"Here, you have to try this," my friend Nancy said, sliding a yellow tablet to me across her bathroom vanity. "It changed my life." No, it wasn't some hot new party drug, but rather, spironolactone, a prescription diuretic commonly used for people with high blood pressure—and sometimes prescribed to women with acne. After hearing me bemoan the hormonal acne that had been clogging my chin and jawline, popping up right around my period, Nancy thought it might help me, but as for me? I was less sure. I used to be a nurse practitioner and was really familiar with the drug, but had never heard of it being used for acne.
Does it really work for acne? "Yes!" Nancy said. "And the best part is that it gets rid of my bloating, too." Curious, I made an appointment with my dermatologist, went on "spiro"–as it is lovingly called by its devotees–and indeed, it was life changing. Well, face changing anyway.
According to Dr. Rachel Nazarian, a dermatologist specializing in acne at New York City's Schweiger Dermatology Group, hormonal acne is cyclically occurring with your period, and usually shows up along the jawline and chin, presenting as "deep, tender" lesions. You know the ones. They pop up, so the medical theory goes, because certain lucky ladies have an increased sensitivity to circulating testosterone. (Yes, women normally have testosterone floating around in their systems.) The testosterone causes oil glands to go into hyper-drive, causing breakouts. So in addition to its pee-inducing and blood pressure reducing qualities, spiro works to decrease circulating testosterone in a few different ways. And the less testosterone there is, the less havoc on your skin.
Hormonal acne can affect women from their early twenties right on up through the forties, so spiro is an appropriate med for both Millennials and Gen-X'ers alike, and often more palatable than the alternative for treating hormonal acne–oral contraceptives. "I cannot emphasize how much I hate the birth control pill. I tried a couple for a few years in high school and hated my life, so that was a non-negotiable for me," says Emily (not her real name), 25, a writer who went on spiro about six months ago when her acne changed from classic to hormonal and Accutane was no longer working for her. My own hormonal acne, probably not coincidentally, popped up when I went off birth control pills.
While doctors have been prescribing spiro for acne for quite a while, the drug is seeing a bit of a resurgence; so many women that I run into lately seem to be on it. Dr. Nazarian backs up my observation. "Frankly, antibiotics are working less and less well, especially with women in the age group who come in with this hormonal [acne] pattern," she explains. "For that reason we're turning to spironolactone more than we used to." Dr. Arielle Kauvar, another NYC-based dermatologist, puts antibiotic failure rate at anywhere from 70 percent to 80 percent for women with hormonal acne, making spiro a much better alternative, especially with all the concern about antibiotic resistance now. Plus, it's either $0 if you have insurance or around $15 for a month's worth of 25mg pills if you're not covered—which is a small price to pay when you consider what you could be shelling out for acne treatments.
"But, wait, tell us about the anti-bloating!" you cry. Turns out it's a bona fide side effect. "People love spironolactone because it helps to decrease bloating and water retention," Dr. Kauvar notes. My friend Nancy claims her monthly bloating is much less than it used to be since she went on the spiro, and Emily says she definitely lost some (presumably) water weight when she went on it. I've also noticed that it affects my bloating, even on a daily basis. I'm not that great about remembering to take it daily, but then when I do, I definitely get a bit of a tummy shrinking effect. Because it makes you pee, spiro pulls off extra fluid, so that side effect makes sense. However, Dr. Nazarian warns that it's not a reason to go on the medicine, and not everyone experiences this effect. "It definitely is the most common side effect that I see, but I find that's more at the very beginning and it's not happening to all of the patients. It's maybe somewhere around a quarter to a third of the patients who have a noticeable diuretic effect." Emily, for example, no longer notices the anti-bloating effect.
Spiro doesn't necessarily work right away either. I started seeing improvement in my acne after one menstrual cycle, but it took Emily about four months, a time frame that Dr. Nazarian notes is common. But then, "It blew my mind. I get maybe one spot now around my period," Emily says.
However, it's not all flat tummies and clear skin. Spiro definitely has some unpleasant side effects, and not everyone can use it safely. Because spiro is a diuretic, you're going to spend a lot more time in the bathroom. Two hours after I take it, I am running to the bathroom like clockwork. I've learned not to go on long bike rides after taking it. It is also classified as a potassium-sparing diuretic, which means your body will hold on to potassium. Dr. Nazarian warns her patients to go easy on things like bananas, coconut water, salt substitutes, and other high-potassium foods, because high potassium levels can be dangerous for your heart. Spiro can also drop your blood pressure, so if you're tiny and already have low-ish blood pressure, it may not be safe.
Finally, here are two things that are absolute spiro no-nos: being a man, and being pregnant. Decreasing testosterone in a man has more implications than for women, like potential gynecomastia (growing breasts) and decreased libido, so it's absolutely not appropriate for them. Additionally, there has been some evidence that spiro can feminize a male fetus. "If you really look at the facts, it's not actually as dangerous as we think it is but it's 100 percent not worth the risk. Everybody gets a super stern warning from me when they're on it that they're not allowed to get pregnant," says Dr. Nazarian.
All things considered, my clear skin and I are totally on board.
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