Brief Answer:
Detailed answer and explanations given below

Detailed Answer:
Hello,

Oral contraception may help with acne in some patients but as you have been experiencing side effects can happen.
Another medication to try for acne that was responding to oral contraception is spironolactone 50-100 mg orally daily for 6-12 months. Spironolactone is a diuretic (medication that stimulate urination) but has also antiandrogenic properties that may make it effective in acne.

Every treatment for acne should be tried for at least 2-3 months before you can say it is not effective, the same with spironolactone, give it some time to see its effect.
If no improvement in 2-3 months with spironolactone then you will need to try oral isotretinoin. Generally all types of acne respond to this drug. The downside of it is that it may as well have some side effects and needs regular monitoring of some blood tests while you use it and you need to have sure methods of contraception because if a woman gets pregnant while using it, there is high chance of problems with the baby (teratogenic effect).

The treatment for acne is generally guided by the severity of it. You will need to talk with your doctor and determine the severity of your acne because if it is mild to moderate, local treatments with combination of creams (benzyl peroxide, clindamycine cream and isotretinoin cream) might be effective, in some cases oral antibiotics can be added as well.

Meanwhile try to use antibacterial soap daily to keep your skin clean and try to not rub your face too much as this might open white dots into black dots and worsen acne.

If you have severe acne and you have irregular menstrual periods, maybe your doctor needs to check you for PCOS, a condition that might cause acne that sometimes are difficult to treat.

To conclude i would say:
- depending on the severity of acne, the treatment is decided. If your acne is mild to moderate then you may benefit from combination of local creams with benzoyl peroxide, clindamycine and isotretinoine and oral antibiotics (doxycycline).
- if your acne is not improved by these (local combined creams and oral antibiotics) then the next step is oral contraception but because you can not use it spironolacton is a good alternative.
- almost all acne types respond to oral isotretinoin but special caution to prevent pregnancy is needed (maybe adding use of condoms while you have mirena IUD) and regular blood tests may be needed as well as side effects are possible.
- good skin care with antibacterial soap and avoiding rubbing skin or picking the pimples are important.


Hope I have answered your query. Let me know if I can assist you further.

Regards,
Dr. Antoneta Zotaj,
General & Family Physician

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