Spironolactone-Not a Cure for Acne- And Here's What Happens When You Stop

Acne can be a frustrating experience, with many women turning to spironolactone for temporary relief from hormonal breakouts. However, this journey often doesn’t conclude with clear skin. After stopping the medication, many find themselves facing a troubling phenomenon known as rebound acne. What causes this to happen? In this post, we will explore the reasons behind rebound acne, its impact on hormonal health, and how to heal naturally through a functional medicine approach.

Understanding Spironolactone and Its Role in Acne Treatment

Spironolactone is a diuretic primarily used to treat conditions such as high blood pressure and fluid retention. It has also gained recognition in dermatology as an off-label treatment for hormonal acne. By blocking androgens—male hormones that contribute to acne—spironolactone helps regulate oil production in the skin. In fact, studies indicate that about 60-80% of women with hormonal acne experience significant improvement while on this medication.

But here’s the kicker: it doesn’t fix the root cause of hormonal imbalance. It simply suppresses symptoms while you’re on it. Spironolactone is not a permanent solution. The hormonal imbalances that contribute to acne may remain. When the medication is discontinued, some individuals may experience an increase in acne symptoms.

Spironolactone Long-Term Use ≠ Long-Term Safety

While spironolactone is generally considered safe in the short-to-medium term, long-term use raises several concerns:

• Electrolyte imbalances: It can cause high potassium (hyperkalemia), potentially disrupting the heart's electrical signals, especially in people with other comorbidities or poor kidney function

• Menstrual Irregularities & Breast Tenderness: Due to its effect on sex hormones.

• Possible hormone balance disruption: Chronic suppression of androgens may disrupt ovarian communication and cause estrogen dominance, low libido, fatigue, etc.

• Pregnancy contraindications: It’s teratogenic — if someone becomes pregnant while on it, it can cause feminization of a male fetus. Definitely not safe for TTC.

The Mechanism Behind Rebound Acne

When spironolactone is stopped, the body can undergo significant hormonal shifts. A common outcome is a surge in androgens, leading to rebound acne. This condition arises because the sudden absence of spironolactone’s effects allows for increased oil production and a rise in acne lesions.

Think of spironolactone as a dam holding back hormonal fluctuations. When you remove it without addressing the underlying terrain, those unbalanced hormones (like elevated androgens, insulin resistance, or estrogen dominance) can flood back in, and the sebaceous glands respond quickly.

Key reasons for post-spironolatone acne flares include:

• Hormonal dysregulation was never corrected (e.g., PCOS, post-pill acne, chronic stress)

• Sudden withdrawal without tapering

• Underlying inflammation or gut dysbiosis is still present

• Skin’s sebaceous glands compensate for the suppression

For example, if a client who had clear skin during her spironolactone treatment saw a resurgence of acne within two weeks after she stopped taking the medication suddenly, resulting in dozens of new acne lesions. Such experiences highlight the potential challenges of discontinuation.

Insights Into Hormone Imbalances

Understanding the dynamics between spironolactone and hormone imbalances is crucial for those facing acne after stopping the medication. Hormonal changes, particularly during and after treatment, can disrupt the endocrine system, leading to skin problems.

Many women, particularly those between the ages of 20 and 40, navigate various hormonal changes due to factors such as menstrual cycles, pregnancy, and conditions like polycystic ovary syndrome (PCOS). For instance, almost 70% of women with PCOS experience acne, which can further complicate the situation for those who have just ceased using spironolactone.

Natural Healing Through a Functional Medicine Lens

If you are experiencing rebound acne after stopping spironolactone, a functional medicine approach can help you heal. This method focuses on identifying and addressing the root causes of acne, rather than just managing its symptoms.

In my practice, I always ask: Why is the body overproducing androgens in the first place?

That might mean looking deeper into:

• Adrenal health and cortisol patterns

• Blood sugar dysregulation (hello insulin resistance)

• Liver congestion impacting hormone clearance

• Nutrient deficiencies (like zinc, B6, Vitamin D)

• Chronic inflammation and gut-skin axis dysfunction

• Mold, toxins, or microbiome imbalances

Suppressing oil production doesn’t solve these systemic patterns—it just quiets the symptoms.

How to Prevent a Rebound Breakout Holistically

If you’re thinking of coming off spironolactone (or already have), here’s what I recommend for a smoother transition:

1. Taper Slowly

Never go cold turkey unless medically necessary. A gradual reduction allows your skin and hormones to recalibrate more gently.

2. Support Hormonal Detox Pathways

Upregulate liver function with cruciferous vegetables (like broccoli sprouts). A gentle liver support protocol can make a big difference.

3. Balance Blood Sugar

Prioritize protein, fiber, and healthy fats at every meal to reduce insulin spikes, which drive androgen production.

4. Heal the Gut by Testing and Not Guessing

The gut-skin-hormone triangle is real—intestinal inflammation and imbalances that can amplify systemic inflammation and hormone imbalance.

5. Add Hormonal Adaptogens

Botanicals like spearmint tea, peony & licorice, and reishi mushroom can support the endocrine system naturally.

6. Use Topical Support Wisely

This is not the time for aggressive topical treatments. Focus on barrier-repairing, anti-inflammatory skincare. We carry a botanical-based adaptogenic skin care line that addresses the root of acne.

6. Mind Body Connection - Trust, Let Go, Be Open

The emotional toll of dealing with acne is significant. Engaging in practices that promote mental well-being, like journaling or mindfulness meditation, can help ease anxiety related to skin issues. Research suggests that mindfulness can reduce anxiety by as much as 30%, promoting a better emotional state while dealing with skin concerns.

When to Seek Professional Guidance

A qualified provider can offer personalized guidance on hormone testing, dietary adjustments, and tailored skincare routines. If rebound acne continues or worsens despite these treatments, it may be time to consider revisiting dermatological options or exploring other holistic treatments.

A Word to My Clients

If you’ve been on spironolactone and are navigating the next phase, know this: post-spiro acne is not a failure. It’s an invitation. Your body is speaking—let’s listen with compassion, not punishment.

With the right support, you can balance your hormones, heal your skin, and transition off medications if that’s your goal. I work with patients every day who do just that, and their skin often looks better than it ever did on meds.

Need help designing a transition plan off spironolactone? Book an Initial Functional Skin Evaluation at Integrative Aesthetics Boston.

Let’s rebuild balance—internally and externally.

Love & Health,

Noemí Paola, Corrective Skin Care Master & Functional Medicine Practitioner

@Integrative Aesthetics Boston