Spironolactone is an oral medication that is used to treat hormonal acne. Although it is often thought of as a blood pressure medication, it is also effective for hormonal acne. Hormonal acne manifests in women as acne that has a predilection for the jawline and chin. Additionally, the acne often flares before periods. Patients with polycystic ovarian syndrome (PCOS) often have hormonal acne as well. Do you have hormonal acne? If so, talk to your medical provider. There are side effects and contraindications to this medication so it’s important to discuss whether this medication is appropriate for you. Additionally, don’t be surprised if the effect of the medication does not kick in immediately. It may take a few months or further dosage adjustments to see an effect!
By Jodi LoGerfo, MSN, APRN, BC, FNP-C
“Yay! More zits,” said no one ever, upon waking up in the morning and looking in the mirror. Acne can cause a lot of anxiety and even depression depending on how bad it is. The good news is there is help and you are not alone.
Actually, acne vulgaris is the most common skin disorder in the United States and nearly 85 percent of all people have had acne at some time during their lives, according to statistics from the American Academy of Dermatology. Acne most often begins during teen years (as we can all attest), but can follow into adulthood. It occurs most often on the face, chest, and back which are areas that have a large number of oil glands.
Acne lesions are caused by a combination of overactive oil glands that produce oil, along with the build-up of dirt and bacteria and irregular shedding of dead skin cells. Contrary to popular belief, acne is not caused by chocolate or dirt or eating greasy foods. Although there is a link between the amount of oil produced in the skin and acne, the amount of oil is not created by food. Instead it is caused by changing hormone levels like those during puberty or cyclical hormonal changes in a female’s menstrual cycle.
How a simple pimple forms
When an oil gland opening (called a pore or hair follicle) becomes clogged with skin’s natural oils, dirt, dead skin cells and bacteria, a comedo forms. We often call those blackheads (open comedo) or whiteheads (closed comedo). Additionally, the surrounding skin can respond by becoming red and inflamed, appearing as small red pimples (pustules or papules) or it can get infected and cause deeper, large and more painful nodules and cysts. These larger, deeper cysts and nodules can cause scarring, so you always want to get treatment from a dermatologist to avoid permanent pits and discoloration.
How you can make pimples worse
While you can’t “cause” your own acne, there’s lots you can do to make it worse:
- Oily, moisturizing products, cosmetics and many sunblocks can further clog up pores causing excess oil to get trapped. Look for formulas that say, “non-comedogenic” on the label, which means, “non-pore-blocking” or use cosmetics that are oil-free.
- Heat, humidity and excessive sweating amplify skin inflammation. Be sure to wash off excess sweat, dirt and oil after excessive activity, especially after exercising or in the summer months.
- Picking or squeezing acne lesions with fingernails or other objects causes acne to look worse and may result in further infection and deeper, permanent scarring. Lesion removal (called acne surgery) should only be done by a medical professional.
How your dermatologist tries to stop your acne in its tracks
There are various approaches dermatologists use for effectively treating acne. Often, we use a combination of methods at the same time to attack acne in different ways. These include:
- Acne Surgery (including corticosteroid injections) performed in a dermatologist’s office to extract blackheads and to open and drain whiteheads. This helps prevent pustule and cyst development, which are the main causes of acne scarring. Inflammatory lesions (pustules, pimples and cysts) are often injected with low potency cortisone to decrease inflammation and help an acne lesion disappear quickly. These intra-lesional injections also help decrease the remaining discoloration that can occur when acne is resolving.
- Isotretinoin, an oral prescription medication can permanently help severe or troubling cystic acne (you may remember it by the brand name Accutane®) or poorly responsive acne that improves less than 50% after 6 months of combined traditional treatment. About 85% of patients treated with isotretinoin see permanently clear skin after just one treatment course.
- Chemical peel (e.g., TCA) is a non-toxic chemical (trichloroacetic acid) that is applied to the skin. It has been used for over 20 years and works by drying up the top layers of skin cells, causing them to peel off. The old skin is removed and a new undamaged layer is revealed.
- Oral antibiotics can help manage the severity and frequency of acne outbreaks. There are a number of oral antibiotics used depending on the type of acne you have.
- Topical lotions, creams or gels containing benzoyl peroxide, antibiotics (e.g., clindamycin and erythromycin) or salicylic acid are known to kill bacteria, unplug pores, exfoliate and decrease inflammation.
- Topical retinoid medications help other acne medications absorb better, have an anti-inflammatory effect and also speed up cell turnover so pores can’t clog. These include Retin-A® (tretinoin), Differin® (adapalene) and Tazorac® (tazarotene).
- Laser or light treatments (e.g., Blue Light, Infrared Light) are designed to target and eliminate acne-causing bacteria and decrease inflammation.
- Androgen blockers (e.g., spironolactone) have been used in acne for years. They decrease the amount of oil that is produced by oil glands and are also effective in those female patients who also have excess hair growth.
- Oral contraceptives have been shown to improve acne by normalizing hormonal spikes and reducing testosterone and progesterone, the hormones responsible for hormonally-induced acne. This may be especially helpful in women with acne along with menstrual irregularities or hirsutism (facial hair growth).
How you can help your acne regimen work better
- Read and follow any label, package or doctor’s instructions exactly for any acne product or medication you are using. If medications are to be applied at different times of the day or in a particular order, follow the regimen exactly because that’s how it is designed to work.
- Treat the acne-affected area (e.g., face) entirely, not just individual pimples (don’t spot treat), so the medication can prophylactically prevent future breakouts.
- Never pick, pop or squeeze your pimples because that often causes more damage to the pore resulting in permanent scars, pits and discoloration. A dermatologist can offer you acne surgery done properly by a medical professional in the office.
- Keep your hands (and the bacteria on your hands) away from your face. Constantly touching your face can cause more infection to inflamed, irritated or open skin.
- Reduce the amount of oily face makeup. Try to use a makeup that is oil-free and always wash it off at night before going to sleep.
- Gently cleanse the acne-affected area; scrubbing inflamed skin (whether from acne itself or as a side effect to acne treatment) can be more irritating.
- Use a cleanser your dermatologist recommends for your specific skin type twice per day and use warm (not hot) water.
- Avoid using over-the-counter alcohol-based astringents, which strip your skin of it’s natural oils, and stick to only products and medications your dermatologist recommends.
- Avoid excessive sun exposure as many acne medications (including Retin A®,oral antibiotics and isotretinoin) make your skin more sun-sensitive. Always use a non-comedogenic, broad spectrum sunscreen recommended by your dermatologist daily to prevent your acne lesions from becoming darker and pigmented.
- The most recent research on acne and inflammation found that people with acne (and more severe acne at that) had lower levels of antioxidants in their bloodstreams and that both oral and topical antioxidants can potentially be used in treating acne. That means a more nutritious diet of fruits and vegetables is more important to acne patients than we thought, and can only help.
Finally, acne treatment regimens usually require 6-8 weeks of treatment before results are noticeable. Don’t give up and stop treatment if you do not see faster results and don’t stop treatment if you notice some preliminary clearing. After 8 weeks, if you see no improvement, your dermatologist will adjust your treatment or suggest different therapies to try.
Keep it up!
Jodi LoGerfo, MSN, APRN, BC, FNP-C is a Family Nurse Practitioner
Board-Certified in Family Medicine and Dermatology at the Orentreich Medical Group in New York City. She runs a patient Question & Answer blog at Orentreich.com/blog.
Retin-A ® or tretinoin is a popularly prescribed medication for acne as well as preventing the signs of skin aging. For acne, it is particularly effective for “whiteheads” (aka closed comedones) or “blackheads” (aka open comedones). In terms of skin aging prevention, it can help improve the texture of skin, even out skin tone, and prevent really fine wrinkles from appearing.
However, many people find Retin A difficult to use and will note irritation. Especially in the beginning of use, the skin often becomes reddish, dry, scaly, and sometimes itchy. This is because the medication helps regulate the turnover of your skin cells and can speed up this turnover.
Here are some tips that you can stick to to make it easier to stick with your medication and see some really good results.
– Use a pea-sized drop for the whole face. Squeeze out a little bit on one index finger and dab it on the other. Dot over the areas to treat (e.g. forehead, cheeks, chin) and then rub in.
– Apply at night
– If you’re having problems with irritation:
- Mix the medication with a gentle face moisturizer (non-comedogenic of course!)
- Space out use. Start every other day and work up to every day.
- Avoid the areas right by your eyes, nose and mouth where the skin is thinner.
- Avoid any areas of open or damaged skin.
- Start with a low dose.
- Ask your physician if there is a gentler formulation of the medication if the above tips don’t help.
– Use sunscreen in the morning. This is normal recommended practice anyways, but the Retin A can “thin out” your skin and make it easier to get a sunburn. Also, it’s no fun getting a sunburn over already irritated areas!
Another important point is that if you are thinking about getting pregnant or are pregnant, stop the medication and let your doctor know.
So how does pregnancy affect your skin?
Here are some things that can happen:
Hyperpigmentation – You may notice areas of your skin becoming darker than your normal skin tone
Melasma – Melasma is also known as the “mask of pregnancy.” It often presents as blotchy dark areas of the face, most commonly over the cheeks.
Hair loss or hair growth – Yes, both hair loss or hair growth (hirsutism) can occur. Hair loss can be temporary, but may also be permanent in that the hair does nt grow back. Hair growth often affects individuals with a personal or family history of increased hair growth.
Changes in the nails – Changes can include brittleness, appearance of lines in the nail, lifting of the nail, or accumulation of material under the nail
Changes to the nipples – The nipples may become bumpy, reflecting enlargement of the glands
Stretch marks – Pregnancy is accompanied by weight gain and stretching of the skin. Stretch marks (“striae”) may be skin colored, pinkish or purplish.
Red spots – These may represent collections of vessels called spider angiomas or, some people get redness of the palms (“palmar erythema”). Veins can become enlarged and lumpy as well (“varicose veins”).
Changes in the mouth – Gums may become enlarged or bumpy.
Leg swelling – You can retain fluid and the feet, ankles and legs may be affected.
Acne – Acne can get worse or better! It’s hard to predict whose acne improves, and whose goes downhill.
The answer is yes! Babies get acne too! “Neonatal acne” or “neonatal cephalic pustulosis” is a common condition that crops up in the first few weeks or month of your baby’s life as little pimples of the forehead, cheeks and chin.
What causes baby acne? We don’t know exactly what causes this condition, but it may be related to exposure to maternal hormones when the baby is in the womb.
So what do you do about baby acne? Baby acne is not harmful so you can leave it alone. This condition usually goes away in weeks, if not months. In the meantime, continue gentle skin care for your baby. Since rashes can be difficult to distinguish to an untrained eye, mention any concerning features to your pediatrician or dermatologist.
Many women complain of acne during pregnancy. You might not have had acne before pregnancy and you may be noticing it for the first time. Or, you may note your acne getting worse during pregnancy.
The same basic rules for acne skin care apply:
– Clean your face if it become dirty and soiled.
– Make sure face products are “non-comedogenic.”
– No picking, popping, or squeezing — this leads to scars!
However, the medications that you can use during pregnancy are limited.
– No Accutane (isotretinoin) – a big nono during pregnancy as Accutane can lead to birth defects. On the same vein, no tetinoin, Retin-A, adapalene, or related meds if you’re trying to get pregnant or are pregnant.
– No doxycycline, minocycline, or tetracycline – Again, its use can lead to birth defects.
Medications we often recommend include:
– erythromycin gel, solution or lotion
– sometimes, erythromycin pills are prescribed
– azeleic acid (aka Azelex or Finacea)
Talk to your obstetrician and/or dermatologist about the use of medications in pregnancy. First, do no harm!
In high school, I had friends who used hydrogen peroxide to bleach/highlight their hair. Well, your acne treatment may contain benzoyl peroxide — a common ingredient found in acne washes, gels, lotions and creams. While it can be quite effective for acne, it can also be a nuisance in that it can bleach your clothes.
You may notice towels, pillowcases and clothing getting bleached.
Here are some tips:
– Use white towels, pillowcases and clothing or ones that you don’t care about getting bleached.
– Wait for the medication to dry before exposing it to clothing you don’t want to get messed up.
– If you sweat after applying your benzoyl peroxide treatment, wipe the sweat away so it doesn’t drip onto your clothes.
Acne is a tough condition to kick. Those zits just pop up at the most inconvenient moments!!! I had one smack in the middle of my nose during my interviews for dermatology residency (I still did okay in the end though).
There are lots of treatments for acne, ranging from face washes, creams/lotions/gels, masks, special brushes, chemical peels, pills, and now there’s a device called Isolaz.
Isolaz is a device that works through a vacuum and light mechanism. The vacuum part of it sucks out the nasty stuff inside of your pores along with any debris around (yes, you can actually see the stuff come out of the pores!) The light it shines on your skin is supposed to help kill bacteria involved in causing acne and fight acne in other ways.
So if you’ve tried other acne treatments and still have acne, how can you get an Isolaz treatment? Find a dermatologist who provides this treatment. Your doctor will discuss whether this treatment is right for you. The actual treatment is pretty painless although you can have a little irritation after the treatment.
There are many different types of topical retinoids, e.g. tretinoin (brand names: Retin-A, Retin-A Micro, Renova), tazarotene (brand names: Tazorac, Avage) or adapalene (brand name: Differin).
When you first start the medication, you can develop redness, dryness, flaking, itching or other irritation since your skin isn’t used to the medication yet. Here are some tips that can help reduce the irritation:
– Use the medication at night.
– Start with application every third or every other night. Work your way up to every night.
– Mix the medication with some face lotion to dilute it, or apply face lotion after applying the medication.
– Use a small pea-sized amount for the whole face. All you need is a thin layer.
– Creams are less drying than gels or solutions.
If these tips don’t work, let your doctor know. It may be time to change to a different formulation or medication!