It happens every month about a week to ten days before your period starts. Those tender and red bumps start to appear along your chin and jawline causing pain and embarrassment. Although you’ve tried numerous products to help with this, nothing seems to be working. Sometimes months or years go by and still no improvement. So, what can be done? Perhaps you live in an area where the wait to see a dermatology provider is weeks or months long. Perhaps you have insufficient or no healthcare insurance. Or maybe you are busy working or caring for your family and it is difficult to get to an appointment. These are just a few of the reasons that telehealth dermatology visits can be of service to you; especially when it comes to the evaluation and treatment of acne.
Although “hormonal acne” is not a medical term, we unofficially refer to acne that fits this pattern as hormonal acne, which is a type of acne that flares in response to hormonal fluctuations. A group of steroid hormones known as androgens fluctuates during the menstrual cycle and usually peaks during mid-cycle. This rise in androgen levels can trigger acne flares because it promotes the skin to produce more oil, or sebum, which can cause pore clogging and colonization of the Propionibacterium acnes (P. acnes) bacteria leading to acne development. Lesions fitting this type of acne pattern tend to form on the lower face, chin, and jawline area but may also appear on the neck and upper trunk.
Not only is this type of acne frustrating, but it can also be a source of embarrassment and low self-esteem for many people. The good news is that we have several treatment options available. If the conventional assortment of oral and topical treatment modalities commonly used to treat acne are unsuccessful, we may choose a different approach. For some, adding an oral contraceptive pill may be enough to regulate the hormones to offer relief for this type of acne. For others, an anti-androgen medication known as spironolactone may help.
Spironolactone is commonly used to treat high blood pressure, heart failure, swelling, and other conditions. However, it has been used off-label for a few dermatologic conditions. Dermatology providers sometimes use spironolactone to treat hirsutism, or dark hair growth of the face as it has been shown to slow the growth rate and diameter of facial hair. It also can be useful to treat female pattern hair thinning as well. Some patients even tell us that it helps to make their scalp less oily!
Dermatology professionals often use it off-label for women in the treatment of acne for its androgen stabilizing effects. This helps to reduce sebum production and thus the formation of acne. Unlike oral antibiotics that need to be discontinued after several months of treatment, oral spironolactone is a treatment that can be used for longer periods of time to treat acne. This medication has the added advantage that it will not interfere with oral contraceptive medications. However, it is important to note that spironolactone is not a form of birth control and women should not take it if nursing or are planning a pregnancy, trying to conceive, or are pregnant due to the potential for birth defects.
If you are interested in treatment with this medication, it is important to understand the side effects of spironolactone before jumping on board. Some women experience breast tenderness and menstrual irregularities such as spotting while taking spironolactone. If this happens, the dose can be adjusted, or the medication discontinued to mitigate this effect. Some of these side effects may improve or resolve after two to three months of treatment.
Spironolactone acts as a diuretic, so it may cause increased urine volume and frequency. In other words, you may find yourself making more trips to the bathroom. For this reason, it is important to stay well hydrated while taking it and drink plenty of fluids. Since the medication may lower your blood pressure, it is important to report symptoms such as headaches, fatigue, and dizziness, especially when rising from a laying or sitting position. Any other side effects should be reported to your provider so that you can be monitored, or the medication discontinued if need be.
Spironolactone can potentially cause an increase in the potassium level of the blood. Potassium plays a significant role in cardiac function and levels that are too high could cause cardiac arrhythmias. For most women with normal kidney and liver function, this is not usually a significant concern. However, it is important to let your provider know what prescription and over the counter medications you take regularly to avoid any interactions. There are certain medications that spironolactone should not be prescribed with, so it is important to coordinate care with any providers that prescribe medications for you. For example, certain blood pressure medications known as ACE Inhibitors, such as lisinopril, and other blood pressure medications known as Angiotensin Receptor Blockers, like losartan, can interact with spironolactone and should not be taken together. Depending upon your age and circumstances, your provider may periodically order blood tests to check your potassium level as well as your kidney and liver function.
Treating acne with spironolactone also has other advantages. This medication has been around for years and is available as a generic, which means that it is generally inexpensive. Most insurance plans, including Medicare, cover this medication. Coupons can also be found on GoodRx.com. According to online resources, the retail price can range on average from $7-$16 dollars for a one-month supply, or around thirty tablets. This, in combination with telehealth dermatology services, can make it one of the easiest and cost-effective means of treating hormonal acne.
Everyone’s acne symptoms and treatment needs are unique and there is never a one-size-fits-all solution to addressing acne. Anyone who seeks an evaluation for treatment needs a customized evaluation. In many cases, a combination approach of oral and topical medications may be necessary to control acne. Fortunately, if there is any specialty that lends itself well to telehealth, it is dermatology.
Live virtual visits or asynchronous photo consultations are an excellent and convenient way to increase access to dermatologic care in a cost-effective way. At The Derm NP, it is our mission to provide such care. Explore our website to decide if you would like to be seen virtually for your hormonal acne evaluation. We look forward to seeing you!