The Big Guns: Spironolactone and Accutane

I thought about it a bit and decided that even though I oppose putting anything other than a vitamin in my body, there are some of you out there who want to know more about more potent acne medications. I recognize this need so I’ll give you as much information as I am able to.

I decided that based on my avoidance of them, the two big ‘acne’ drugs are spironolactone and Accutane. Spironolactone treats acne by inhibiting the production of androgens in the body while Accutane works by preventing the formation of sebum.

Each drug takes a completely different approach to curing acne and as such they each have varying results and varying side-effects.

Spironolactone for acne

Spironolactone is an anti-androgen drug and is used mainly to treat hormonal acne by inhibiting androgen receptors from absorbing androgen. Androgen is usually considered a ‘male’ hormone although it is present in both males and females.

Estrogen in women is supposed to conterbalance androgen levels, but sometimes women produce too many androgens for this to happen and as a result, women get acne.

Spironolactone is also used as a potassium-sparing diuretic, which means that while it causes the kidneys to excrete more salt and water, it promotes the retention of potassium. This is important to remember because if you are taking spironolactone for acne and not for health issues related to low potassium levels, you can develop hyperkalemia (high blood potassium).

If you’re familiar with basic physiology, you’ll know that potassium plays a huge role in generating electrical signals within the body, especially those used in the central nervous system and cardiovascular system.

Excessive blood potassium levels can cause abnormal electrical heart rhythms and severe hyperkalemia can cause cardiac arrest and death.

Okay, now that I’ve scared you half to death, let me say that the dose you’ll be taking for acne is significantly lower than what you would be taking for other health issues and you can monitor your potassium intake. For example, don’t take a multivitamin that contains potassium.

Used as an acne treatment, the dosage prescribed is usually 50mg taken twice a day. Some people see results with as little as 25mg twice a day.

Because this drug will cause retention of potassium in your blood, have your potassium levels checked regularly while using it. Actually, when prescribed spironolactone, your physician will call you in about two weeks into the treatment precisely for this reason.

I’ve looked at dozens and dozens of reviews on spironolactone used for acne and I’ve noticed two trends. One, women seem to be extremely happy with their results as far as acne is concerned and two, almost all of these women have experienced a weight gain averaging around 7 pounds.

The ironic thing is that while women should be looking at the potential development of hyperkalemia, the main cause for quitting the treatment seems to be the weight gain.

I’ll let you guys weigh it out for yourselves. But just so that you know, the side effects of spironolactone used in the treatment of acne have not been historically severe enough for people to quit the treatment and many women have seen significant improvement in their complexion.


how accutane worksWhile spironolactone is used for the treatment of hormonal acne or adult acne, Accutane is usually used to treat teenage acne because its method of function focuses on the elimination of sebum. Completely eliminating sebum production is a very invasive treatment method because the mechanisms involved in making facial skin oil are also important in other functions.

Sebum production increases during puberty when you become reproductively mature and the elimination of sebum caused by using a drug like Accutane can cause severe birth defects. Therefore, this should serve as a hint that the production of sebum is an side-effect of something functional in your body.

Since Accutane will completely eliminate production of face oil, side effects include dry mouth and lips, extremely dry skin, nose bleeding, eye-lid swelling, and thinning hair. Remember that sebum forms a protective layer on your skin, so taking it away can cause severe dryness.

Other more dangerous side effects include depression, suicidal thoughts, extreme sensitivity to sun, tingling skin, yellow eyes, diarrhea, concentrated urine, and rectal bleeding among others.

Because the danger to developing embryos is so severe, anyone using Accutane is now required to take a pledge of abstinence or birth-control.

Accutane vs Spironolactone

While Accutane is used to treat teenage acne, Spironolactone is usually recommended for hormonal acne or adult acne. However, teens can be treated with spironolactone if their acne is discovered to be hormonal.

Accutane is by far more toxic and causes dangerous side-effects. This is one of the main reasons that while Spironolactone can be used long-term safely, Accutane should be a short-term treatment.

The predominant common side-effect of Accutane is severely dry skin (including lips, eyes, scalp) while Spironolactone seems to cause weight-gain.

Accutane can have serious side effects. Here's a list of them and their probability.

Accutane can have serious side effects. Here’s a list of them and their probability.

My Advice

First of all find out what type of acne you have. Just because you’re a teen does not mean that your acne is ‘teen acne’. Many times, people assume they have teen acne only to find out that it continues into adulthood and only then is it diagnosed as hormonal acne.

I’ve often wondered about Spironolactone and it surprises me how many times women say that they wish they had discovered it sooner. Therefore, if you are planning to go the pharmaceutical way, I recommend Spironolactone over Accutane.

It seems that every year, Accutane is discovered to be harmful in yet another way and I simply do not trust it. However, I am not an expert, so I recommend consulting one and having them explain the exact function of Accutane and all of the related side-effects.

Please let me know what your experience has been using one of these drugs so that our visitors can benefit from your comments.


1.”Hyperkalemia Causes, Symptoms, Diagnosis, and Treatment – MedicineNet.MedicineNet. N.p., n.d. Web. Nov. 2013.

2. “Accutane Oral : Uses, Side Effects, Interactions, Pictures, Warnings & Dosing – WebMD.WebMD. WebMD, n.d. Web.Nov. 2013.

Paula M

Hey there, I'm Paula, the creator of Acneremovr. I've been fighting acne for the better part of the last 10 years and I've created this site to my learnings during my fight against this condition. I hope you find this helpful and I wish you all best of luck to get rid of acne.

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