Should I consider spironolactone or birth control for adult hormonal acne?

[PatrickL]

I'm a 28-year-old woman who has struggled with persistent hormonal acne along my jawline and chin for years, well beyond my teenage years. I've tried over-the-counter salicylic acid and benzoyl peroxide washes with limited success, and my dermatologist recently prescribed a topical retinoid, which is causing significant dryness and peeling. I'm feeling frustrated and wondering if I should stick it out or explore other options like spironolactone or changing my birth control. For those who have found an effective acne treatment for adult hormonal breakouts, what was your journey like? Did you have to combine prescriptions with specific lifestyle or diet changes to see real, lasting results?

[Harper.R]

You're not alone—topical retinoids are often drying; try lowering frequency to every other night, then seal in moisture with a gentle, fragrance-free moisturizer before or after applying the retinoid, depending on what you find tolerable. If the dryness continues, a short break or rotation (e.g., retinoid a few nights on/away) can help. Some people also try a lightweight moisturizer first to act as a buffer. Alternatives like azelaic acid (15–20%) can be gentler and still help with clogged pores and redness, and it can be used alongside or instead of a retinoid in some regimens.

[RonaldS]

Spironolactone is a common option for hormonal acne in adults. Many patients notice improvement after a couple of months. Side effects can include heavier periods, breast tenderness, and dizziness; it can raise potassium so it requires blood tests and kidney function monitoring. It isn’t used in people who are pregnant or might become pregnant. If you’re considering it, a clinician will typically start at a low dose and adjust, balancing the benefits with potential risks.

[JohnTM]

For birth control, some combined pills that include antiandrogenic progestins can help with hormonal acne, especially if your cycle seems tied to flare-ups. The trade-off is an increased risk of blood clots with estrogen-containing pills, which is higher if you smoke or have other risk factors. A discussion with your clinician is key to pick a formulation that aligns with your health and contraception needs.

[BrandonL]

Diet and lifestyle can influence acne for some people. You might experiment with a lower-glycemic diet (fewer refined carbs and sweets), moderate dairy reduction, adequate water, and consistent sleep. Some find omega-3 rich foods helpful, and stress management—via mindfulness, yoga, or breathing exercises—may reduce flare-ups indirectly by lowering cortisol. Supplements like zinc or magnesium are popular but should be discussed with a provider due to possible interactions and kidney considerations.

[PenelopeA]

If you want, tell me your current regimen (which retinoid, frequency, any other meds), and what concerns you most about trying spironolactone or a new birth control. I can help you assemble a concise list of questions to bring to your dermatologist so your next visit becomes a concrete plan rather than a back-and-forth.”