Acne Won't Clear? Why Your Skin Is Still Breaking Out & Medically Approved Spironolactone Next Steps

If your acne just won't clear — even after trying cleansers, spot treatments, or prescription creams — you're not alone. Persistent acne can be frustrating and confusing, especially when you feel like you're doing everything right.

The good news? There are clear medical reasons why acne lingers, and there are proven treatments that can help — including spironolactone, a prescription medication often used for hormonal acne.

Let's break down why acne sticks around, when to consider spironolactone, and what your next safe, medically supported steps should be.

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Why Your Acne Isn't Going Away

Acne (also called acne vulgaris) happens when pores become clogged with oil, dead skin cells, and bacteria. But ongoing breakouts usually mean something deeper is driving the problem.

Here are the most common reasons acne won't clear:

1. Hormones Are Driving It

Hormonal fluctuations increase oil (sebum) production. More oil means more clogged pores.

Common signs of hormonal acne:

• Breakouts along the jawline or chin
• Flares before your period
• Deep, painful cysts
• Acne that started or worsened in adulthood

Hormonal acne often does not fully respond to topical treatments alone. This is where spironolactone may help.

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2. You're Treating the Surface, Not the Root Cause

Over-the-counter products work for mild acne. But moderate to severe acne often needs prescription therapy.

If you've tried:

• Benzoyl peroxide
• Salicylic acid
• Retinoids
• Antibiotic creams

…and you're still breaking out, it may be time to reassess your treatment plan with a clinician.

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3. You're Experiencing Medication-Resistant Acne

Sometimes bacteria adapt to antibiotics, or inflammation continues even after bacteria are reduced. In these cases, doctors often shift strategies — and hormonal therapy becomes an important option.

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4. Underlying Conditions Could Be Contributing

Persistent acne can sometimes be linked to:

• Polycystic ovary syndrome (PCOS)
• Androgen excess
• Certain medications (like steroids or lithium)
• High stress levels

If your acne is severe, worsening, or associated with irregular periods or hair growth changes, it's important to speak to a doctor.

If you're unsure what's causing your breakouts or want to better understand your symptoms before your appointment, try using a free Acne Vulgaris (Acne) symptom checker to help identify patterns and guide your conversation with your healthcare provider.

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What Is Spironolactone?

Spironolactone is a prescription medication originally developed as a blood pressure and heart medication. However, dermatologists widely prescribe it "off-label" to treat hormonal acne in women.

It works by blocking androgen hormones (like testosterone) that stimulate oil production.

Less androgen effect = less oil = fewer clogged pores.

Spironolactone is especially effective for:

• Adult female acne
• Jawline and chin breakouts
• Cystic acne
• Acne that worsens around menstruation

It is not typically prescribed for men due to its hormonal effects.

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How Effective Is Spironolactone for Acne?

Clinical research shows that spironolactone significantly reduces acne in many women with hormonal patterns. Improvement often includes:

• Fewer deep cysts
• Reduced oiliness
• Less inflammation
• Decreased frequency of breakouts

Many patients see improvement within 8–12 weeks, though full results may take 3–6 months.

It's not an overnight fix — but it can be a long-term solution for persistent hormonal acne.

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What to Expect When Starting Spironolactone

Typical Dosage

• Usually 50–100 mg daily
• Some patients require up to 200 mg
• Dose is adjusted gradually based on response and tolerance

Common Side Effects

Spironolactone is generally well tolerated, but possible side effects include:

• Increased urination
• Breast tenderness
• Irregular periods
• Fatigue
• Mild dizziness

Because it can increase potassium levels, your doctor may order blood tests to monitor electrolytes — especially if you have kidney disease or take certain medications.

Important Safety Notes

• Not safe during pregnancy
• Usually paired with contraception if pregnancy is possible
• Requires medical supervision

Always speak to a doctor before starting or stopping spironolactone.

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When Should You Consider Spironolactone?

You might be a good candidate if:

• You're an adult woman with persistent acne
• Breakouts follow a hormonal pattern
• Topical treatments haven't worked
• You want an alternative to long-term antibiotics
• You're not pregnant and can use reliable contraception

Spironolactone is often used alongside:

• Topical retinoids
• Benzoyl peroxide
• Gentle skincare routines

It can also be an alternative for patients who want to avoid isotretinoin (commonly known as Accutane).

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What If Spironolactone Doesn't Work?

While spironolactone is effective for many, it doesn't work for everyone. If acne persists, doctors may consider:

• Adjusting the dose
• Adding topical retinoids
• Hormonal birth control
• Isotretinoin for severe cystic acne
• Evaluating for PCOS or endocrine conditions

Persistent, painful, or scarring acne should always be medically evaluated. Delaying treatment can increase the risk of permanent scars.

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Practical Steps You Can Take Right Now

While considering spironolactone, you can support your skin by:

✅ Simplifying Your Routine

• Use a gentle cleanser twice daily
• Avoid harsh scrubs
• Choose non-comedogenic products

✅ Being Consistent

Acne treatments take time. Changing products every two weeks can worsen irritation.

✅ Avoiding Over-Treatment

Too many active ingredients can damage your skin barrier and make acne worse.

✅ Tracking Patterns

Note:

• Cycle timing
• Stress levels
• New medications
• Dietary changes

This helps your doctor tailor treatment.

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When to Seek Medical Care Urgently

Acne itself is rarely life-threatening. However, you should speak to a doctor promptly if you experience:

• Severe, sudden acne with other hormonal symptoms
• Rapid facial swelling or allergic reaction to medication
• Signs of high potassium (muscle weakness, abnormal heart rhythm) while on spironolactone
• Severe depression or mood changes

If something feels serious or unusual, don't wait — seek medical advice.

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The Bottom Line

If your acne won't clear, it's not a personal failure. Persistent breakouts usually mean the underlying cause hasn't been fully addressed.

For many women, spironolactone is a medically approved, evidence-supported treatment that targets hormonal acne at its source. It reduces oil production, decreases cyst formation, and can significantly improve skin over time.

That said:

• It requires a prescription
• It needs medical monitoring
• It's not appropriate for everyone

Start by understanding your acne pattern. Consider using a free online symptom check for Acne Vulgaris (Acne) to organize your symptoms, then schedule a visit with a healthcare professional to discuss whether spironolactone is right for you.

Clearer skin is possible — but it starts with the right diagnosis and a treatment plan guided by a qualified clinician.

If you have severe symptoms, medication side effects, or concerns about underlying hormonal conditions, speak to a doctor promptly. Your skin is important — but so is your overall health.