After a 5-Year Hiatus, This Is Why I Got Back on Spironolactone to Treat My Acne

Welcome to The Spot, a monthly column tackling acne and our relationships to it. Here, we ask women how they deal with blemishes at home—and consult with skincare experts to find out what really works.

I first started taking medication for my acne when I was fourteen. My mom scheduled an appointment with my dermatologist the summer before I started high school. By then, I had already made my way through most of Proactiv’s line-up and had tried a few other acne treatments without seeing real results. Looking back, my acne was not especially aggressive or cystic at the time, but the constant breakouts across my face were enough to keep me from leaving the house or letting anyone get too close to my face. So when the dermatologist told me I could take one pill a day to clear my skin, I was immediately on board.

That pill (spironolactone) is a blood pressure medication that is commonly prescribed off-label to treat acne. Spironolactone works for acne by slowing down the body’s production of androgen, a group of hormones that can cause excess oil that clogs pores and leads to breakouts. After about a month of starting spironolactone, I noticed that my acne had slowed down. While my breakouts never completely went away, I’d only have to deal with the occasional pimple rather than the mountain range of zits that typically spanned across my forehead.

Then, between my freshman and sophomore years of college, I went on birth control and decided to stop taking spironolactone—I figured I could slim down my medicine cabinet. Plus, I had started to learn about holistic skin care and the way my lifestyle could affect my skin. I liked the idea of clearing my complexion with healthier habits rather than having to rely on a prescribed drug to do the trick. So, I began to take daily probiotics, drink more water, have a consistent sleep schedule, and, for a brief period, even cut back on dairy.

All of this seemed somewhat manageable until I hit my senior year of college and experienced my most stressful year yet.

I pretended to have everything under control, but my skin revealed signs of my poor sleep schedule, diet, and stress. Also, instead of clusters of pimples, I was getting large, cystic acne across my chin and cheeks for the first time. This kind of acne hurt more and lasted longer than my baby pimples, and it left dark spots on my face that stayed for months. My birth control wasn’t enough to regulate the hormone roller coaster I was experiencing. Plus, my hormonal acne would get worse during the week I’d take placebo birth control pills for my period to come.

Since hormones were the primary issues for my breakouts, it didn’t matter what products I used topically to treat my breakouts. I thought about going back on spironolactone but didn’t want to go back on my commitment to leading a holistic life. Plus, I figured that I could get my life, and my skin, back on track after graduation.

However, I was being naive. Life doesn’t exactly get easier after college. There are some things I’ve been able to better control over the past year in the “real world.” With a consistent work schedule, my sleep routine has improved some, and I’m able to spend more time cooking healthy meals—with dairy frequently on the menu—but stress is not something I can simply cut out.

So, at the end of June, I sucked up my pride and visited my dermatologist to get back on spironolactone.

For the past few years, the idea of getting back on spironolactone seemed like an admission of failure. I had hoped that my acne would improve with time and had so desperately wanted a holistic approach to work for me. However, spending hours a day stressing over and hating my skin (and sometimes myself) because I couldn’t get my breakouts under control was in no way the healthier alternative.

My dermatologist sent me home with a prescription for 50 mg tablets of spironolactone, and I’ve now been taking it for two months. After a month, my skin started clearing up, as did the real estate of headspace that had been dedicated to worrying about acne. Spironolactone doesn’t keep me from getting pimples altogether—and the mascne struggle is no joke—but it does keep my skin consistently clearer and, more importantly, gives me peace of mind.

Holistic skin care is still the long-term goal: I hope to get to a point where I have a consistent sleep schedule, eat a hormone-balancing diet (cheese included), can better manage my stress, and can be fully content with my skin—with or without acne. Until I get there, though, being on spironolactone allows me to spend less time obsessing about my skin and more time enjoying my life.