I have adult acne. Can lifestyle changes help me control it?

Question

Hello doctor,

I am a 32-year-old female with persistent adult acne, oily skin, and some facial hair. Laboratory tests show high DHEA-S 410 µg/dL, testosterone 70 ng/dL. Periods are irregular, and my dermatologist suspects PCOS. I started Spironolactone 50 mg daily, considering hormonal contraceptives. I have a few concerns -

How effective is spironolactone alone for long-term acne control?
Will regulating hormones resolve acne or just temporarily reduce lesions?
Which skincare routines or ingredients work alongside medications without irritating?
Are there blood tests or imaging to monitor hormone therapy safely?
Will lifestyle changes help improve hormonal acne in the long term?

Kindly help.

Answer 1

Hello,

Welcome to icliniq.com.

I read your query and can understand your concern.

So, your symptoms and laboratory findings, like elevated DHEA-S (dehydroepiandrosterone sulfate), mildly high testosterone, irregular cycles, acne, and facial hair, do fit well with polycystic ovary syndrome (PCOS). Spironolactone is effective for hormonal acne, especially at doses of 50 to 100 mg daily, and many women see significant improvement within three to six months.

However, it usually controls acne rather than curing it, meaning acne may return if treatment is stopped unless the underlying hormone imbalance is also addressed. Combining Spironolactone with a hormonal contraceptive pill is often more effective, as contraceptives regulate cycles, lower androgens, and prevent the menstrual irregularities and pregnancy risks associated with Spironolactone.

For skincare, a gentle noncomedogenic cleanser, daily sunscreen, and targeted ingredients such as Benzoyl peroxide (to reduce bacteria), Salicylic acid (to clear pores), and topical Retinoids (like Adapalene or Tretinoin to regulate cell turnover) can work well alongside medications, provided they are introduced gradually to avoid irritation.

Monitoring for Spironolactone usually includes checking potassium and kidney function at baseline and periodically, especially if higher doses are used.

For PCOS, do pelvic ultrasound and periodic metabolic laboratory tests (glucose, lipids, HbA1c) since PCOS increases cardiometabolic risk.

Finally, lifestyle changes such as maintaining a healthy weight, a balanced diet with reduced refined carbohydrates, and regular exercise can help improve insulin sensitivity, reduce androgen levels, and support long-term control of both PCOS and hormonal acne.

I hope this helps you. Feel free to contact me at any time. I am always here to help.

Thank you and take care.

Regards.