- Spironolactone is a blood pressure medication that dermatologists often prescribe for hormonal acne.
- It's not FDA-approved for acne treatment but is generally considered low-risk by doctors.
Courtney Sims had tried everything to clear her acne: Birth control, facials, and seemingly endless skincare routines and products. She even took a low dose of spironolactone, only to go off it after six months of little improvement.
Still, spironolactone prescriptions as acne treatments kept growing in popularity, especially in her own social circle.
"I would say almost 70% of my friends take spironolactone and had really good results from it," the 29-year-old previously told Insider. She said that not all of them use it for acne, either — some just see it as a route to glowing skin.
Spironolactone's ubiquity is also credited to its low side-effect profile. While it's designed to manage high blood pressure and isn't FDA-approved to treat acne, doctors consider the medication mild enough for most patients to use long-term without any complications.
So when a dermatologist recommended she try it in 2021, Sims decided to give spiro another shot. "I was just thinking 'OK, this has got to be something deeper, beneath the surface,'" said Sims, hoping that this time would be the charm.
Her acne didn't clear until she upped her dose
The first time Sims had taken spironolactone years ago with no results, she remembered it was at a fairly low dose: 25mg tablets. She had several friends who took 100mg, so she felt comfortable when her doctor suggested upping her dosage. Dr. Ivy Lee, a board-certified dermatologist practicing in Los Angeles, says that her starting dose for patients is usually 100mg.
Sims was bumped up to 50mg, then gradually to 75mg, 100mg, and eventually 150mg, where she "started to see a little progress" in her acne fading.
She started experiencing side effects, including dizziness and fainting
While her skin cleared up a little, Sims said she also started feeling off.
"I've always been super in touch with everything going on in my body," she said. "I've been very active my whole life. I've been tracking my cycle since I started."
So when she didn't have her period for four months — a studied side effect of long-term spironolactone use — she felt alarmed. She said she also experienced "constant dizziness," lethargy, trouble sleeping, and seemingly neverending dehydration.
"I could tell I was very dehydrated, but I was also drinking so much water, so I just couldn't understand why I was feeling like that," she said.
Part of this could be that spironolactone is a diuretic — meaning it can make you pee a lot, according to Cameron Rokhsar, MD, a board-certified dermatologist and associate clinical professor of dermatology at Mount Sinai Hospital. He said it's vital for patients to take supplements with electrolytes to offset dehydration.
Sims had already been taking a probiotic, magnesium, and a multivitamin containing vitamin D, iron, omega-3, and vitamin B12 long before she started the treatment. She was also incorporating liquid IVs to help replenish electrolytes and balance out the dizziness and dehydration she experienced on the medication.
Eventually, Sims said, her lightheadedness reached a breaking point during a movie night with her mom.
"I got up to go to the bathroom and right as I stood up I just knew something was very off," she said."I'm pretty sure I blacked out — I just fell backward, hit the floor, woke up, and my mom came over screaming 'Oh my God, are you okay?'"
Lowering the dose made her acne come back without reducing the side effects, she says
Sims spoke to her doctor about lowering her dose back to 100mg in the hopes of reducing the side effects. But they didn't disappear, and if anything, she described her acne as coming back "so much worse," describing inflamed cystic acne mostly on her cheeks and close to her jawline.
Spironolactone isn't a medication that "cures" acne, Dr. Ronda Farah, Associate Professor at the University of Minnesota's Department of Dermatology and the University of Minnesota Health Cosmetic Lead told Insider. It must be taken long-term to see consistent results, and lowering a dose or stopping completely can lead to the acne returning.
She eventually went off the medication and switched up her skincare routine
Eventually, Sims "cold-quit" spironolactone, and reported that, for the past two months, her skin finally cleared up.
According to her, swapping out a few products in her beauty regimen made a difference. For instance, she realized she is prone to dry skin and using a harsh exfoliant, which she exchanged for using Revision's Pumpkin Enzyme Mask once a week. She also uses the brand's Gentle Cleansing Lotion, only switching to a benzoyl peroxide cleanser when she breaks out.
But overall, Sims said her greatest takeaway from the experience is the importance of listening to her body.
While Lee notes that there still isn't robust evidence on the impact of diet and gut health on acne, Sims says she believes her balanced diet and regular exercise helped to improve her skin, too.
"Health is not a one-size-fits-all," Sims said. "The more you become educated and aware, the better decisions you can make for yourself regardless of what may work for others."