Spironolactone for teens

[crazyforlatin]

Apostrophe, an online acne treatment provider, prescribed 50mg of spironolactone for Dd16. Her acne became worse when we started her on tretinoin through Curology, which I initially attributed to the purging effect. It's been 14 weeks and it's ongoing. 
 

Has anyone had great or not so great stories about this oral medication, spironolactone? I've never heard of it until this week. We're supposed to monitor potassium levels and blood pressure. 50 mg seems high as I've read that some people can start out at 25 mg. There's a topical option, but apparently that doesn't work as well as the oral option. 
 

Dd doesn’t have cystic acne, just clogged pores on forehead, temples, cheeks, but pimples are a daily occurrence at this point. Honestly it was much better prior to tretinoin, but again, people tell us she's going through the purging stage. 

[Mrs Tiggywinkle]

I’ve taken it for acne for 20 years(and to reduce testosterone levels, thanks PCOS).  It’s worked great and even though I’m 40 soon I still break out without it.  100mg is the usual dose for acne. 

[crazyforlatin]

Thanks so much for sharing your experience. Do you happen to know if teens can have pcos? I didn't think about pcos until people mentioned taking spironolactone for it. So sebum overproduction and more facial hair, mainly upper lip comes to mind for DD, but then she doesn’t exhibit other pcos symptoms. 

[RootAnn]

Dd#2's derm offered it as an option. We are ruling out other treatmrnt options first (currently on .5 tretinoin & other topical stuff, going to do 3 months of antibiotics next if topical doesn't work). He thinks most of her issue is hormonal.

[crazyforlatin]

9 minutes ago, RootAnn said:

Dd#2's derm offered it as an option. We are ruling out other treatmrnt options first (currently on .5 tretinoin & other topical stuff, going to do 3 months of antibiotics next if topical doesn't work). He thinks most of her issue is hormonal.

Thanks RootAnn! What antibiotic did your doc suggest? 

[RootAnn]

15 minutes ago, crazyforlatin said:

Thanks RootAnn! What antibiotic did your doc suggest? 

We aren't there yet. Ask me in December!

[RootAnn]

It is funny that when I asked about a temporary trial of antibiotics, the derm says they only allow a short run of them -- acting like I asked for her to stay on them forever. I specifically didn't want her to be on some med for the rest of her life (and they don't mention that the spironolactone would be a perpetual thing when they bring it up). I just wanted to try different options. Apparently, being on a med forever (going off of it when you want to get pregnant) is much preferrable to trying the 3-4 other options that were the go-to options 30 years ago.

[crazyforlatin]

6 minutes ago, RootAnn said:

We aren't there yet. Ask me in December!

Hopefully tret will work out for your Dd. I started using it last year, but I'm no teen so no purging. It's helped me a lot especially since I couldn't go to my esthetician. Thanks to me, Dd's skin is similarly to mine when I was younger.

[kristin0713]

It made my blood pressure dangerously low.  

[crazyforlatin]

3 minutes ago, kristin0713 said:

It made my blood pressure dangerously low.  

I did tell Dd to monitor hers daily if she decides to take it. That is one of my concerns along with the potassium level getting too high.

[RootAnn]

I'm not surprised they didn't mention Isotretinoin (the old accutane), but I am miffed that in this day & age, the doctors seem to go straight to a long-term (years vs months) off-label med for teenagers that just cover up the problem & don't even try to get to the root of the issue.

[crazyforlatin]

5 minutes ago, RootAnn said:

I'm not surprised they didn't mention Isotretinoin (the old accutane), but I am miffed that in this day & age, the doctors seem to go straight to a long-term (years vs months) off-label med for teenagers that just cover up the problem & don't even try to get to the root of the issue.

The dermatologist just offered topical spirolactone, so we're trying that first. She did say that we need drop benzoyl peroxide and Salicylic acid.

[Arcadia]

1 hour ago, crazyforlatin said:

Do you happen to know if teens can have pcos? I didn't think about pcos until people mentioned taking spironolactone for it. 

Teens can have PCOS. The first obgyn I had mentioned it https://pediatrics.aappublications.org/content/145/Supplement_2/S210

[RootAnn]

29 minutes ago, crazyforlatin said:

The dermatologist just offered topical spirolactone, so we're trying that first. She did say that we need drop benzoyl peroxide and Salicylic acid.

Topical! That would be an option, maybe. Keep me posted on how it goes. It is a gel or a cream?

[mmasc]

I tried it as a mid-30s woman with hormonal acne, usually 1-3 cystic ones on my chin monthly. It didn’t work for me. We tried the 25mg but my body just didn’t like it. My blood checked out ok while on it, but the bre@st tenderness was so severe that I couldn’t even get a hug from dh. I also had breakthrough bleeding regularly every month. I tried to take it for quite a few months and then stopped. Two or three years later my new doctor recommended birth control (pill). I had discounted it because I didn’t need “birth control”, but it has been very, very good for me. I did also get on curology about 6 months ago. They put clindamycin, very low tretinoin, and azelaic acid in my formula. It has pretty much put the brakes on any acne that I’d still get monthly. 

Good luck to your dd!

eta: I think the birth control pill really helped control the hormonal acne I was having. I’d still get the occasional spot every month, but I believe the clindamycin in the curology is what pretty much stopped ALL pimples every month. I know everyone is different, but I just wanted to add more info!😊  

 

Edited October 5, 2021 by mmasc

[crazyforlatin]

3 minutes ago, mmasc said:

I tried it as a mid-30s woman with hormonal acne, usually 1-3 cystic ones on my chin monthly. It didn’t work for me. We tried the 25mg but my body just didn’t like it. My blood checked out ok while on it, but the bre@st tenderness was so severe that I couldn’t even get a hug from dh. I also had breakthrough bleeding regularly every month. I tried to take it for quite a few months and then stopped. Two or three years later my new doctor recommended birth control (pill). I had discounted it because I didn’t need “birth control”, but it has been very, very good for me. I did also get on curology about 6 months ago. They put clindamycin, very low tretinoin, and azelaic acid in my formula. It has pretty much put the brakes on any acne that I’d still get monthly. 

Good luck to your dd!

eta: I think the birth control pill really helped control the hormonal acne I was having. I’d still get the occasional spot every month, but I believe the clindamycin in the curology is what pretty much stopped ALL pimples every month. I know everyone is different, but I just wanted to add more info!😊  

 

I do want to try the Spiro/clindamycin topical combo. We did clindamycin on her scalp for folliculitis which didn't work that well when she was 12 yo. Hopefully this combo will help her.

[crazyforlatin]

7 minutes ago, RootAnn said:

Topical! That would be an option, maybe. Keep me posted on how it goes. It is a gel or a cream?

It says cream, combo of Spiro 5% and Clindamycin 1%. I just read that topical is like a booster for the oral Spiro, but we're taking it step by step for now.