Spironolactone vs. Tretinoin for Acne: 5 Differences to Consider

Fighting acne can be challenging. Many over-the-counter options exist, but sometimes a prescription medication is necessary. Two medications dermatologists frequently prescribe to treat acne are spironolactone (Aldactone, CaroSpir) and tretinoin (Retin-A, Altralin, Altreno).

Both medications are effective for treating acne. But they work in different ways and can cause different side effects. We’ll review five key differences between spironolactone and tretinoin.

1. Spironolactone and tretinoin come in different dosage forms

One big difference between spironolactone and tretinoin is their dosage forms. Spironolactone is an oral medication, while tretinoin is applied to the skin.

Spironolactone is available as tablets (Aldactone) and an oral suspension (CaroSpir). Spironolactone isn’t FDA approved for acne. But it’s sometimes prescribed off-label to treat hormonal acne in women. The typical dosage for acne is 25 mg to 200 mg by mouth daily.

Tretinoin is available as a few topical products. They are applied directly to the affected skin once a day. For treating acne, tretinoin comes as a cream and a gel (Retin-A). Retin-A Microgel is a gel that can help lessen side effects, such as redness and burning. Tretinoin also comes as a lotion (Altreno).

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2. Spironolactone and tretinoin work differently for acne

Another difference between spironolactone and tretinoin is how they work to treat acne. Spironolactone targets hormones that can contribute to acne. Tretinoin is a retinoid that has a few effects on the skin.

Sometimes, hormones can be behind breakouts. Too much of certain hormones can make the skin produce too much oil, which can clog pores. This is where hormonal treatments such as spironolactone may be beneficial. They treat acne by slowing down production of hormones called androgens in your body.

Tretinoin belongs to the drug class known as retinoids. These are chemicals formed from vitamin A. Tretinoin treats acne in a few ways:

• Promotes the turnover of skin cells

• Unclogs pores

• Lowers inflammation

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Because of how it works, tretinoin is also useful in reducing the appearance of wrinkles and helping to clear up dark spots. For wrinkles, tretinoin is sold under the brand name Renova.

3. Spironolactone and tretinoin may work better for different types of acne

Spironolactone and tretinoin are both effective at treating acne. But when you’re considering your treatment options, the type of acne you have matters.

As mentioned, spironolactone is sometimes prescribed for hormonal acne in women. This type of acne is caused by fluctuating hormones. If you experience breakouts during your period, you might have hormonal acne. It’s typically used in combination with other acne treatments for hormonal acne.

Tretinoin is effective at treating comedonal acne. This type of acne happens when your skin pores are clogged. Many things can lead to clogged pores, including oily skin, bacteria, and dead skin cells not shedding. Tretinoin helps your skin shed dead skin cells and unclogs pores.

Your dermatologist can determine the cause of your acne and guide you to the best treatment. In some cases, they may prescribe both spironolactone and tretinoin to treat your acne.

4. Spironolactone and tretinoin can cause different side effects

Because spironolactone and tretinoin work differently, they also have different side effects. Spironolactone is taken by mouth, so its side effects tend to affect different parts of your body. Most side effects from tretinoin are around the sites where you apply it on your skin.

Spironolactone was developed as a diuretic (“water pill”) to get rid of excess fluid from the body. For this reason, and because it affects certain hormones, it can cause many side effects. These include:

• Dizziness

• More frequent urination

• Breast tenderness

• Low libido

• Headache

• Menstrual irregularities

Spironolactone can also cause high blood potassium levels. But this isn’t usually a concern if you’re in good health. And since it can harm a growing fetus, spironolactone isn’t a safe option if you’re pregnant.

The most common tretinoin side effects are skin related. These include:

• Dry or peeling skin

• Skin redness

• Irritation

• Increased sensitivity to the sun

Side effects, such as redness and irritation, typically appear during the first 2 weeks of starting tretinoin. For many people, this gets better with time. To minimize side effects, be sure to apply tretinoin properly, use a good moisturizer, and protect your skin from the sun. And as with spironolactone, it’s best to avoid tretinoin during pregnancy.

5. Tretinoin may work faster for acne than spironolactone

With both medications, it can take some time before you notice changes in your skin. But in some cases, tretinoin might work faster than spironolactone.

For some women, it can take time to find the right dose of spironolactone that works well to treat their acne. You might notice positive skin changes within a few weeks of starting spironolactone. But it can take 24 weeks or more to see the full effects.

With tretinoin, you might notice improvement in your skin as soon as 2 weeks after starting treatment. But it could take 12 weeks before you see the full benefits.

If you’re not seeing the results you’d like, follow up with your dermatologist. They can tell you what to expect with your acne treatment.

Can you use spironolactone and tretinoin together for acne?

Yes. Your dermatologist may recommend taking spironolactone and tretinoin together to treat your acne. They belong to different drug classes and work differently. So combining the two might work better than using one by itself.

In one small study, researchers found that some women who took spironolactone together with a retinoid (like tretinoin) had a better response compared with those taking a retinoid alone.

Talk with your dermatologist about the different acne treatments available. They can help you come up with a plan to treat your acne that may include more than one medication.

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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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