Enter the dermatologist. This one of the easiest things to treat in my practice, and I see more adult female acne patients, than I do see teenager acne patients! Don’t waste time running from salons and spas to spending tons of cash on over-the-counter treatments that don’t work.

My favorite medication for this condition is spironolactone. Many of my patients consider it the “miracle drug”. When used at low doses such as 50-150mg per day, the androgen hormones are not cycling so rapidly which in turn causes the cystic acne, especially located on the lower cheeks, jawline and neck regions. Interestingly, spironolactone is an older drug that has been used since the 50s but at different doses, it acts by a completely different mechanism of action. Thus, it is as though it is two completely different drugs, depending on the dose, but it has the same name. I have even had patients come to me after leaving the pharmacy, and the pharmacist is telling them that this drug is “unsafe” or it “lowers blood pressure”. That is absolutely not true at all. The only negative aspect of spironolactone dosing at these levels is that a woman should never get pregnant while medicating with this due to ambiguity in the fetal genitalia.

I prefer spironolactone over an oral antibiotic since women with adult acne will likely have this condition at least until menopause, and by starting and stopping an oral antibiotic over many years, we are contributing to drug resistance and decreased microbial response. Spironolactone is completely and totally safe to use on an ongoing basis once the correct dose is determined by the treating physician. I like to check a potassium level when my patients are at the 150mg dosing, but I have yet to see an elevated potassium level in my patient population. I will repeat myself, I consider  completely safe to use on an ongoing basis for the treatment of adult female acne!

Lastly, I like to incorporate topical medications such as retionoids, topical antibiotics and topical anti-inflammatory agents to better resolve and control the adult acne. Added benefits such as anti-aging with use of topical retinoids are a plus as well. Thus, there is hope for adult female acne. In fact, if you are reading this and it sounds like you are dealing with this issue, schedule an appointment to see a dermatologist!

Authored by Dr. Ellen Turner, Dermatology Office of Dr. Ellen Turner, M.D., Dallas, TX