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This Acne-Treating Spironolactone Alternative Completely Changed My Skin

In my early 20s, I learned that I had a two-centimeter lump in my right breast, diagnosed as a fibroadenoma. At the time it was discovered, I was on a high-dose birth control pill that did right by me in some ways (clear skin, regular periods), but wreaked havoc in others (by hardening the benign mass that sat in my chest). Years later, when I switched to a low-estrogen pill, my fibroadenoma softened, but my skin suffered. It became greasy, acne-prone and red, scattered with pimples, some deep and cystic that hurt even with the slightest touch. The lower-estrogen birth control dose addressed the larger issue at hand, but my acne had never been worse. While this would be trying for lots of people, it was an especially frustrating ordeal as a beauty editor.

My dermatologist suggested I try oral spironolactone, which has been lauded by many struggling with hormonal acne. But my gynecologist wasn't having it: With my prior medical history of hormone imbalance, it wasn't advisable that I start a medication that might magically clear my acne at the expense of potential side effects like interrupting my cycle or breast health, my doctor advised.

That's when I first heard about Winlevi, sometimes called "topical spironolactone" and an alternative to the ingestible acne treatment that's thought to potentially be just as effective on hormonal breakouts. With the blessing of both my dermatologist and my gynecologist, I started on a strict regimen. And it completely changed my skin.

What Is Winlevi?

"First of all, I wouldn't call it 'topical spironolactone,'" says Dr. Hadley King, a board-certified dermatologist based in New York City. "I've had patients crush their spironolactone tablets and add water to make a paste and put it on their skin, which I do not recommend." (Writer's note: please do not try this.)

Instead, she clarifies that Winlevi is a topical clascoterone, which binds to acne-producing hormone receptors in the skin known as androgens. "Studies suggest that [Winlevi] inhibits the action of androgen receptors on cells in sebaceous glands, reducing sebum production and inflammation," explains Dr. King. By attaching itself to these receptors and ridding them of excess oil and sebum, Winlevi ultimately leads to fewer hormonally-induced pimples.

When I first started applying the topical drug, I noticed that this hypothesis rang true: After a few weeks of use, my skin began to feel less oily overall, and as time went on, my once slick-as-a-McDonald's-french-fry complexion looked matte and grease-free. I could finally put the blotting wipes away, and replace them with just a powder compact and mini brush in my purse. My pimples had not yet disappeared, but they were improving.

What's the Difference Between Winlevi and Oral Spironolactone?

Both Winlevi and oral spironolactone pills decrease the effects of androgens in the skin, but they have different methods for how they get there.

Spironolactone, the oral kind, is a diuretic and blood pressure medication that's usually prescribed for acne off-label. "As an antiandrogen, it reduces testosterone levels by directly inhibiting the enzyme that is required for the synthesis of testosterone," says Dr. King. Because oral spironolactone actually prevents testosterone synthesis, it causes the body to have a lesser reaction, so to speak, to said hormones everywhere, including those that produce acne on the skin. Because it's systemically ingested, oral spironolactone is quite effective, with many acne-free faces and studies as proof. On that same token, its systemic method can lead to a variety of side effects, like irregular periods, breast tenderness and high potassium levels.

"[Winlevi] only works at the level of the skin," says Dr. Devina Mehta of Schweiger Dermatology Group. "Because it does not get into your bloodstream, there are fewer side effects than oral spironolactone." And since Winlevi works in this targeted manner, it only addresses the hormone receptors in your skin. This is why it's best to apply it on specific areas where your acne crops up — for me, that's around my nose, on my chin and on my T-Zone, so I've made a point to focus the topical on these hot spots.

Unlike Retin-A or other vitamin A-derived prescription acne treatments, Winlevi has relatively few side effects on the skin itself. While it inhibits excessive oil production, it doesn't cause the dryness, irritation or redness often associated with some other topical acne meds.

How Long Does It Take for Winlevi to Work?

According to Ohio-based board-certified dermatologist Dr. Hope Mitchell, it can take several weeks to a few months to see significant results from Winlevi. "Consistency is key when using [Winlevi], and the time it takes for it to work can vary from person to person and depends on several factors, including the severity of the acne, the individual's skin type, and their adherence to the treatment regimen."

The author before starting Winlevi (wearing makeup).<p>Photo: Courtesy of Alanna Martine Kilkeary</p>
The author before starting Winlevi (wearing makeup).

Photo: Courtesy of Alanna Martine Kilkeary

For me, it took about three months with consistent application of Winlevi on my chin both morning and night to eventually eliminate the stubborn cystic bumps that had made a home for themselves in that area for so long. I noticed few to no pimples forming in my most acne-prone spots around the six-month mark and onward.

Who are the Best Candidates for Winlevi?

According to all the experts we consulted for this story, Winlevi is a great tool for patients with mild to moderate acne who may have a contraindication (the medical term for when a particular medicine or procedure might harm an individual) to the oral spironolactone pill.

"Patients might be directed to avoid oral spironolactone due to concerns about hormonal imbalances, heart conditions, hypertension or other systemic issues," says Dr. Mitchell.

Overall, Winlevi is generally less effective than oral spironolactone, "but that doesn't mean that it's not useful," Dr. King assures. And she's right — in my experience, it can be a solution for someone with a tricky hormonal history like mine.

It's also important to note that Winlevi can be used in tandem with the oral spironolactone pill if suitable for the patient. "The topical can be used alongside the oral in cisgender women as an adjunct, meaning it could allow for a lower dose of the oral medication given the added boost from the topical," says Dr. Mehta. She also adds that because cisgender men are not usually candidates for oral spironolactone due to its hormonal effects as a testosterone suppressant, Winlevi is the only anti-hormonal acne tool for them.

Incorporating Winlevi Into Your Routine

By far one of my favorite aspects of Winlevi is how effortless it is to incorporate it into a skin-care routine. "It can be used with other acne medications as well as with serums and moisturizers, sunscreen, et cetera, and it's usually not irritating or drying," says Dr. King. I can confirm that I've never experienced irritation nor drying from using it, pre- or post-application. Of course, it's best to test it out on a small area of the skin to confirm this, as Dr. Mehta noted that some of her patients on Winlevi did experience burning and redness upon use.

"If you are using more than one acne medication, I would generally recommend applying the other acne medication first and then Winlevi. Follow with a moisturizer, and during the day, follow with a sunscreen," says Dr. King. Winlevi can be applied twice daily, morning and night, and Dr. Mehta also recommends starting with two-to-three nights a week and gradually increasing the frequency as tolerated.

My routine echoes the dermatologists' suggestions: I use an acne-medicated cleanser in the morning and evening. (The CeraVe Acne-Foaming Cream Cleanser with 10% BPO is my holy grail.) I then follow with an acne-fighting duo of Amzeeq, a prescription topical minocycline formula, and a dime-sized amount of Winlevi on my most acne-prone areas. I finish with a lightweight moisturizer (the Summer Fridays Cloud Dew Gel Cream Moisturizer is a favorite) and top it with sunscreen for daytime (EltaMD UV Clear Face Sunscreen is excellent for acne-prone skin).

As a beauty editor, I'm adamant about the skin-care formulas and ingredients I use; a big pro of using Winlevi is that it generally plays well with all the other parts of my routine.

Is Winlevi Pregnancy Safe?

Although Winlevi targets hormones at the skin's level, experts agree that, like oral spironolactone, Winlevi should be avoided during pregnancy. "It is not considered safe in pregnancy given the known contraindication of the oral [version]," says Dr. Mehta. There are no studies on Winlevi and pregnancy just yet, as it is classified as a Category C drug (not studied in pregnant women), so dermatologists err on the side of caution, and recommend avoiding it.

The author after one year of treatment with Winlevi.<p>Photo: Courtesy of Alanna Martine Kilkeary</p>
The author after one year of treatment with Winlevi.

Photo: Courtesy of Alanna Martine Kilkeary

My Winlevi Results

It's been a little over a year since I first took a tube of Winlevi home from the pharmacy, and I've seen a huge improvement in my skin after using it every single day since. I rarely break out, and when I do, the pimples are tiny and easy to conceal, never painful, and only last a couple of days. This is a far cry from the bouts of stubborn, cystic pimples that have followed me throughout my hormonal journey. Of course, it's always best to refer to your dermatologist to see if Winlevi is the right option for you.

"Ultimately, individuals with persistent or severe acne should seek evaluation and treatment by a dermatologist, who can develop a personalized treatment plan tailored to their specific needs," says Dr. Mitchell. "With proper care and guidance, many individuals can achieve clearer, healthier-looking skin with the help of [Winlevi]."

Winlevi has accompanied me in the delicate dance with my hormones, and I'm happy to say that, thanks to this topical cream, we've finally reached the same rhythm.

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