Spironolactone has relatively minor side effects, like low appetite, weakness, or cramping, but there’s one major exception: spironolactone comes with a black box warning about its cancer-causing effects. The FDA is required to include this label based on a study conducted in the 1950s that found carcinogenic properties in the spironolactone given to rats in an experiment. However, the dose of spironolactone used in this study was nearly 500 times higher than the dose currently prescribed, and no studies since have found anything carcinogenic about spironolactone. Because of this, most dermatologists feel comfortable prescribing spironolactone for acne. Still, it’s something to be aware of before you take it. Additionally, those with low blood pressure or kidney conditions are likely not good candidates for spironolactone and may want to explore other acne treatment options.


How to Handle It: If you've tried the usual anti-acne ingredients, like salicylic acid and benzoyl peroxide (which, we should warn you, rarely work for this), you should consider paying your dermatologist a visit. "You may need a cortisone injection or an oral medication, like an antibiotic, in addition to topical formulas," says Zeichner. He's also a fan of a prescription topical medication called Epiduo Forte Gel, since, he says, it's been shown to be effective at controlling severe acne without the help of oral treatments.
A review published in the Archives of Dermatological Research found evidence that sleep deprivation, stress and other aspects of “modern life” are linked to adult female acne. The researchers point out that “Modern life presents many stresses including urban noises, socioeconomic pressures and light stimuli. Women are especially affected by stress during daily routine. Women also have a higher risk of developing psychiatric disorders such as depression and anxiety. Sleep restriction is added to these factors, with several negative consequences on health, including on hormonal secretion and the immune system.” (7)
Retinol: Retinol is simply another word for vitamin A, sort of like how we call vitamin B7 “biotin.” It’s important that our bodies get systemic vitamin A through our diet for good vision, a strong immune system, and general organ function, but some research suggests that vitamin A could have a positive impact on the skin when applied to it directly. The problem is, regular retinol doesn’t actually do much for acne. That’s because the retinoic acid found in retinol isn’t always activated when left to its own devices. We typically have to activate the retinoic acid synthetically through the creation of various medications.
First, let’s talk about what causes acne. Pimples form when the oil and dead skin cells on your skin combine to form a plug that blocks the pores. “As the P. acnes bacteria that naturally live on skin overgrow within this plugged follicle, the area becomes inflamed and this is when you start to see papules, pustules, and cystic lesions,” RealSelf dermatologist Sejal Shah, M.D., tells SELF. The treatments ahead work to exfoliate away dead skin cells, suck up excess oil, stop inflammation, and kill the P. acnes bacteria. There are even a few treatments that target hormonal acne specifically.
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If you’ve ever suffered from acne in the past, then you’re probably wondering how to get rid of acne scars that can remain for months or even years. Treating acne scars takes patience and perseverance. The sooner you start treating a scar, the better possible results. The vast majority of individuals who get acne will experience some degree of scarring. The most important thing you can do to prevent scarring? During a breakout, never pick or pop pimples, whiteheads or blackheads!
If you find that acne appears around your hairline, commercial hair products may be to blame. Shampoo, conditioner, hair spray, gels and mousses contain acne-causing ingredients, including petroleum, parabens, silicone, sulfates, panthenol and other chemicals. Try my Homemade Honey Citrus Shampoo that is void of harmful chemicals and leaves hair soft and manageable. Follow with a touch of coconut oil or my Homemade Conditioner made from apple cider vinegar and essential oils.

“Acne cleansers with these ingredients will gradually unclog pores, reduce the size of existing blackheads and slow or stop the formation of new ones,” she says. “Benzoyl peroxide is also the best ingredient for treating the acne-causing bacteria called p. acnes. In fact, study after study continues to show that benzoyl peroxide is more effective than prescription topical antibiotics at treating p. acnes.”


The best acne treatment system will include a cleanser, exfoliant and a treatment product that can be used daily. The idea is to have a product that cleans and clears clogged pores, kills bacteria, exfoliates to remove dead cells and spot treats trouble spots to combat stubborn blemishes and reduces inflammation and redness. For those with oily skin, a toner may be useful. For those with black heads, deep cleansing pore strips will help. If you have dry skin, foaming face wash would be something you want to avoid. The point is, a carefully tailored system is the best approach to an effective acne treatment.


“Acne cleansers with these ingredients will gradually unclog pores, reduce the size of existing blackheads and slow or stop the formation of new ones,” she says. “Benzoyl peroxide is also the best ingredient for treating the acne-causing bacteria called p. acnes. In fact, study after study continues to show that benzoyl peroxide is more effective than prescription topical antibiotics at treating p. acnes.”
Whether it’s just or not, you are judged by your appearance: the clothes you wear, your hairstyle, your body language. And if you have acne, life can be more difficult for you. You may feel uncomfortable in social settings. You may lose your confidence. It could destroy intimacy with someone you care about. If your poor self-esteem affects your job performance, then having acne could even have a negative impact on your income and career advancement. There’s no such thing as ‘growing out of acne’. It’s an issue that needs to be taken seriously. The only way to fight acne is by treating it. And to fight acne head-on, you need to find the best acne treatment for you.
You’d be hard-pressed to find a derm who won’t tell you to run to the drugstore to pick up this retinoid, the only one available OTC. A retinoid (a vitamin A derivative that speeds cell turnover) can treat acne by exfoliating the skin to prevent clogged pores, says Dr. Meinhardt, who recommends Differin to patients. Use a few times per week and then build up to nightly use, he says. (Once you’ve got control of your acne, check out these OTC retinol products for a complete skin overhaul. They’ll ban blemishes, reduce wrinkles, and combat aging.)
For individuals suffering from the cystic form of acne, a controlled clinical trial has found that Guggul supplements (also known as guggulsterone) outperformed 500 milligrams of tetracycline by a small margin. (16) In the study, 25 milligrams of guggulsterone taken twice daily for three months resulted in the reduction of acne, but more importantly, 50 percent fewer participants had acne relapses. Researchers noted that patients with oily skin responded remarkably better to guggul than others in the study.

Salicylic acid and azelaic acid. Azelaic acid is a naturally occurring acid found in whole-grain cereals and animal products. It has antibacterial properties. A 20 percent azelaic acid cream seems to be as effective as many conventional acne treatments when used twice a day for at least four weeks. It's even more effective when used in combination with erythromycin. Prescription azelaic acid (Azelex, Finacea) is an option during pregnancy and while breast-feeding. Side effects include skin discoloration and minor skin irritation.

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