Permanent solution? Roaccutane. Personally, I don’t subscribe to the scary effects that the internet and some doctors make it out as having, because there have been many good studies that show it is a very safe drug, if prescribed and managed appropriately.
You can read this previous post about accutane in Singapore, and my personal experience with it.
Having said that, spironolactone is also a very good choice in acne treatment for females, especially if you find that your acne is hormonal (happens cyclically, say around your periods), and occurs mostly at your jaw/chin/neck.
Here are some quick facts about spironolactone, in answer to your questions:
Spironolactone takes at least 3 months to work
Only used for females, as it blocks male hormones (testosterone)
Don’t get pregnant while on spironolactone as it can cause feminization of a male baby
You may pee a little bit more (as you rightfully pointed out that it is a diuretic)
Yes, you can’t eat too many bananas/drink too much coconut water as spironolactone tends to increase your potassium levels, which can cause heart rhythm problems if your potassium get too high (rare, as I assume you are young, and your kidney does a very good job of regulating the levels).
Checking your potassium levels at the start, with a repeat a couple of weeks later (to ensure that your kidney is regulating your potassium levels well), or as otherwise advised by your doctor is ideal.
I’d say don’t stress too much about foods containing potassium, as long as you aren’t overeating. Evidence suggests that in the young and those without underlying kidney problems, (and who are not on any other potassium-sparing hypertensive medications), the likelihood of encountering problems with high potassium levels is extremely unlikely.
Overall, yes, spironolactone is indeed a very safe drug.
I still have some tretinoin on hand do you think I can apply the tretinoin while on spironolactone?
Yes, I would almost always recommend patients to use a topical retinoid (like tretinoin) for the management of acne, as long as he/she is not concurrently on oral isotretinoin as well.
Combination therapy in combating acne is far superior, and studies have also shown that taking spironolactone and applying topical tretinoin to be much more effective than using either one alone in the control of acne.
Besides being an extremely effective anti-acne treatment, topical retinoids are also a very good anti-aging/wrinkles agent.
Just take care to apply it only at night (it makes your skin photosensitive!), and if you find that it dries out your skin too much, you can apply it on alternate days.
