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Ask Dr. D. Love Your Own Question
Dr. D. Love
Dr. D. Love, Doctor
Category: Dermatology
Satisfied Customers: 19313
Experience:  Family Physician for 10 years; Hospital Medical Director for 10 years.
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I have been taking Spironolactone acne

Customer Question

Hi, I have been taking Spironolactone for my acne for more than 3 months but my acne is actually getting worse! I am really depressed about it. My Dermatologist told me to keep going but I feel I will stop, can I have some recommendations?
Submitted: 1 year ago.
Category: Dermatology
Customer: replied 1 year ago.
I had a blood tests that shows that I had "a slightly high sex binding globulin but low testosterone level. The first one, according to my dermatologist, goes with the low testosterone, i.e. when testosterone goes low, sex binding globulin goes high. So they provide similar information." However, never had so many spots since taking Spiro! :-(
Customer: replied 1 year ago.
The only time I had clear skin was when I took Yasmin or Dianette. So I was thinking that the oestrogens were was I needed to keep the acne away. Anyway, dermatologist told me to keep taking Spiro. Thank you for your advices. I have been patient but getting uglier every day, really hard to wait longer.
Customer: replied 1 year ago.
Ps: My acne was mainly on my chin - so we thought it was hormonal, especially because I have diagnosed with Polycystic ovaries 6 years ago BUT since taking Spiro, I have been having spots everywhere! Cheeks, forehead, areas I never had spots before! I lead a very healthy life and my current contraception is a copper coil. Thank you!
Expert:  Dr. D. Love replied 1 year ago.
Hello from JustAnswer.What dose of spironolactone are you taking?What creams have you tried thus far?Have you been treated with any medicines for the polycystic ovaries?
Expert:  Dr. D. Love replied 1 year ago.
I had asked for some additional information and have not heard back. There are several options to consider in this situation, but let me make some comments based on the current information. First, if you are on a lower dose of spironolactone, it would be an option to increase the dose to the maximum dose of 100 mg per day. Second, certain treatments for polycycstic ovaries can also help with the metabolic symptoms that can occur with polycystic ovary syndrome, including acne. The treatment that has been most effective is metformin, which is primarily a drug used for diabetes, but has been shown to help polycystic ovary syndrome, including reducing acne associated with polycystic ovary syndrome. There are some other anti-androgen that can be used, including the progestin in the Yasmin and Dianette, which may still be considered, even if you are using a copper coil. This is not commonly done, because one of the advantages of the copper coil is the avoidance of hormonal treatment, but it can be considered. There also is a stronger medicine available, called flutamide. It has more side effects, so is also not commonly used, but would be an option in certain cases. There are also a wide variety of other medicines that can be fdirectly used for acne, but you may have already been tried on these options, so it would require knowledge of what medicines have been tried to say whether there is an option that is still available. Of these options, I would usually try the maxiumum dose of spironolactone first and the metformin second, although this would obviously depend upon whether this has already been tried. If I can provide any additional information, please let me know.
Customer: replied 1 year ago.
Dear Doctor Love,
Thank you for your reply. I am based in the UK, hence the time difference in my reply.
I have tried creams like Duac, Benzoyl Peroxide, Epiduo and others that have not make much difference.
I have never tried any medecines for polycysitic ovaries directly.
Now, I am really upset with my Dermatologist as it appears my blood test for my hormones is wrong since they put me on the laboratory test as "Male"! I saw this yesterday after writing to you. Therefore, my testosterone and sex binding globulin levels may be fine for a woman.
I had the test done 3 years ago and the ONLY thing that was slightly high was my LH. (12.7 iu/l when max healthy range is at 12.6)
The results 3 years ago were for Testosterone: 0.6nmol/L (healthy range on paper was between 0.10 and 1.80) and my sex binding level was: 69.4nml/L (healthy range on paper was between 32 and 128).
NOW in 2016, it shows my testosterone as <0.4 nml/L(!) (healthy range on paper between 7.6 and 31.4) and sex binding 75nml/L (healthy range on paper 16-55)
I have no idea what the lab did wrong but it does not seem right at all.
I am now waiting for the laboratory to come back to me. I have decided to stop today Spriro as I have been taking it for more than 4 months now and it is making my skin MUCH worse. I started on 50mg/day for 3 months then dermato put me at 100mg/day. NO improvement whatsoever. I told my Dermato many times I had breakouts, was getting worse, he only told me to "keep going".
Yasmin/Dianette were the only things that helped my acne. Would you know why? I know Yasmin has about 25mg spiro in it, so it must mean the OTHER agents are helping. May I lack oestrogens? Should I see an Endocrinologist? Thank you for your advices. I will definitely sue my dermatologist if negligence has been done. A lot of people don't seem to understand yet how acne can wreck life and confidence.
Kind regards, Audrey
Customer: replied 1 year ago.
I have added my two tests (2013 and 2016) for you to see. Thank you.
Expert:  Dr. D. Love replied 1 year ago.
Yasmin and Dianette are good for acne because of the progestin component, not the estrogen component. The progestin component acts as an anti-androgen, as I noted above. As for the LH of 12.7, any result that is only 0.1 above the upper limit of the normal range is still normal. The normal range is a statistical determination - two standard deviations above and below the mean. If you recall any previous statistics class, you may recall that two standard deviations above and below the mean will encompass 95% of the normal population. But this also means that 5% of normal people will have results that are just outside the normal range. So, an LH result of 12.7 is still normal. However, as the lab report notes, an LH that is high compared to the FSH is suggestive of polycystic ovary syndrome, even if both are in the normal range. It is not considered diagnostic, but since you are already diagnosed with polycystic ovaries, this finding is not surprising. The error on gender identification on the lab will not affect the results, only the normal ranges and the accuracy of whether a result will be labeled as abnormal. Since you have already been tried on the maximal dose of spironolactone, I would usually next try to use metformin to treat the polycystic ovary syndrome. This is more often treated by an OBGyn, although an Endocrinologist can also help with treatment.
Customer: replied 1 year ago.
Dear Dr Love,
Many thanks for this explanation. I understand better.
I will definitely see an endocrinologist and will consider taking Yasmin again.
Kind regards ***** ***** a good day,
Expert:  Dr. D. Love replied 1 year ago.
You are most welcome. Please remember to provide a positive rating so that I am credited for assisting you.