This is how the drugs saved me from my hormonal acne

The results speak for themselves.

I was ten when I got my first pimple – a juicy white head right on my Cupid bow. Mortified, I spent the whole day at school hoping no one would notice – and I almost escaped unscathed – until a girl asked me in disgust what “this thing about.” [my] face ”was. I came home crushed, embarrassed and feeling, for the first time in my life, ugly.

My mom assured me that the pimple would go away in a few days and my skin would return to its clear appearance ten years before long. I had no idea this was just the start of a thirteen-year battle (and it’s not over).

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It started with a few pimples here and there, a gradual increase in face oil production, and a change in texture and color, transforming my once olive complexion into an oily red shade. Before long, I was twelve years old and struggling with acne, blackheads, and rapidly declining self-esteem on a daily basis.

Finally, at fourteen, a doctor gave me what seemed to be the answer to my suffering: the contraceptive pill. Ignoring the now obvious (and worrying) fact that I was just a pubescent virgin, I jumped on anything that could clear my rashes.

And he did. Kind of. Six months on the pill saw my skin transform into the soft, healthy glow I was looking for after all these years. It lasted until one morning in my senior year of high school, when I woke up to find a lump on my chin. You know the painful blinders under the skin that you can’t do or touch.

Before I knew it, I had developed a whole face of angry cystic acne, dropping my self-esteem into the ground. I have tried and tested a number of “natural” ways, trying to cleanse my skin on a “clean” vegan diet and drinking four liters of water a day (yes, four). My parents, after months of watching my failed healthy eating attempts, finally convinced me to start a course of Accutane.

The drug worked quickly, clearing my skin in a matter of months. I was thrilled to say the least, even though it dried out my skin and lips, ached joints and muscles, and made my skin hypersensitive to the sun. But alas, it was clear.

It wasn’t until I was living away from home at twenty that my vengeful nemesis returned (surprise bitch, bet you thought you saw the last of me). I tried resuming the pill – now that I needed it for birth control too – but never got the full results I hoped for. Even though my acne was not cystic at this point, I still had frequent rashes and patchy skin texture.

This brings me to last year when I started researching skin care ingredients and finding the right products for my skin type. With a social media feed filled with influencers like Skin care by Hyram and Doctor Derm, I started to hear conflicting opinions. Use The ordinary. Do not use the Ordinary. Exfoliate. Do not exfoliate. The list goes on. I felt overwhelmed and my acne was getting worse.

My cystic breakouts returned, but this time along my jawbone, especially around my period. Although my cycle is irregular, anytime I was greeted with a beard of sore, angry spots, I would definitely get my period shortly after. Once I noticed this model, I decided to take it to the experts.

After seeing a doctor, a dermatologist, doing blood tests and even an ultrasound, I found the root of my problem: polycystic ovary syndrome (more commonly known as PCOS). I had heard of the disease before, but never fully understood it until my diagnosis. While the symptoms are different for every woman, for me it ultimately gave an explanation for hormonal surges, excess facial hair (peach fuzz), and irregular periods. My main concern being acne, I was prescribed an antibiotic but didn’t see much improvement.

Enter Spironolactone (let’s keep it simple and call it Spiro)

I’d seen Spiro’s name pop up before while digging through TikToks skincare reviews and desperate late night Google searches (“Why do I have cystic acne as an adult?” “). But it wasn’t until I got a doctor’s prescription and dosage advice from a dermatologist that I began to understand why this drug was often prescribed for women in their 20s and 30s with hormonal acne. .

Spiro is actually designed to treat high blood pressure and excessive fluid retention. Corn dermatologists have been prescribing it for years to treat acne and excessive hair growth in women, two common symptoms of PCOS. It is effective for women like me, who do not want to change their hormones while taking the birth control pill, or experience the severe side effects of Accutane.

I started with a very small dose of 25 mg, and was advised to increase by 25 mg every two weeks until reaching 100 mg – the “hero dose”, for lack of a better term. It can often take up to six months to see full results, but it’s common to have lighter skin in the first few weeks. While I still have a long way to go on my Spiro journey, I was delighted to see my cystic pimples finally start to subside.

Previously, after my period ended, it took weeks for the rashes to finally wear off. And by then, the next escape was already brewing. It was an endless cycle. Now on Spiro, I still have a few spots under the skin on my jawline and cleavage, but they go away faster and are much less red and painful.

But what exactly does Spiro do? I turned to Dr Shyamalar Gunatheesan, founding dermatologist of ODE Dermatology, to get to the heart of the matter.

“It’s one of my favorite drugs,” she tells me. “I treat a lot of hormonal acne, rosacea and even hair loss in women. Acne is pretty multisectoral, so your diet, genetics, and hormones all play a role. Women are constantly subject to hormonal fluctuations, and as we get older – and also while breastfeeding – you experience hormonal fluctuations again.

“A lot of people don’t realize that both men and women have testosterone. We women have male hormones called androgens, which fluctuate at different times in our menstrual cycle. Androgens mainly bind to androgen receptors to increase the production of sebaceous glands or to hyperstimulate these glands to produce more sebum.

“We then have more sebum congestion, clogging of the pores, and that’s when we have a black point or a white point which then becomes a pimple. This inflammation of our skin can lead to hormonal acne.

“There are different ways to treat acne in adult women. One of the methods is a hormone modulating tablet like Spiro. I like it because it doesn’t deliver estrogen or progesterone to your body, it just modulates the androgen receptor. By attaching yourself to this receptor, you have less expression of androgens on your sebaceous glands or on your hair follicles.

“I also like it because it’s not an antibiotic, so you’re not going to have an effect on your gut health. You just go to the source of acne and fluctuating hormones, and you modulate it, ”she explains.

When she asked Dr Shyamalar how long it takes Spiro to start up, she replied, “It takes two or three months for some people, but some of my patients notice a big difference within a few weeks: their hair is getting longer. thick, they have less oil. production on the face and scalp, and generally less congestion ”.

But what are the side effects (if any)?

“Sometimes your periods can be irregular or you may feel breast tenderness. It’s a blood pressure medication, so it makes some people a little dizzy. It is also a diuretic, so I always tell patients to drink plenty of water to make up for the loss of fluids. In some people it can also increase the potassium levels in the blood, so you will need to watch your potassium intake, ”Dr Shyamalar tells me.

“Otherwise, it’s a very well-tolerated drug, and unlike drugs like Accutane or Isotretinoin, it doesn’t make you sensitive to the sun. It is still not safe to get pregnant with the drug, but you can actually experience better effects by combining it with an oral contraceptive pill – if you want to.

I also ask Dr. Shyamalar if there is a first stage of ‘purging’, something that a lot of people experience with drugs like Accutane, or even when they start with a retinol product.

“Unlike other acne tablets, you don’t really get that initial purge with Spiro,” she says. “It can take at least six weeks to take effect. I always say increase the dose gradually. It’s different for each person, but for facial and hormonal acne most people would get a pretty good result on 100 mg per day.

“There are many studies that show that around 40% of people see a 60% improvement with Spiro; about 30% notice moderate improvement; and only about six percent of people notice any improvement in hormonal acne. It therefore has a fairly good success rate.

“I see patients with PCOS all the time wanting to see a dermatologist about acne breakouts, facial hair, and thinning hair on the scalp. Spiro can help treat all of these problems, and sometimes even help ease a period that is heavy at first. It’s a great drug, but it’s just not as well-known as antibiotics or Accutane.

Our conversation only further solidified what I had already started to realize – this drug is a miracle worker (well, almost). And after only taking it for eight weeks so far, I can’t wait to see the results coming.

For more information on hormonal acne and your treatment options, talk to your GP. To find out more, try this.

About Sally Dominguez

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