Spironolactone not working for acne - how long to wait and what next?

By Dr Magnus Lynch
MA(Cantab) DPhil(Oxon) MRCS FRCP
Consultant Dermatologist & Dermatological Surgeon
Published November 2026

Spironolactone works gradually. Most women notice a benefit after 2 to 3 months of treatment, so it is too early to judge before then. If there has been little improvement after that, it can be combined with other treatments, or other treatments such as isotretinoin or Aviclear laser can be considered.

Give it time

Improvement is usually gradual. Spots in the first few weeks do not mean it is not working.

If it has helped only a little

• The dose can sometimes be increased, with blood tests to monitor potassium.
• Spironolactone can be used alongside topical treatments.
• For some women the combined pill, particularly forms such as Yasmin that also block male hormones, can be used in combination. This is prescribed by your GP.

If it has not helped

Not all acne in women is hormonal. If spironolactone has not helped after a fair trial, isotretinoin is the most effective treatment for moderate or scarring acne.

Related Articles

• What treatments are effective for hormonal acne?
• Spironolactone
• When should I consider isotretinoin for my acne?
• Spironolactone treatment

About Dr Magnus Lynch

MA(Cantab) DPhil(Oxon) MRCS FRCP

I am a London-based Consultant Dermatologist and Dermatological Surgeon. I am highly experienced in skin cancer diagnosis, Mohs micrographic surgery, acne, rosacea, acne scarring and laser treatments. I studied at the Universities of Cambridge and Oxford, and completed my dermatology training and Mohs fellowship at the prestigious St John's Institute of Dermatology. I graduated from medical school in 2003 and have worked exclusively in Dermatology since 2012.

I lead a research team at King's College London investigating the molecular biology of skin cancer. In recent years I have been involved in Media Appearances, including the Channel 5 series 'Skin A&E', where I perform skin surgeries and treat various skin conditions.

My NHS practice is at Guy's Hospital. I consult with private patients at OneWelbeck (near to Bond Street station), on Harley Street and at The Shard (London Bridge). Book A Consultation.