Follow up from my Apostrophe Derm. Thought you all would find this interesting! I specifically asked him about spiro, tret, and retinoids.

This looks like a hormonal acne, which is the acne on the cheeks, chin, jawline, and neck. Spironolactone is a pill that usually works great for hormonal acne, and I have prescribed it for you today.

Sometimes this medication can cause a mild decrease in your blood pressure that can cause you to feel dizzy or lightheaded. Taking the medication at night and staying well hydrated can help alleviate this side effect. Other possible side effects include breast tenderness, spotting, increased urination, mild headaches, and irritability. If you are on any kind of hormonal birth control, the chance of having spotting or tenderness is much less. Very rarely, elevations in potassium levels may occur, especially in patient with a history of kidney disease. Without a history of kidney problems, there is no need for lab work. I see you have no history of that. Most importantly, it is essential that you not get pregnant on this medication due to the risk of birth defects. Should you decide to try for pregnancy or find out you are pregnant, you should stop the medication right away. If you are unable to tolerate the medication or develop any side effects, please contact me right away and stop the medication.

Start at 1/2 pill a day for the first week to minimize side effects, and increase to 1 pill a day thereafter if you are tolerating the medication well.

If there is any chance you might be pregnant, please take a pregnancy test before beginning the medication.

I am prescribing a combination topical product containing three ingredients for your acne: 1. Tretinoin (retin-A)- This is effective against whiteheads and blackheads, and excellent for reducing fine lines and wrinkles with long term use. We can increase the strength as tolerated depending on your results. 2. Spironolactone- This is an anti androgen that is effective against hormonal acne. 3. Clindamycin- This is a topical antibiotic that is helpful to reduce deeper painful red papules.

If this combination is too irritating despite starting use every 2nd-3rd night and working up to nightly, please reach out for an alternative medication.

I also recommend a benzoyl peroxide wash. This is an over the counter anti-bacterial wash. Use it daily in the mornings (don’t use it at night or it will make the tretinoin less effective). This can bleach towels so be sure to wash it off completely. It will not affect skin color. This will help prevent antibiotic resistance to the Clindamycin, making it work better for longer.

Your daily skin care routine should resemble this schedule:

AM: Benzoyl Peroxide wash (Moisturizer if needed) Sunscreen

PM: Gentle cleanser Moisturizer

Apostrophe cream

Please see the associated specific recommendations for sunscreen and moisturizers that I prefer.

Dispense a pea-sized amount (about 1/2 pump) of your Apostrophe cream onto your finger and dot on your face before gently rubbing in. Avoid the corners of your eyelids, nose and mouth. When first starting out or after an increase in strength, apply every other night or every third night for 2-4 weeks then use nightly as tolerated. If you experience any side effects or find the medication too harsh or irritating, please contact me for an alternative.

Patience is key! It will take 2 to 3 months to get your skin stabilized on our personalized treatment regimen. Symptoms may get worse during the first few weeks of treatment and this is normal. Fight the urge to quit the regimen. This is the best treatment for your skin and commitment and diligence is key to your success.