I have acne with high DHEA-S. Can I treat it without OCPs?

Question

Hello doctor,

I am 29 and dealing with stubborn adult acne mainly on my chin and jaw. My dermatologist said it might be hormonal, and my laboratory tests showed DHEA-S of 375 and testosterone 61 ng/dL.

I was started on Spironolactone 50 mg daily, but I am nervous about long-term side effects. Does this dose usually help with hormonal acne, or do people often need birth control too? I would prefer avoiding OCPs if possible.

I would like to know about the following:

Should I be tested further for PCOS?
Are there topical skincare ingredients that work well with hormonal acne, like Azelaic acid or Niacinamide?
How long until I see skin improvement?

Please suggest.

Answer 1

Hello,

Welcome to icliniq.com.

I understand your concern.

Adult acne concentrated on the chin and jawline, especially with elevated DHEA-S (dehydroepiandrosterone sulfate) (375) and testosterone (61 ng/dL), strongly suggests an androgen-driven or hormonal component.

Spironolactone 50 mg daily is a common starting dose, and many patients respond well. However, dermatologists often increase the dose gradually up to 100 to 150 mg (milligram) if tolerated and needed. It can take two to three months to start seeing noticeable improvement, so patience is key.

Birth control pills are often used alongside Spironolactone for added hormonal regulation. However, if you are aiming to avoid OCPs (oral contraceptive pills), Spironolactone alone can still be very effective for many.

However, given your androgen levels, it is reasonable to screen for PCOS (polycystic ovarian syndrome), especially if you have irregular periods, ovarian cysts, or signs like hirsutism or weight fluctuations.

As for skincare, yes, Azelaic acid (great for inflammation, pigmentation, and clogged pores), Niacinamide (for oil control and calming), and Salicylic acid or Benzoyl peroxide (if tolerated) work synergistically with hormonal acne treatments.

I suggest you avoid overly stripping products and always pair actives with a good moisturizer and sunscreen.

With consistent oral and topical treatment, most people see steady progress by eight to 12 weeks, though it may take longer for full results.

I hope this helps.

Thank you.