Do you continue to see acne along your lower face, jawline, and neck despite trying all sorts of acne treatments? Have you taken an antibiotic to treat your acne and been disappointed with the results? Are you struggling to clear acne on your chest or back as well?

Women who answer yes to any of these questions may want to consider hormonal therapy for acne.

What exactly is hormonal therapy for acne?

Any medication that acts on our hormones is called hormonal therapy. Two hormonal therapies that can effectively clear acne in women are:

• Oral contraceptive pills (better known as birth control pills or “the pill”)
• Spironolactone (spy-ren-no-lac-tone)

How well does hormonal therapy work, and is it safe?

The pill: Many studies have looked at how well oral contraceptive pills fight acne. The pill has been found effective at treating blackheads, whiteheads, pimples, and acne nodules and cysts.

In fact, the pill has proven so effective that the U.S. Food and Drug Administration (FDA) has approved some oral contraceptives for treating acne.

The pill is generally considered safe for women. Some women, however, should not take it. Your dermatologist can tell you whether the pill may be a safe and effective treatment option for you.

Spironolactone: Doctors prescribe this medication to treat high blood pressure. It’s also prescribed for people who are retaining too much fluid.

Dermatologists have been prescribing it for many years to treat acne and excess hair growth in women. When other acne treatments don’t work, it can effectively treat deep-seated, tender acne on the lower face, jawline, or neck.

Spironolactone is not prescribed to treat acne in men due to side effects. Men have developed breasts while taking this medication to treat acne.

Spironolactone is generally considered safe for healthy women.

Taking both spironolactone and the pill can increase effectiveness. This combination has another advantage. It’s essential to use birth control while taking spironolactone. If you get pregnant while taking spironolactone, your baby can have serious birth defects.

Spironolactone may also be prescribed without the pill. If you’re 35 years of age or older, the pill may not be an option for you and only spironolactone may be prescribed. Taking spironolactone without the pill is also recommended when you have a medical condition that makes it unsafe to take the pill, such as having had a blood clot or stroke.

A word of caution: If you can get pregnant, you’ll need to use birth control while taking spironolactone.

When taken alone, spironolactone can be quite effective. In looking at the medical records of 85 women who took spironolactone, researchers found that 1/3 of the women had complete clearing and 1/3 had noticeably less acne. Only 7% saw no improvement.

Studies have also shown spironolactone to be effective. Improvement ranges from a 50% to 100% reduction in acne.

Before taking spironolactone, it’s important to know that this medication is a diuretic, so you’ll find yourself urinating more often. If this could be a problem, let your dermatologist know.

Taking spironolactone? Too much potassium can be dangerous. Skip the coconut water and supplements that contain potassium.

What’s involved in taking hormonal therapy for acne?

These medications must be prescribed by a doctor. Each is a pill that you would take daily.

If you’re wondering whether hormonal therapy could help clear your acne, you may want to make an appointment to see a dermatologist. After examining your acne and gathering the necessary information about your health, this doctor can tell you if hormonal therapy may be an option.

Before you see a dermatologist, it helps to prepare for your appointment. You’ll want to be able to tell your dermatologist the following:

• Medical conditions you have (or had), including high blood pressure, heart disease, blood clots, migraines, or cancer
• Medications you take
• Supplements and other natural products you take
• Surgeries you’ve had
• Medical conditions of close blood relatives, including cancer, kidney disease, or heart disease

If the pill is an option for you, you will have your blood pressure taken to rule out high blood pressure. You don’t need a Pap smear or pelvic exam before a dermatologist can prescribe the pill to treat acne.

Before your dermatologist prescribes spironolactone, you will need some blood tests.

If you begin hormonal therapy, you will need to keep follow-up visits with your dermatologist. Spironolactone requires that you gradually increase the dose, so you’ll need to see your dermatologist every 4 to 6 weeks when you start taking it.

How long does it take to see results?

How long do most patients take hormonal treatments?

When hormonal therapy helps to clear acne, a patient may stay on it for a long time. You will often stop other acne treatments like an antibiotic and medication that you apply to your skin. Hormonal therapy can be used alone to prevent new breakouts.

Taking hormonal therapy long term appears to be safe.

Taking spironolactone to keep your skin clear? Studies show taking it at the same time every day can give you the best results.

What are the possible side effects?

To reduce the risk of a woman developing serious side effects, dermatologists carefully screen their patients before prescribing hormonal therapy. Possible side effects include the following:

The pill: Taking the pill increases the risk of:

• Blood clots
• Heart attack
• High blood pressure

While these side effects may not seem worth the risk, most women who are healthy do not have side effects. In fact, the risk of developing blood clots is greater during pregnancy and just after having a baby than when taking the pill.

It’s also important to know that there is less risk of serious side effects today than in past. Today, the pill contains less estrogen.

Some women taking the pill develop , dark patches on their face. Protecting your face from the sun can help prevent these patches.

Breakthrough bleeding is another possible side effect. You can often prevent this by taking the pill at the same time each day.

Taking the pill? Stay active, drink lots of water, and don’t smoke. This reduces the risk of blood clots.

Spironolactone: When taking spironolactone without a birth control pill, the most common side effects are:

• Painful periods and cramping
• Irregular periods
• Breast tenderness
• Breast enlargement

These side effects may be decreased when women also take the pill.

Other possible side effects of taking spironolactone include fatigue, headache, and dizziness. These rarely cause a woman to stop taking the medication.

You may also see a warning about breast cancer in the information that comes with the medication. This warning was included after researchers gave animals very high doses of spironolactone. Some of the animals developed breast cancer.

The possibility that this medication increases a woman’s risk of getting breast cancer is still controversial.

We really don’t have evidence that shows taking spironolactone increases the risk of getting breast cancer. In one study, 1,475 patients prescribed spironolactone were followed for 3 to 7 years. During that time, 9 cases of breast cancer were reported. If none of these patients had taken spironolactone, it is expected that about 8 of them would have developed breast cancer during that time. Other studies have shown similar results.

What helps get the best results?

When taking hormonal therapy for acne, it’s helps to:

• Give the medication time to work
• Take the medication at the same time every day
• Use everything on your acne treatment plan
• Keep all follow-up appointments with your dermatologist
• Contact your dermatologist’s office right away if you experience signs of a serious side effect, such as cramping in your leg or arm

Hormonal therapy is an option for many women with stubborn acne, but it’s not always the only option. A dermatologist can tell you what can help clear your stubborn acne.

Images: Getty Images

References

Carol, R. “Hormonal therapies serve as key adjunct acne treatment.” Dermatol World. 2012 May (Acne suppl). 2-6.

Ebede TL, Arch EL, et al. “Hormonal treatment of acne in women.” J Clin Aesthet Dermatol. 2009; 2(12): 16–22.

Harper JC. “Use of oral contraceptives for management of acne vulgaris. Practical considerations in real world practice.” Dermatol Clin. 2016;34(2):159-65.

Kim GK, Del Rosso JQ. “Oral spironolactone in post-teenage female patients with acne vulgaris: Practical considerations for the clinician based on current data and clinical experience.” J Clin Aesthet Dermatol. 2012;5(3):37-50.

Plovanich M; Weng QY, et al. “Low usefulness of potassium monitoring among healthy young women taking spironolactone for acne.” JAMA Dermatol. 2015;151(9):941-4.

Reynolds RVS. ‘Hormonal treatment for acne.” Presented during the forum: Acne guidelines: Translating evidence into practice. 2017 Annual Meeting of the American Academy of Dermatology; 2017 March 3-7. Orlando, FL.

Zaenglein AL, Pathy AL et al. “Guidelines of care for the management of acne vulgaris.” J Am Acad Dermatol. 2016;74:945-73.

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If you have acne that just won’t go away, you may want to take a closer look at your skin. It’s possible that you don’t have acne. Other skin conditions can look a lot like acne.

Stubborn acne can also be a sign of something serious going on inside your body. To see clearer skin, you’ll need to get that serious condition under control first.

You’ll find pictures along with descriptions of such skin conditions below. If your acne resembles any of these pictures, seeing a dermatologist can help you get the right diagnosis and treatment.

Acne sending a warning sign

Acanthosis nigricans

Clues you have more than acne: Women who have polycystic ovary syndrome (PCOS) often have acne. They usually have other signs of a hormone problem like hair loss on their head, noticeable hair growth on their face, or an area of skin that starts to darken and sometimes thicken. PCOS can also cause irregular periods, sleep apnea, diabetes, heart disease, and other health problems.

Treatable: Yes. Women who suspect they may have PCOS should see their dermatologist or primary care doctor immediately.

If you’re diagnosed with PCOS, you should also be under the care of a doctor who can treat the cysts in your ovaries. You may also need to see other doctors to get treatment for conditions like diabetes or heart disease.

A dermatologist can treat your acne, hair loss, and noticeable hair growth. The darkening skin usually goes away when the disease causing it is treated. The medical name for this darkening skin is acanthosis nigricans.

Additional related resource

5 skin conditions that can look like acne

Rosacea

Clues you’re not dealing with acne: The acne-like breakouts usually appear where you have redness on your face. The redness may come and go or be permanent. The skin on your face tends to be very sensitive. It may sting or burn. Your eyes may feel gritty.

Treatable: Yes. Treatment can clear the acne-like breakouts and help your skin feel better. Rosacea cannot be cured, so you may need ongoing treatment.

Additional related resource

Keratosis pilaris

Clues you’re not dealing with acne: Unlike pimples, these bumps feel rough and usually appear on dry skin. You’ll usually see them on your upper arms and on the front of your thighs. You may notice that family members also have these bumps.

Treatable: These bumps are harmless, so you don’t need to treat them. If the itch, dryness, or appearance bothers you, treatment can help.

Additional related resource

Hidradenitis suppurativa

Clues you’re not dealing with acne: You have pimple-like bumps or deep acne-like cysts in places where skin touches skin, such as the underarm, groin, buttocks, or upper thighs. Women can also get these underneath their breasts.

Treatable: Yes. Treatment is important because it can prevent HS from worsening. If HS worsens, the acne-like eruptions can grow deep into the skin and become painful. They can rupture, leaking bloodstained pus onto your clothing. This fluid often has a foul odor.

As the deep bumps heal, scars can form. With repeat outbreaks, the skin often begins to look spongy as tunnel-like tracts form deep in the skin.

Additional related resource

Perioral dermatitis

Clues you’re not dealing with acne: You have a breakout that looks like many small pimples, but it develops only around the mouth. Sometimes, the breakout develops only around the eyes (periorbital dermatitis) or nose (perinasal dermatitis) instead of the mouth. The skin may burn or itch.

Treatable: Yes. Dermatologists recommend treatment. Without it, the breakout may last for months or years.

Chloracne

Clues you’re not dealing with acne: Chloracne is very rare. If it develops, you’ll likely see blackheads. These can form on the temples, cheekbones, and elsewhere on the body. You may see whiteheads, nodules, or straw-colored cysts on the face and elsewhere. Patches of gray-colored skin are common. Some people have blisters. Most people with chloracne feel very sick.

The signs and symptoms usually develop 2 to 4 weeks after you’ve come into contact with toxic chemicals found in insecticides, herbicides, or wood preservatives. Agent Orange was a known cause of chloracne during the Vietnam War.

Treatable: The skin will clear when you stop coming into contact with the chemical that caused the chloracne. The clearing usually happens within 6 months to 3 years.

The skin can also be treated with antibiotics, isotretinoin (a medicine used to treat severe acne), and procedures that dermatologists use to treat other skin conditions.

Dermatologist can help you see clearer skin

If your stubborn acne looks like any of these conditions, seeing a dermatologist can be helpful. A dermatologist can tell you whether it’s stubborn acne or another condition. Your dermatologist can also create a treatment plan for you, whether you have one of these skin conditions that looks like acne or stubborn acne.

Yes, even stubborn acne can be treated successfully. Thanks to advances in acne treatment, virtually everyone can see clearer skin.

Images 1, 4, 5, and 7: Used with permission of the Journal of the American Academy of Dermatology.

• (J Am Acad Dermatol 2007;56:S100-2.)
• (J Am Acad Dermatol 2010;62:637-45.)
• (J Am Acad Dermatol 2015;73:672-90.)
• (J Am Acad Dermatol 2016;74:143-70.)

Images 2, 3, 6: Used with permission of the American Academy of Dermatology National Library of Dermatologic Teaching Slides.

References

Alikhan A, Lynch PJ, et al. “Hidradenitis suppurativa: A comprehensive review.” J Am Acad Dermatol 2009;60(4):539-61.

Chamlin SL and Lawley LP. “Perioral dermatitis.” In: Fitzpatrick’s Dermatology in General Medicine (seventh edition). McGraw Hill Medical, New York, 2008: 709-12.

Crawford GH, Crawford GH, et al. “Rosacea: I. Etiology, pathogenesis, and subtype classification.” J Am Acad Dermatol. 2004;51(3):327-41.

Nedorost ST. “Medical Pearl: The evaluation of perioral dermatitis: Use of an extended patch test series.” J Am Acad Dermatol. 2007;56(5 Suppl):S100-2.

Patterson AT, Kaffenberger BH, et al. “Skin diseases associated with Agent Orange and other organochlorine exposures.” J Am Acad Dermatol. 2016;74:143-70.

Schmitt JV, Lima BZ. “Keratosis pilaris and prevalence of acne vulgaris: a cross-sectional study.” An Bras Dermatol. 2014 Jan-Feb; 89(1):91–5.

Sood A and Taylor JS, “Occupational noneczematous skin disease due to biologic, physical, and chemical agents.” In: Fitzpatrick’s Dermatology in General Medicine (seventh edition). McGraw Hill Medical, New York, 2008: 702.

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