A physician recently called concerning a 13-year-old male with severe cystic acne. We were told the parents had exhausted all commercial treatments except isotretinoin capsules (trade name Accutane) and the parents were opposed to this due to side effects. The physician was asked if there was a hormonal component to his condition. I explained that spironolactone was used as an antiandrogen in women. To minimize the risk of system antiandrogen effect in a teenage male, I suggested a low strength topical cream with phenylephrine HCL to further reduce the possibility of system effects. The spironolactone was combined with nicotinamide and vitamin A. Three aromatic oils were used to cover the scent of the spironolactone. The patient was instructed to apply the cream at bedtime and wash off in the morning. Forty-five days after start therapy, the physician call stating that the patients face was clear. Parents of other teenagers have noticed the dramatic change in the patient’s face. They are impressed that the results were achieved with out the risk of isotretinoin capsules.