My Tretinoin Journey: How I Finally Cured My Hormonal Acne

I’ve been suffering from persistent hormonal acne for about 10 years. And like most people with acne, I've temporarily "cured" it for short periods of time only to have it come back with a vengeance. In the last decade, I’ve tried almost everything to fix my skin and get rid of my acne for good. Some things worked, at least for a short time (such as clindamycin and benzoyl peroxide) and others had disastrous results.

Acne can have such a profound impact on a person’s self-image. Personally, my acne defined me for so many years. I saw myself as “that girl with bad skin” and thought that I would always be this way. Having acne destroyed my self-confidence – at times, I didn’t even want to leave the house because I felt so awful about my skin. I refused to go in public without makeup on, and I was terrified of anybody but my closest friends and family seeing my bare face.

After years of struggling, trying every fad diet and fancy serum under the sun, spending thousands upon thousands of dollars along the way, I can finally say that my acne is gone! I haven't gone this long without a breakout since I was in middle school. Over the past 6 months of following this routine, my acne has steadily decreased to the point that I haven’t gotten a cystic zit or anything more serious than a whitehead for nearly 2 months now.

It took me a decade to finally figure out what works for my hormones and my skin, and my biggest takeaway is this: find a dermatologist you trust. I resisted seeing a dermatologist for years because of negative past experiences, but once I finally put in the effort and found someone who really listens to me and cares about how I feel, it was a game-changer.

Without further ado, here’s what I’ve been doing for the past 6 months to heal my hormonal acne. Hopefully this helps you and gives you some confidence that it is possible to heal acne, it just takes a lot of time, patience, and a great dermatologist!

Part I: Tretinoin

The first big change I made that had a huge impact on curing my acne was tretinoin. Otherwise known as Retin-A, tretinoin is a vitamin A derivative that’s been proven over many years of research to help cure acne (as a bonus, it also has major anti-aging powers – win-win!) I wrote up a blog post all about the different types of retinoids available, which you can check out here.

I did a ton of research on tretinoin before taking the plunge and getting a prescription from my dermatologist, so I felt quite confident starting it. I started off with the tretinoin cream formulation at 0.025% concentration. This is the lowest and least irritating formulation you can get. After about 5 ½ months using 0.025%, my results had plateaued and I decided to go up to the 0.05% concentration, which is what I’m using right now.

In the beginning of using tret, I applied every third night. Then after a couple weeks, I moved up to every other night. Then, after I felt my skin could tolerate it, I moved up to using it every night, which is what I’ve been doing for the past 3 ½ months.

I experienced some dryness and peeling around my mouth at the beginning, but it was solved by applying a barrier (like Vaseline) before tret. I also incorporated the La Roche Posay Cicaplast Baume B5 on my dry areas, which did an amazing job of moisturizing and soothing my skin.

Part II: Spironolactone

The other major change that I attribute my success in healing my hormonal acne to is spironolactone. Spironolactone is a medication that inhibits androgens which tend to cause acne. DISCLAIMER: Spironolactone is a prescription medication and should only be taken under a doctor’s supervision.

I saw my general physician and asked to go on spironolactone after doing some research and hearing about its amazing results for hormonal acne. Spiro is often prescribed along with birth control, since you are not supposed to get pregnant while taking spiro. I had already been on a birth control pill specifically meant for acne for several years, so that is the combination I’m taking right now.

I started off with 50mg daily of spiro, which is a low dose. After about 3 months seeing little results, I bumped up to 75mg daily which definitely improved my breakouts. So far, I haven’t had any serious side effects, but it is possible to experience dizziness, light-headedness, nausea, headaches, and other effects so be aware and make sure to speak to your doctor about this. Spiro is also a diuretic so you need to make sure to stay extra hydrated (be warned that you will have to pee – a LOT).

Part III: Azelaic Acid

Finally, I incorporated azelaic acid into my routine about 2 months ago, which has really helped reduce redness. I’m very prone to redness and PIH, and I have rosacea which is what azelaic acid is commonly prescribed for. I’ve been using Paula’s Choice 10% azelaic acid every other day, and I’ve been loving it so far. In the future, I will likely get a prescription from my dermatologist for a higher concentration of azelaic acid (also called Finacea).

My AM Routine

• Cleanse with CeraVe Hydrating Cleanser or Neutrogena Ultra Gentle Hydrating Cleanser
• Paula’s Choice 10% Azelaic Acid Booster OR The Ordinary Niacinamide + Zinc Serum
• Moisturize with CeraVe Moisturizing Cream (in the tub)
• Sunscreen (NEVER skip sunscreen while on tretinoin, even when you’re staying inside all day! My current favorite is Paula’s Choice Super Light Daily Wrinkle Defense SPF30 but I also like the ones from EltaMD)

My PM Routine 

• Remove makeup/sunscreen with an oil or balm cleanser (my favorite is the Boscia MakeUp BreakUp Cleansing Oil, but right now I’m trying out the Drunk Elephant Slaai Makeup Melting Butter Cleanser)
• Cleanse with CeraVe Hydrating Cleanser or Neutrogena Ultra Gentle Hydrating Cleanser
• Moisturize with Neutrogena Hydro Boost Water Gel (the fragrance free version only!) OR CeraVe in the tub (depending on how dry or irritated my skin is feeling)
• Wait 10-20 minutes to fully dry (Never apply tretinoin to damp or wet skin!)
• Apply pea-sized amount of tretinoin all over my face, avoiding the mouth and eyes (I like to apply a generous amount of CeraVe Healing Ointment to my lips before tretinoin, otherwise the corners of my mouth start peeling)
• Optional: Apply La Roche Posay Cicaplast Baume B5 to dry areas
• Optional: Pimple patch on any active zits

Before and After Pictures

*I only bothered showing the bottom half of my face in these pictures since that's where 100% of my acne was, since it was all hormonal.

Before starting tretinoin (March 2020)

2 months into tretinoin 0.025% while purging (May 2020)

6 months into using tretinoin 0.025% (September 2020)

There's such a huge difference in not only my acne, but the texture and tone of my skin from the first pictures until now. I even have a little bit of that sought-after "tret glow" in the last photos! As you can see, I still do suffer from some leftover PIH and redness, and I get occasional small pimples which I'm hoping the tretinoin 0.05% will help get rid of. Overall, I'm extremely happy with my progress and I've never felt better about my skin!