Many cases of acne are hormonal in nature, meaning that they occur in adolescent girls and women and are aggravated by hormonal fluctuations such as those that occur during the menstrual cycle or in the setting of underlying hormonal imbalances as seen in polycystic ovary syndrome. For these patients, antihormonal therapy such as spironolactone is a valid and efficacious option. Herein, initiation and utilization of this medication is reviewed.