January 26, 2023

This video includes a partnership with Apostrophe. Use my code “SAMELLIS” to get your first consultation for $5 and $5 off your first order:

I get so many questions from my patients and from my followers on social media about the use of spironolactone to treat acne so today i’m going to teach you all about spironolactone and hopefully help you decide if spironolactone may be a good treatment option for you hey if you’re new here i’m dr sam ellis and i’m a board certified dermatologist i’m here to

Help you understand your skin and find products that work for you if that sounds good give this video a thumbs up and don’t forget to subscribe before i get started i just wanted to note that this video contains a partnership with apostrophe if you’re not familiar with apostrophe it’s an online dermatology service that connects patients to an expert dermatology

Team to help diagnose and treat common skin disorders like acne and rosacea and hyperpigmentation as a board certified dermatologist i want as many people as possible to have access to expert dermatologic care and for a variety of reasons many people aren’t able to be seen in person for their dermatology services so what is the next best thing having access to a

Board-certified dermatologist through an online service and that’s the thing that i really love about apostrophe is that your initial evaluation and your treatment plan are put together by a board-certified derm several months ago i used the apostrophe service as a patient because i really wanted to see what is the experience like what’s the intake like how are

They assessing you how do they put together the treatment plan all of that and i was really impressed it kind of very much modeled what i do in my own clinic in terms of getting a very thorough health history on my patients looking at what they’ve tried in the past what they haven’t tried what they’re interested in all of that was taken into consideration when

I did my own consultation so i was very impressed by the entire process it always makes me a little bit sad when i have a patient who comes into my clinic who says dr ellis i’ve been struggling with acne for years and i finally got into a dermatologist but that breaks my heart for these common skin conditions where there are great treatments out there and ways

To get treatment we don’t want people suffering longer than they have to so if you’re someone who has limited access to a dermatologist but are struggling with something like acne or rosacea or hyperpigmentation or even you have fine lines and wrinkles that you want to address looking into a service like apostrophe i think is really worth your while when i did my

Initial consultation with apostrophe one of the things i was interested in trying was topical spironolactone because i had taken oral spronalactone in the past but didn’t want to take oral spironolactone at that point in time because i was just starting my breastfeeding journey and even though spironolactone orally is safe and breastfeeding i was a little bit like

I kind of want to try it topically first then i posted about it on my instagram and then so many of you were like oh can you talk about topical spironolactone actually can you also talk about oral spironolactone so that’s what gave me the idea for this video and so let’s get into spironolactone so first let’s talk about what spironolactone is first and foremost

Spironolactone is what we call a potassium sparing diuretic meaning that it is essentially a water pill that helps people eliminate excess fluid from their body without peeing out excess potassium now that has absolutely nothing to do with how spironolactone leads to the improvement of acne but i mention it because spironolactone has had an fda approval since 1960

To help with other health conditions like high blood pressure or heart failure things where someone might carry excess fluid that negatively affects their health what they found is that spironolactone doesn’t just act on receptors in the body that manage fluid retention or fluid balance but that it also acts on something called androgen receptors androgens as a

Reminder are a category of hormone that circulate in the body and include things like testosterone and you have androgen receptors all over your body including in your skin they’re attached to the oil gland a spironolactone molecule is the perfect size and shape to essentially bind to an androgen receptor on your oil gland and when it’s bound there testosterone is

Unable to bind it’s like spironolactone stole testosterone’s parking spot and if testosterone is unable to bind and stimulate that oil gland you don’t get an excess production of oil the reason that’s so important when it comes to acne treatment is because when you’re thinking about the causes of acne you want to pick treatments that address the cause and acne is

Caused by a plug forming in your hair follicles of dead skin cells and sebum or oil so if you’re able to regulate that oil production you are then able to decrease the chance of forming a plug in your follicle and thus less likely to form a pimple or acne as you’ve probably already realized there are so many different treatments for acne but each of them focus on

Addressing one or more of the causes of acne so for example if you are taking oral antibiotics or using topical antibiotics you are treating or killing off the bacteria that lead to the acne lesion if you’re using retinoids like tretinoin for example you are acting on the inflammation as well as that sticky plug of dead skin cells to treat and prevent acne and if

You’re using something like spironolactone or even an oral birth control pill that has estrogen and progesterone in it you’re essentially counter balancing the effects of testosterone on the oil gland and therefore you have decreased oil production your oil can’t help clog your pores and you have less acne so a lot of people hear about the use of spironolactone for

The treatment of hormonal acne and i use quotations there because when you read a dermatology textbook there’s really no such thing as hormonal acne most acne is driven by hormones it’s why it shows up when you’re a teenager but now we’ve sort of adopted the term of hormonal acne to describe the type of acne that happens in women and is predominantly focused on the

Lower face like the chin and the jawline and for whatever reason that acne in that pattern doesn’t seem to be as responsive to topical retinoids or even oral retinoids or topical or oral antibiotics and tends to respond best to some type of hormone therapy like a birth control pill or something that augments the effects of hormones like sporonolactone as a cosmetic

And medical dermatologist i treat a lot of adult women it’s probably the biggest sort of demographic in my practice and i have women constantly coming in in their 30s and their 40s and even their 50s being like listen why do i still have acne what can i do about it i’ve done antibiotics i’ve done retinoids like what else can i do and spironolactone is often such a

Great solution for them for so many women spironolactone ends up being like i can’t even tell you how many messages i get from patients being like nothing has worked until i tried spironolactone or this has changed my life for the better so spironolactone can be incredibly effective for that stubborn lower facial acne although it can help with all types of acne as

I mentioned in the beginning of this video it does block testosterone from binding to the oil glands but can block testosterone in other parts of the body too not in a significant way for women but for men it can and so it can cause men to like grow excess breast tissue which generally is undesirable so oral spironolactonite only prescribed for women for acne now

I also mentioned earlier on in this video that when i got my prescription from apostrophe it included topical spironolactone because i didn’t want to be on oral spironolactone at that point in my breastfeeding journey and if you compare the effects of topical spironolactone versus oral spironolactone there is much much much more data to show the efficacy of oral

Spironolactone when it comes to the treatment of acne that being said there are some small studies that show that topical spironolactone can be helpful with things like oil production which in turn can lead to the improvement of acne in my practice i prescribe a lot of oral spironolactone because it addresses a lot of different types of acne without having to put

A patient maybe on antibiotics for a prolonged period of time or say they don’t want to take a birth control pill but they have this very kind of lower facial dominant acne breakout spironolactone can be really helpful for that even for my patients who are on a birth control pill either to help with contraceptive methods or to help with their acne but they need a

Little bit more oomph spironolactone can be used in combination with an oral contraceptive pill to improve acne further sometimes i’ll get asked can a teenage girl be on spironolactone or is it just for adult female acne absolutely a teenager can be on spironolactone and i actually prescribe a lot of spironolactone for this demographic because many teenagers don’t

Want to be on a birth control pill for a variety of reasons but they still have that lower facial acne that might respond well to some type of hormonal augmentation and spironolactone really fits that niche well now of course if you’re taking oral spironolactone you are at higher risk of side effects which we are going to talk about in a second so that might be a

Reason why you want to try topical spironolactone first you’re nervous about side effects or you have a health reason why you need to be on topical versus oral for example you have really poor kidney function that would be a reason to not be on oral spironolactone or you have really low blood pressure that would be a reason to not be on oral spironolactone although

We’ll talk about that too because even people with low blood pressure often can be on spironolactone and then of course if you are male i would not put you on oral spironolactone for the treatment of your acne so topical spironolactone might be a good option there whether you are on oral or topical treatment with spronolactone similar to other acne interventions

When using oral or topical spironolactone we really want to give you at least 8 to 12 weeks to see improvements if we try to examine your skin sooner than that we might not be appreciating the full improvements that are possible okay let’s talk about side effects next because i feel like one of the biggest deterrents to people using oral spironolactone is that

They’re worried about the side effects that or they haven’t heard of oral spironolactone so remember spironolactone is a potassium sparing diuretic meaning that it helps you pee out excess fluid and hold on to potassium so some side effects are potentially related to that you could get light-headed or dizzy if you were to get dehydrated you could have a headache

Those are probably the most common things or you could even appreciate feeling like you have to go pee more often or more intensely now most of my patients never report any of that but those are things that i would have my patients look out for now because spironolactone also acts on androgen receptors throughout the body you can have some hormone-like side effects

As well so you can have spotting between your periods you can have a mist period or an extra period that can happen you can also have some breast tenderness or even breast enlargement any time you’re taking an oral medication there’s always the potential for stomach upset so things like nausea can happen and then one thing i’ll get asked about because this is

A potassium sparing diuretic is am i going to have a buildup of potassium in my body that is problematic and no you are not if you have properly functioning kidneys you are going to pee that excess potassium right on out of you we used to do potassium monitoring for people when they were on spronolactone but there has been a wealth of data that has supported the

Fact that that is not necessary so we no longer recommend any type of potassium monitoring for young healthy women women who are under the age of 45 who are on this medication now i’m not going to list all the potential side effects of spironolactone if you do that for any medication you could talk for quite some time but really what i want to drill down on here is

The fact that those side effects tend to be very well tolerated when they do happen to someone or they don’t happen at all so when we look at how spironolactone is used in practice and what people are complaining about they’re often not complaining at all they do really really well with this medication and when you compare that to the side effects of even things

Like topical tretinoin or oral antibiotics people tend to do better with spironolactone which is something that’s important to keep in mind i’m sure there will be people watching this video who have had a bad experience with spironolactone that can happen with any medication but the chance of that is really low and that’s something that’s worth noting the other

Thing i mentioned earlier in this video is the house phronolactone can cause low blood pressure because it’s a treatment for people with high blood pressure and a lot of adult women who have acne also happen to have low blood pressure so can they be on spironolactone and oftentimes they can i will counsel them about it and that they have to be really careful if

They’re feeling light-headed or dizzy especially when they stand up and they have to keep themselves very well hydrated but even if you have lower blood pressure oftentimes bronelactone is okay you just have to start maybe at a lower dose and kind of work your way up and make sure you still feel good on that medication now when we look at topical spironolactone

It’s not absorbed into your bloodstream so it’s not going to have any of those potential systemic side effects that oral spronolactone can have the main side effects with topical spironolactone would be things like redness or irritation or a little bit of stinging the same for any other acne topical the other thing i want to mention is that spironolactone orally or

Topically can be used on its own or it can be used in combination with other acne treatments for example when apostrophe compounds their spironolactone they don’t just give you topical spironolactone but you can also have it in combination with tretinoin and then clinomycin which is an antibiotic or you can have it in combination with tretinoin and tranexamic acid

Which helps with hyperpigmentation so i find that spironolactone is an incredible medication for acne but like any acne treatments it often works best when combined with other things that are attacking acne from other angles and then when it comes to oral spronolactone you can combine it with other medications as well so like i mentioned earlier you can take it

With oral contraceptive pills you can use topical tretinoin or topical antibiotics with it and even sometimes can combine it with oral antibiotics when necessary so i really like spronolactone because it tends to play nice with others hopefully that answers some of your questions about spironolactone are you interested in trying spleronolactone or have you already

Tell me in the comments below thank you so much for watching don’t forget to like this video and subscribe to the channel and i will see you next time you

Transcribed from video
Dermatologist Explains Spironolactone for Acne Treatment | Dr. Sam Ellis By Dr. Sam Ellis