Every day we hear someone advocating “good skin health”. Yet for those suffering from severe skin problems and adult acne, a good skin routine and products containing skin nourishing ingredients like hyaluronic acid and retinol, are simply ineffective.

Fashionista.com recently reported on a pill it calls “magical” for adult acne. It’s called Spironolactone (Spiro). The local equivalent, available in South Africa, is called Aldactone.

Originally the medication was formulated to treat hypertension, edema and a few other cardiovascular troubles, but at a low dosage it is apparently very effective at treating severe acne. Intothegloss.com says the pill is now a firm favourite with dermatologists in the States.

For a long time acne sufferers have looked to oral contraceptives to regulate hormones and strong drug solutions like Roaccutane or Oratane. These drugs contain the active ingredient isotreretinion which, like retinol is an ingredient derived from Vitamin A. 

Though highly effective, Roaccutane comes with side-effects that include severely dry skin and eyes, hypersensitivity to the sun and it is strongly contraindicated in pregnant women as it can cause birth defects. In rare cases it has been linked to liver damage and depression.

Spironolactone (Spiro) allegedly has little to no adverse side effects and is incredibly effective at treating stubborn acne. Besides the lesser side effects, it is also much cheaper than alternative acne medications.

How does it work?

"Spironolactone is sometimes used off-label at low doses to treat women with persistent adult acne due to increased androgen levels (hormonal acne), because the drug is able to inhibit the activity of sebaceous glands (small skin glands that releases an oily, lubricating substance called sebum).

"The development of acne lesions is associated partly with increased sebum secretion, which can be stimulated in women by androgen excess," says local dermatologist, Dr. Nomphelo Gantsho.

Not for men

Fashionista reports that it blocks androgen hormone receptors - often referred to as “male hormones” as testosterone is a well-known androgen. Androgens are present in both men and women – only at different levels.

Elle.com notes that testosterone can cause oil glands to overproduce oil, causing breakouts, especially during your period. Spiro actually helps to decrease circulating testosterone in women and “the less testosterone there is, the less havoc on your skin.”

Androgens are also responsible for body-hair growth and sebum production in both men and women, says IntoTheGloss, so when taking Spiro it will block the body’s production of androgens, which is why the drug is mostly only prescribed to women.

If a man takes Spiro it would have negative implications. These include the possibility of growing breasts, a decreased libido and other hormonal fluctuations.

No quick fix

"Although it treats hormonal acne, it's not a quick fix. Spiro takes about three months to kick in, and it's possible you'll still get small monthly menstrual-cycle-related breakouts on it," says Dr Ganstho. 

"The main difference is that you'll get a manageable, gone in two days kind of zit—not an entire situation on your face. And right, it's a diuretic, which means you'll be going to the bathroom more times a day than you'd prefer.

"It's also potassium-sparing, which means there's a slight risk of building up too much potassium in your body. It's advised that you cut down on potassium-rich foods while on the drug and get your blood checked every six months to a year (depending on your dosage and doctor)," warns Dr. Nomphelo Gantsho.

Dr Gantsho says she will prescribe this pill to her patients once oral contraceptives have failed to improve acne.