichner tells TZR. “It can also raise potassium levels, though young, healthy women have little to no issues, generally speaking.” He notes that extremely high doses of spiro have been associated with the development of tumors in rats, but “it has not been shown to be a problem in humans.”
Since spiro does mess with your hormones, it’s not recommended for women who are pregnant, trying to get pregnant, or breastfeeding. “The only reason I will stop taking spiro is when I want to start a family,” Jesmer says.
This repurposed blood pressure medication certainly isn’t the only option for hormonal acne sufferers, though. The seed cycling method works in much the same way, albeit naturally, to tamp down oil production during certain phases of your menstrual cycle and keep skin free from hormonal breakouts. “Continuing with a birth control pill instead can sometimes keep acne at bay,” Dr. Herrmann adds.
Spiro is only available via prescription, so if it sounds like it’d be a good fit for you, consult your dermatologist.