Spironolactone 50 to 100 mg daily is the first-line treatment for hormonal acne in women — one study of 85 women showed roughly one-third achieved full clearing and another third saw substantial improvement. FDA-approved combined oral contraceptives (Yaz, Ortho Tri-Cyclen, Estrostep) are the second option; they elevate sex hormone-binding globulin, which lowers free androgens that drive sebum. Topical tretinoin or adapalene 0.1% nightly cuts comedone formation alongside. For severe nodulocystic patterns, isotretinoin (Accutane) is the only treatment with multi-year remission data. Patches like Rael Microcrystal and ZitSticka Killa handle the active flare; the prescription handles the cycle. Expect 12 weeks before the prescription shows full effect.