Managing Adult Female Acne and Milia with Spironolactone & Tretinoin in Katy & Houston, Texas
At Reena Jogi, MD, we see many women in their 20s and 30s experiencing persistent acne that does not fully respond to over-the-counter treatments. This case highlights a 25-year-old female patient from the Katy and Houston, Texas area who followed up for acne vulgaris and milia after beginning prescription therapy.
Patient Background
The patient was first evaluated in August 2024 for moderate acne, characterized by comedonal papules, inflammatory papules, and pustules. At that time, she began:
Spironolactone 50 mg daily, increasing to three times per day
Topical tretinoin nightly
Supportive recommendations: OTC Neutrogena spot treatment, non-comedogenic cleansers, and moisturizers
She returned for follow-up reporting that her acne was stable and controlled with treatment.
Clinical Findings
On examination:
Acne vulgaris: comedones, papules, and pustules present but improved compared to baseline
Milia: small yellow-white cystic papules on the face, consistent with superficial keratin-filled cysts
No signs of scarring, cystic lesions, or severe flares
Diagnosis
Acne Vulgaris (L70.0) – chronic but stable on current regimen
Milia (L72.0) – benign, superficial keratin cysts
Treatment Plan
Acne:
Continue spironolactone 50 mg three times daily – ongoing hormonal management of acne
Continue tretinoin 0.025% cream nightly – to prevent clogged pores and improve skin texture
Emphasized use of non-comedogenic skincare (Cetaphil, Cerave, Elta MD UV Clear)
Suggested benzoyl peroxide washes to reduce bacterial resistance
Counseling included:
Acne treatments may take 2–3 months for visible improvement
Common tretinoin side effects include dryness and irritation
Spironolactone side effects include breast tenderness, dizziness, fatigue, and rare elevated potassium levels
Milia:
Explained that milia are benign and often resolve with continued retinoid therapy or professional extraction
Attempted in-office extraction of three lesions without charge, but not fully successful
Patient referred to a dermatology provider for extraction or electrocautery if persistent
Follow-Up Plan
Continue spironolactone and tretinoin as prescribed
Return in 1 year for acne monitoring unless earlier concerns arise
Schedule with dermatology staff for milia management as needed
Why This Case Matters for Adult Female Patients in Katy & Houston
Adult female acne is often hormonal in nature and may require prescription therapy such as spironolactone to stabilize breakouts. In addition, retinoids like tretinoin not only control acne but also improve skin texture, reduce scarring, and help with secondary conditions such as milia.
At Reena Jogi, MD, we specialize in personalized acne treatment plans that balance efficacy, safety, and cosmetic outcomes for patients of all ages.
Key Takeaways:
Spironolactone is highly effective for hormonal acne in women
Tretinoin helps both acne and milia prevention
Supportive skincare with non-comedogenic products enhances treatment results
Patience is key—most acne treatments take 2–3 months for visible improvement
