Spironolactone vs. Accutane for Acne: 5 Differences to Consider

Dealing with acne can be a frustrating experience. For many people, it’s not just an occasional breakout, but a persistent struggle ranging from stubborn pimples to severe, painful cysts. Fortunately, there are a variety of acne treatments to choose from — but which one is right for you?

The best choice can depend on the type of acne you have, its severity, and your preferences. Spironolactone (Aldactone, CaroSpir) and Accutane (isotretinoin) are two oral medications that you may come across in your search for clearer skin. Both are available with a prescription. But, there are several important differences between them to consider.

1. Accutane is approved for acne, while spironolactone may be prescribed off-label

One major difference between Accutane and spironolactone is that Accutane is FDA-approved to treat acne. And while spironolactone has been used for decades to treat certain types of acne, it’s not actually approved for this use.

Initially approved in 1982, Accutane was the first brand-name isotretinoin product. Today, isotretinoin is available as branded generics, including Accutane, Claravis, and Amnesteem. Generic isotretinoin capsules are also available. Accutane is approved for adults and adolescents ages 12 and older.

Spironolactone is an oral diuretic (water pill) that’s approved for health conditions such as heart failure, high blood pressure, and swelling. But it has been used off-label to treat acne in women since the 1980s. Adults and adolescents may be prescribed spironolactone for acne. But it’s typically avoided for acne in men since it can cause breast enlargement as a side effect. 

EXPERT PICKS: WHAT TO READ NEXT

• What to expect: Spironolactone is a diuretic (water pill) that’s often prescribed off-label for hormonal acne. Because of how it works, spironolactone has some unique side effects — from breast tenderness to irregular menstrual cycles.

• Waiting for results: If you’ve recently started taking Accutane (isotretinoin), it’s natural to wonder when you’ll start seeing clearer skin. But exactly how long does Accutane take to work?

• Your complete guide: Finding the right acne treatment can involve some trial and error. But it helps to know the best place to start based on your acne type and severity. Experts cover which treatments work best for each type of acne.

2. Spironolactone and Accutane work differently to treat acne

Another difference between spironolactone and Accutane is how they work to clear up acne. Spironolactone targets hormones that are thought to cause acne. Accutane reduces oil in your skin, among other effects.

Accutane is a retinoid (a medication related to vitamin A). It’s thought to treat acne in a few different ways. One way Accutane works is by lowering the amount of oil that’s produced in your skin. Too much oil can sometimes lead to clogged pores and acne. Accutane can also prevent pimples by stopping your pores from getting clogged by certain cells in your skin.

As mentioned above, spironolactone is a type of water pill. But when it’s used for acne treatment, spironolactone is known as a hormonal agent. That’s because it works to treat acne by blocking hormones called androgens (such as testosterone) from making too much oil in the skin.

3. Spironolactone and Accutane have different side effects and risks to consider

Because of how they work, spironolactone and Accutane can also cause different side effects. They have different risks to consider, too.

Accutane has a long list of possible side effects, including:

• Dry lips and skin

• Dry eyes

• Thinning hair

• Nosebleeds

• Muscle and joint pain

• Worsening acne

• Sun sensitivity

• Mood changes

• Liver problems

• Skin reactions

Accutane can also harm a growing fetus. You’ll be enrolled in a mandatory program called iPLEDGE to manage this risk. If you’re able to become pregnant, the iPLEDGE program requires you to take pregnancy tests before starting Accutane and again every month during treatment. You’ll also need to take two forms of effective birth control while you’re taking the medication.

As a water pill, spironolactone removes fluid from your body. So, you may notice that you’re urinating more often while taking it. Other potential spironolactone side effects include:

• Headache

• Dizziness

• Irregular menstrual cycles

• Breast tenderness

• Lower sex drive

• Fatigue

• Nausea

• Diarrhea

• Higher potassium levels

Most people taking spironolactone for acne don’t need regular blood tests. But your prescriber may recommend them if you have risk factors for high potassium. And similar to Accutane, spironolactone isn’t recommended during pregnancy. But, you don’t need to enroll in a program or take monthly pregnancy tests to fill your prescription.

4. Accutane can be an effective option for severe acne, while spironolactone may be helpful for hormonal acne

When choosing the best treatment for your acne, it’s important to consider your acne type and severity. For example, spironolactone can be particularly helpful for hormonal acne. Accutane, on the other hand, is typically reserved for severe acne that hasn't responded to other treatments or is causing permanent scarring.

Hormonal acne is a type of acne that usually happens around the time of your menstrual cycle, during menopause, or at other times when your hormones may be fluctuating. Spironolactone can help hormonal acne by targeting hormones that make acne worse. For best results, your dermatologist may have you combine spironolactone with other acne treatments.

Accutane is recommended for acne that’s severe — including hormonal acne. It’s reserved for use when other oral or topical treatments haven’t worked well. Accutane is very effective, but it has many potential risks and side effects compared with other options.

Many things have been linked with acne, including genetics, bacteria, and hormones. Diet, stress, and sleep quality are also known triggers for breakouts. Medications are another potential culprit. Your dermatologist can help you figure out what might be causing your acne and how best to treat it.

5. Spironolactone is taken long term, while Accutane is taken for a short period of time

With both spironolactone and Accutane, it can take a few weeks before you notice an improvement in your acne. But how long you’ll need to take them can be different.

A typical course of Accutane usually lasts 4 to 5 months (sometimes less), which is sufficient for most people to see results. But if needed, a second course may be recommended at least 2 months after the first course. Accutane often clears the skin for a long time. And for many people, their skin stays clear permanently.

There isn’t a recommended amount of time that you should take spironolactone. In general, your dermatologist may have you continue it as long as it’s helping your acne and you’re not having side effects. One small study followed women who took spironolactone to treat acne for up to 8 years. Researchers found that long-term use appeared to be safe.

Be sure to attend all of your follow-up appointments with your dermatologist. That way, they can make sure your acne treatments are safe and working well for you.

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Written by:

Kristianne Hannemann, PharmD

Kristianne Hannemann, PharmD, is a licensed pharmacist in California. She has been a retail pharmacy manager and staff pharmacist for over 7 years and has contributed drug information content to different health companies.

Edited by:

Alyssa Billingsley, PharmD

Alyssa Billingsley, PharmD, is the director of pharmacy content for GoodRx. She has over a decade of experience as a pharmacist and has worked in clinical, academic, and administrative roles.

Reviewed by:

Maria Robinson, MD, MBA

Maria Robinson, MD, MBA, is a board-certified dermatologist and dermatopathologist who has practiced dermatology and dermatopathology for over 10 years across private practice, academic, and telehealth settings. She is a fellow of the American Academy of Dermatology and the American Society of Dermatopathology.

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