Isotretinoin vs spironolactone. When each is appropriate
Patients often ask me which is better, isotretinoin or spironolactone. The honest answer is that it depends. They are not competitors. They do different jobs.
When spironolactone makes sense
Spironolactone works by reducing the effect of hormones on the skin. It is particularly helpful for women with:
- Acne focused around the jawline or lower face
- Acne that flares around periods
- Adult-onset acne that never quite goes away
It can be very effective and is generally well tolerated. The downside is that it tends to control acne rather than cure it. Many people need to stay on it long term to maintain results.
Read more: Our spironolactone service
When isotretinoin is the better option
Isotretinoin works at a deeper level. It reduces oil production, inflammation, and the tendency for pores to block in the first place.
This is why it is usually recommended for:
- Severe acne
- Acne that is causing scarring
- Acne that has not responded to other treatments
Many patients only need one carefully managed course to achieve long-term clearance.
Read more: Our isotretinoin service
Choosing the right treatment
There is no one-size-fits-all answer. The right choice depends on your acne type, severity, medical history, and personal circumstances.
This is why I am always cautious about blanket advice online. Dermatology works best when treatment decisions are individual, not algorithm-led.
Dr Sreedhar Krishna is a UK-based Consultant Dermatologist with a specialist clinical focus on acne, including the safe prescribing and monitoring of isotretinoin and other systemic acne treatments. He is the Chief Medical Officer and co-founder of skindoc, a consultant-led dermatology service providing both in-person and online care. His work centres on evidence-based acne management, patient safety, and maintaining high clinical standards in UK digital dermatology.