Adult acne: When nothing's working (and you don't want to go on Accutane)

Oh, the joy of a Sightglass macchiato on a rainy day! Now that I'm taking spironolactone, I'm able to enjoy macchiatos without stressing about caffeine and dairy-induced acne.

Happy 2017! The holidays were a whirlwind for me: traveling, spending time with family, and baking up a storm. I hope you enjoyed a wonderful holiday season as well! This year, I'll continue sharing my favorite anti-acne and anti-wrinkle discoveries with you all. Thankfully, 2017's been a pretty acne-free year for me so far. Read on to find out why :)

Within three years of finishing my last course of Accutane, my skin had relapsed to a less severe (but still annoying) version of its natural state: oily, pimply, and full of clogged pores.

I was at a loss for what to do - my usual zit-fighting tactics weren't working for me anymore:

• Topical Aczone helped with oil control and as an acne spot treatment, but not for those stubborn PMS pimples.
• Nightly applications of Retin-A prevented pimples somewhat - but whenever I traveled to a new climate or had PMS, my skin became a greasy mess.
• Going caffeine and dairy-free also helped a little, but I discovered that a completely latte-free lifestyle simply wasn't sustainable for me. Plus, I'm an avid baker who loves using traditional ingredients for her cakes and pies (read: lots and lots of butter). Doesn't help that I got obsessed with making cheesecakes over the holidays!

One of several cheesecakes I baked from this recipe during the holiday season! Full of skin-unfriendly dairy ingredients: cream cheese, brown butter, heavy cream...but the joy I get from baking and eating these cheesecakes is worth the occasional pimple or two. Though I haven't gotten any yet in 2017, thanks to spironolactone.

I was considering a FOURTH course of Accutane, but because my husband and I are planning to have a baby in the next 3-5 years, my dermatologist advised against it (Accutane can cause severe birth defects when ingested in the months leading up to pregnancy). She instead recommended that I try a small daily dose (25 mg) of orally ingested spironolactone, a potassium-sparing pill that prevents your body from absorbing too much salt and keeps your potassium levels from getting too low.

While spironolactone is typically prescribed as a treatment for heart and kidney disorders, it's becoming more common to prescribe it off-label for acne treatment as well.

Sounds scary, but my dermatologist assured me of spironolactone's safety, especially at such a small daily dosage. I'm so glad I listened to her. Here are the benefits I've experienced since I started taking spironolactone a few months ago:

• I'm now able to consume dairy and caffeine in modest quantities without stressing out about zits.
• No more dreaded PMS oiliness or acne.
• I can travel without climate-induced breakouts!

Spironolactone curbs acne by acting as an androgen inhibitor, blocking the effect of male hormones that contribute to acne. It also blocks activity of sebaceous glands, helping with oiliness. It's no wonder that being on spironolactone feels like I'm getting the benefits of Accutane, without the severe side effects.

Pros of spironolactone (for me):

• Smooth, shine-free skin, even leading up to my period and on trips when my skin has to adapt to a new climate.
• Almost completely zit-free (I get a few small pimples monthly, but they come to a head and disappear quickly).
• Able to consume dairy and caffeine without problems.
• Small pill that's safe (only 25 MG once a day, and I check in with my dermatologist regularly).

Cons of spironolactone (for me):

• Didn't see results until about 3 weeks into taking the medication.
• Have to get a blood test every 6 months to make sure potassium levels are normal.
• Slightly more frequent urination (this went away within 2 months).
• Initially irregular periods (this also went away within 2 months).
• The possibility of birth defects if spironolactone is taken while pregnant (but I don't have plans to get pregnant anytime soon, and according to my dermatologist, spironolactone is safe to take leading up to pregnancy - just don't take it while you're pregnant).

Other cons of spironolactone:

• Guys can't take it (can lead to gynecomastia).
• In large doses, it can cause hyperkalemia (but the derm says 25 mg/day should be safe).

Traveling with spironolactone versus traveling without spironolactone was like night and day: When I went to Asia two years ago, I was breaking out like crazy, especially on my forehead and around my jawline, where I tend to get oily. My skin couldn't handle the changes in temperature and humidity. But on this year's Asia trip, spironolactone made acne a non-issue: by the end of my stay in Taiwan, I was barely using concealer anymore. Less time putting on concealer means more time for fun and adventure when I'm traveling! Spironolactone is a game-changer for an acne-prone girl who loves travel as much as I do.

Guzzling a latte at Red Circle Cafe in Taipei from our recent Asia trip. I was engaging in three acne triggers here: travel, dairy, and caffeine – any of these on their own used to be enough to cause a massive breakout, but on spironolactone, I could do all three at the same time without worrying about my skin. Which is a relief because I love trying new cafes and milky coffee drinks when I'm on vacation!

In conclusion - spironolactone combined with a solid topical skincare regimen has helped me curb my adult acne, without having to resort to another course of Accutane. If you're frustrated with your acne like I was, and you tend to break out before you get your period, I highly recommend talking to your dermatologist about spironolactone.