Acne, Roaccutane and Spironolactone

Back in May, I had a long overdue check-up with my dermatologist and started taking a new medication – Spironolactone.

For anyone new around here, I’m 50 years old and have suffered from acne since I was 12. Not the occasional spot or hormonal breakout. I’ve really suffered with it. I’ve been on some form or other of prescription medication since I was 16.

At 40, I went on Roaccutane, the strongest acne drug there is. It can only be prescribed by a dermatologist and issued by a hospital pharmacy. Needless to say, it is more usually prescribed to teenagers, who tend to stay on it for six or nine months. It usually clears up their acne completely.

I’ve had a rollercoaster with it and have never been able to come off it. My skin is much better than it was, but it still isn’t ‘normal’. Most of the time, I’m on just 5mg, which is an extremely low dose. To put that into context, my sons were on 40mg and I was initially on 20mg. Technically, my sons could even have had 60mg, but it would have increased their risk of side effects.

My skin hasn’t been clear, despite the Roaccutane, since 2020. My dermatologist thought it was probably the stress of lockdowns etc which triggered it. I think it was more likely the Mirena coil. I suspected the coil had been responsible for the worsening of my acne through my 30s and into my early 40s, so I had it removed. Then when I went on HRT, I was basically told I needed to have the Mirena coil again.

It’s wonderful being menopausal and suffering from something which affects teenagers.

So I went back to the dermatologist earlier this year with a few spots around what he nicely describes as the ‘muzzle’ – chin and mouth basically.

Credit to my dermatologist. For him, a few spots isn’t good enough. His aim is always perfect skin. So he offered me a new solution.

Spironolactone.

Spironolactone is a blood pressure medication, which just happens to be good at curing spots. Apparently it is widely used in the USA for treating acne as they really dislike Roaccutane over there. One of the big advantages of Spironolactone is that it’s licensed for long-term use. Roaccutane isn’t licensed for long-term use, but I totally trust my dermatologist. He has years of experience and has had enough patients on it long-term in the past to know that the risks are actually minimal. His preference would always be to keep someone on a low dose in the long-term than let them suffer with bad skin.

The plan was for me to take both Spironolactone and my 5mg Roaccutane for six months and then review. After that, I could keep going with both, take only Spironolactone or take maybe 10mg of Roaccutane without the Spironolactone.

Spironolactone is safe for people with normal or even low blood pressure. My own blood pressure is on the low side of normal. He recommended I take it at bedtime just in case – if you feel faint at bedtime, that’s OK, because you’re in bed!

I had to build up my dose every week – starting at 50mg, then increasing to 100mg, 150mg and then 200mg.

I didn’t feel faint, but once I got to 200mg it started affecting my stomach. I have IBS and I don’t need anything making it worse.

The good news is, my skin improved significantly.

After that first month, I started taking 100mg daily, plus my 5mg Roaccutane. I had no problems with my stomach. My skin wasn’t perfect, but it was a lot better than before the Spironolactone.

I’ve now made it to six months. For the time being, I’m staying on both medications. It may be that in a year or two I can drop one of them or alternate them. That would be nice, but keeping my skin looking reasonable is more important to me than cutting out the medication.

If you’re reading this and thinking I should just drink more water/ eat more vegetables/ take a herbal supplement, it doesn’t work like that for me. For me, acne is a long-term health condition and I need to take medication for it, like many people do for other long-term health conditions. I’ve had to be quite brave over the years and face the world with the sort of skin which would make many people hide away. I don’t want to keep doing that.