Acne wasn't such a big deal when I was younger. It was piled into a heap with bangs that wouldn't flip the right way, a stomach that was slightly pudgier than I would have liked, and the general awkwardness of adolescence.
Sure, having bad skin sucked, but I was too preoccupied with what That Boy said in AP Euro to dwell on it.
Maybe the reason I didn't consistently wig out about my acne was because (for the most part) it wasn't on my face. It was on my back, and it was an absolute horror show.
I took pains to only wear things that were extremely high-cut in the back, and I loved me some blazers. By the spring of my freshman year of high school, my mother decided it was time to take me to a dermatologist.
My imagination ran wild. I pictured an unsympathetic face delivering the news: “I’m sorry, ma’am. This is the worst we’ve seen in a long time. Here’s a novelty-size paper bag to cover your entire body; insurance should take care of it.”
Of course I was wrong. Chelsea, my dermatologist, was incredibly stylish and kind--and realistic about my skin problems. She told me my problems were moderate and could benefit from medication.
Since swimsuit season was just around the corner, I was eager to get rid of the acne on my back, as well as the massive cysts that would sometimes crop up on my chin and nose. Chelsea sent me home with a prescription for a month-long round of antibiotics and two topical treatments, Benzaclin and Differin.
For the next few years, the two topical treatments combined with occasional rounds of antibiotics kept my problem in check. My back had completely cleared up by senior year. (The scarring is just now starting to fade.)
Then I started taking the birth control pill and Sprintec generic--which is a combination hormone pill of estrogen and progesterone--and had remarkably (and consistently) clear skin... for about four months.
The uncontrollable cystic breakouts on my chin and nose began last fall, when I started college. Thankfully my back remained clear, but the problem areas on my face destroyed my confidence.
I had no idea what to do. My topical treatments did nothing, and the effect of birth control had long since waned. So I became painfully sanitary about my skin. I washed my hands obsessively, tried not to touch my face, changed my towels and pillowcases regularly, and spot treated wherever necessary. None of it helped.
In late February of this year, I broke down and cried to my mom. Acne had finally worked its way up to the top of my insecurities list, and I was weaponless.
My lovely Chelsea had moved, but Anna, my new dermatologist, and I discussed three options: 1.) Different topicals and longer-term antibiotics 2.) Accutane 3.) Spironolactone.
I'd tried topicals and antibiotics before, and Anna suspected they could be irritating to my skin, so that was out. Accutane wasn't going to work for me either, because I have dry skin and numerous autoimmune disorders, and Accutane readily exacerbates both dryness and conditions like irritable bowel syndrome. It also seemed too severe for me, since my issues were very concentrated on my chin.
That left Spironolactone. What is that, you ask? According to the Journal of Clinical and Aesthetic Dermatology, oral Spironolactone was originally intended for blood pressure, but “has been used for over two decades” in “post-teenage women with acne vulgaris.” The drug decreases circulating androgen levels, which in turn decreases sebaceous gland activity and size. This is most effective in treating hormonal and/or cystic acne, which most often appears on the chin and jaw (hey there!).
Dramatic and lasting effects usually happen in about three months on a typical dose of 100-200 mg administered via two pills daily
The most common side effects of Spironolactone are menstrual irregularities, breast tenderness, and diuretic effects. I'm not sure whether it's attributed solely to the drug, but the only side effect I experienced was menstrual irregularity.
As for my skin, the drug wasn't immediately life-changing. Cysts became less frequent after one month of use, but by three months I experienced significantly reduced acne. Today, I rarely get cysts on my chin, although I do get minor blemishes.
The condition of my skin is still improving over time; my dermatologist says the drug can take up to a year to reach full efficacy. I have my confidence back, though, thanks to this little underdog acne drug called Spironolactone.
Which acne medications and topicals have worked for you? Have you tried Spironolactone?