I often get compliments on my skin from people telling me that I'm so lucky, and they're not wrong — if you look at me on any given day, my skin is clear. I rarely wake up with pimples, and when I do, it's usually because I'm getting my period soon and it goes away within a few days. But I don't consider myself to be "blessed with good skin" because my skin wouldn't look anything like it does if not for a magical oral medication [1] called spironolactone.
For some background: I had clear skin when I was a teenager. I used my drugstore face wash and moisturizer every night, probably didn't get every last trace of makeup off before bed, and still didn't break out frequently. This luck continued until I was in my early 20s — then everything changed. My skin situation was flipped on its head and I started getting hormonal acne [2] in the form of deep, painful cystic pimples [3] all along my jaw and the bottom half of my cheeks.
I tried every serum, cream, and topical treatment I could get my hands on as a beauty editor, but nothing helped. I felt rather hopeless about the entire situation for over a year and became extremely self-conscious of my skin [4], especially without makeup on. Finally, I scheduled an appointment with my dermatologist (something I should have done sooner) to get to the bottom of it.
As it turned out, my acne was most definitely caused by a mix of hormones and genetics and the doctor advised me that no topical treatment alone, especially one that's over-the-counter, would take care of the situation — it called for something a bit more heavy-duty. Enter: my hero, spironolactone.
At first, I was hesitant about the idea of going on an oral medication to help my skin. For anyone who doesn't know, spironolactone was originally created to treat high blood pressure, but it doubles as a hormonal acne cure. When I tried looking it up to see if other people had luck with the prescription I found very little information that went deeper into the topic than just "this is what it is and this is what it does." My dermatologist informed me of the potential side effects — which included elevated potassium levels, dizziness, and irregular periods — and ultimately, I decided to give it a shot because I was desperate. The cost of the prescription can vary depending on your insurance. Mine costs me about $3 for a three-months supply, but it can cost up to $30 without it, according to the estimates online.
The prescription took a little getting used to at first. I was told to take it at night before bed and it made me feel a little dizzy, but nothing terrible. I kept with it despite there being no signs it was actually working and ended up having to up my dosage with my doctor. It wasn't until three months after doing so (because the medication takes months to actually take effect) that I started to see an improvement — I was waking up with fewer pimples on my jawline. This gave me hope.
I took the spironolactone in conjunction with topical acne treatments, like retinol, to help get rid of acne marks and little by little, my face cleared up. After about eight months on the medication, my skin looked amazing. I kept with that routine for about two years and reached the best skin of my life — then COVID-19 happened.
Because pimples were no longer a concern for me (so I thought) I briefly stopped my oral medication at the start of COVID-19, because I heard that it could potentially leave you at a higher risk for getting the virus [6]. I thought I was doing great without it until about three months after stopping the prescription — when it finally left my system — and the acne came back. Again, I found myself trying to get rid of it with various topicals but nothing worked. I discovered the hard way that without a doubt, I still needed the oral meds to keep my skin clear and so began my spironolactone 2.0 journey of restarting the medication, waiting three months, and seeing some progress in my complexion.
Since starting this rollercoaster of a journey years ago I've learned that many other people I know in the beauty industry have tried this oral medication for their hormonal breakouts. Lots of people swear by it, although it didn't work for some, as are the odds with any medicine. Now, I'm back to taking my pill every night before bed and my skin looks great, but it's not lost on me that I owe it all to spironolactone. Gotta love modern medicine.
Still, I'm very aware this is not a widely known option for people with acne — in part, probably, because not everyone has access to a dermatologist. That's why whenever I can be transparent about my skin, I am, because I know exactly what it's like to feel as if you've tried every product on the market with no success.