Acne & Hormonal Acne Support

Also called acne vulgaris, hormonal acne, adult acne, breakouts, pimples

Acne is treatable, and most proven treatments are widely available. When a provider prescribes a form or strength that is not, such as topical spironolactone, Mixwell in Chino, CA prepares it.

Reviewed by Linda Pungpravat, Compounding Pharmacist, RPh Mixwell Compounding Pharmacy, Chino, CA

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Signs people notice

Blackheads and whiteheads
Red, tender pimples
Deep, painful bumps under the skin
Breakouts along the jaw and chin
Flares that follow the menstrual cycle
Dark marks left after pimples heal
Pitted or raised scars

Clinical Overview

What is acne?

Acne is a common skin condition that causes clogged pores, pimples, and deeper painful bumps, most often on the face, chest, and back. It affects preteens, teens, and adults, starting as young as age 9 [1]. It is treatable, and the right plan depends on how severe it is and whether it is leaving marks or scars.

What hormonal acne means

Acne in adult women often flares along the jaw and chin and around monthly cycles. The American Academy of Dermatology conditionally recommends two hormonal options for these patients: combined oral contraceptive pills and spironolactone [1].

Acne on its own is not a reliable sign of a hormonal disorder. Acne along with irregular periods or excess facial or body hair can point to polycystic ovary syndrome, a common hormonal condition, and is worth raising with a provider [5].

How it is treated

The AAD strongly recommends benzoyl peroxide, topical retinoids, topical antibiotics, their fixed dose combinations, and oral doxycycline. It strongly recommends isotretinoin for severe acne, acne that scars or causes significant distress, and acne that does not respond to standard treatment [1]. To limit antibiotic resistance, it recommends pairing antibiotics with benzoyl peroxide and limiting oral antibiotic use when possible [1].

How Compounding Can Help

Most acne treatments are FDA approved and widely available [1]. A compounding pharmacy fills specific gaps when a prescriber orders it.

Topical spironolactone gel, since spironolactone is FDA approved only as tablets and an oral suspension. Evidence for the topical form comes from small trials with mixed results [2].
A spironolactone oral liquid for patients who cannot swallow tablets
Azelaic acid combinations at strengths or with actives that commercial products do not offer
Dye free and fragrance free versions for sensitive skin

Spironolactone labeling warns it may affect the development of a male fetus, so it is avoided in pregnancy or used only after discussing that risk [3]. Your provider decides which option fits.

Common Formulas Prescribers Order for This

Gel · TopicalSpironolactone 5% Topical Gel (WO6® Anhydrous)A compounded 5% spironolactone gel in WO6 anhydrous base, prepared in Chino, CA to a prescriber's order for topical u...Technical details Oral suspension · OralSpironolactone Oral Suspension (SuspendIt®)A sugar free spironolactone oral suspension in SuspendIt, compounded in Chino, CA to a prescriber's order when the ap...Technical details Topical cream — XemaTop™ base; combin...Azelaic Acid / Miconazole Topical CreamTechnical details Permeation EnhancerAzelaic Acid 15% / Tranexamic Acid 3%TopicalTechnical details

Each formula is prepared only with a valid prescription. Your prescriber decides what is appropriate.

What to ask your provider

How severe is my acne, and is it at risk of scarring?
Which over the counter products should I try first, and for how long?
Could my acne be hormonal, and should I have any tests?
Would spironolactone or a birth control pill be an option for me?
How do I avoid antibiotic resistance if I need an antibiotic?
When should I see a dermatologist rather than keep trying on my own?

Call (909) 378-7301

Common Questions

What is hormonal acne?

Hormonal acne usually describes acne in adult women that flares along the jaw and chin or around monthly cycles. The American Academy of Dermatology conditionally recommends combined oral contraceptive pills and spironolactone as options. Acne along with irregular periods or excess facial or body hair can point to polycystic ovary syndrome and is worth raising with a provider.

Does spironolactone help acne?

Oral spironolactone is conditionally recommended for acne by the American Academy of Dermatology. Topical spironolactone gel has been studied only in small trials with mixed results. Spironolactone is avoided in pregnancy because it may affect a male fetus. Your provider can explain whether either form fits your situation.

When should I see a dermatologist for acne?

See a dermatologist if acne is deep and painful, leaving scars, affecting your mood or confidence, or not improving after a few months of consistent over the counter treatment. Guidelines recommend stronger treatment for acne that scars or causes significant distress.

Can several active ingredients be combined into one topical?

Often yes, when a prescriber orders it. Combining actives can turn a multi step routine into one application, which some patients find easier to keep up. The prescriber chooses the ingredients and strengths, and our pharmacist reviews whether they are compatible in a single base before compounding.

Do I need a prescription for a compounded medication?

Yes. Every compounded preparation is made for one patient with a valid prescription from a licensed prescriber, such as a physician, nurse practitioner, dentist, or veterinarian. If you do not have one yet, ask your provider whether a compounded preparation fits your situation, and they can send the order to us.

References

Reynolds RV, Yeung H, Cheng CE, et al. Guidelines of care for the management of acne vulgaris. J Am Acad Dermatol. 2024;90(5):1006.e1 to 1006.e30. doi:10.1016/j.jaad.2023.12.017
Oral and topical spironolactone in acne treatment: a meta-analysis of effectiveness and safety. Naunyn Schmiedebergs Arch Pharmacol. 2025. PubMed 39878821
CAROSPIR (spironolactone) oral suspension, 25 mg/5 mL. Prescribing information. U.S. Food and Drug Administration, 2017. FDA label
988 Suicide and Crisis Lifeline. 988lifeline.org
Teede HJ, Tay CT, Laven JJE, et al. Recommendations from the 2023 international evidence based guideline for the assessment and management of polycystic ovary syndrome. J Clin Endocrinol Metab. 2023;108(10):2447 to 2469. doi:10.1210/clinem/dgad463

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Compounded in Chino, CA. Delivered across California.

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Mixwell Compounding Pharmacy 13788 Roswell Ave, Ste 158, Chino, CA 91710
(909) 378-7301

Mixwell is a state licensed, non sterile compounding pharmacy and a PCCA member, preparing each formula in a lab built to USP 795 and USP 800 standards. Compounded medications are not reviewed or approved by the FDA and are dispensed only with a valid prescription. We do not prepare sterile products or injectables. Nothing here promises a specific result, and compounded preparations are not presented as superior to commercially available products. Mixwell does not accept insurance. Call for pricing.

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