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Q:  I have hereditary Cystic Acne on my back and in my groin area. Have had many
deep cysts surgically removed and have the typical deep acne scarring. I'm 44 and have had this since my early teens. I've taken oral contraceptives, anti-biotics and accutane to no avail. I also had a partial hysterectomy 2 years ago. I was advised by a skin consultant that Aldactone might be of
benefit to me. Please advise.

The condition you describe in the groin area sounds like hidradenitis supporativa, though of course I can't be sure just from your description. This condition usually affects the underarms and groin but sometimes other areas where skin is against skin, for example, under the breasts. It consists of what look like small boils and often drain yellow material. Hidradenitis does not affect the face but since both it and cystic acne are triggered by testosterone, the two can go together. My experience suggests that lowering and blocking testosterone can help. The use of Aldactone (spironolactone) and other medication for this purpose is discussed in the acne article on this website. However so far as I know, there are no studies of use of spironolactone for hidradenitis. It does work well for cystic acne however. Accutane usually works for cystic acne but not for hidradenitis.

I would suggest having your testosterone and DHEA-S measured and discussing anti-androgen treatment with a knowledgeable physician.

Please remember that I cannot make a specific diagnosis or treatment recommendations over the web. I hope this general information is helpful to you.

Geoffrey Redmond, MD

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