The Accutane Diaries—3 Women Share Their Experience
There are pink dots of Mario Badescu Drying Lotion all over my face as I'm typing this. My cystic acne has come back, and at this point, all I can do is pray it doesn't get any worse.
That's the thing about acne. It can always get worse. I've had it since I was a teenager. When I first started to break out in high school, I tried the Clinique 3-step system for a few months with no luck. So my mom took me to the dermatologist and I was prescribed a few topical treatments. The results were pretty underwhelming. While my skin didn't look any worse, it also didn't look any better.
Since then, I've tried most at-home acne treatments, prescription antibiotics, high-tech facials, laser treatments, as well as changing my diet and lowering my stress level. I’ll go up to a year without a breakout, and just when I think I'm in the clear (literally), that's when I lose faith in my skin again.
Acne is more than what you see on the surface. It can make you feel out of control and hopeless. And even if it does get better, it could always come back or leave scars as a reminder. It's the money you tirelessly spend on products, treatments, prescriptions, and dermatologist and esthetician visits. It's staying up late sifting through skincare threads on Reddit, hoping to find a hidden piece of advice that might finally work. It's staying in on a Friday night because you're sick of concealing it all with heavy makeup. Basically, it's living your life by the state of your skin. And it sucks.
That's why I can't help but wonder: Should I just take Accutane?
Chances are if you’ve had acne or know someone who has, you’ve heard of Accutane (Isotretinoin). It’s a medication that dermatologists commonly prescribe to patients with cystic and nodular acne, especially if scarring is present. It’s widely known as the “closest cure” we have for the common skin condition. But, also? For it's share of bad side effects. Patients have reported severe dry skin, blurred vision, depression, anxiety, and even suicidal thoughts. You also can’t take it while you’re pregnant because it can have ill-effects on a fetus. But again, it is effective for treating most forms of cystic and nodular acne. To monitor any health risks or negative side effects, patients are required by law to give monthly blood samples to test cholesterol, liver function, and a chance of pregnancy, which is known as the iPledge system.
Because of this, many people think of Accutane as a last resort medication, but that's not always the case. According to Dr. Jennifer Herrmann, a dermatologist at MFC Dermatology, “ If a patient shows deep cysts, nodules, and scarring, or significant psychological distress from acne, sometimes we begin on this medication quickly. Acne scars are exceptionally difficult to treat, so their prevention is important.”
Accutane is a Vitamin A derivative that belongs to a class of drugs called retinoids. Retinol, a common ingredient in anti-aging skincare, is also a retinoid. Both work to increase cell turnover, except Accutane is taken orally in a stronger dose. With an increase in cell turnover, “Accutane targets oil glands to reduce sebum production, as well as have an antimicrobial effect on Propionibacterium acnes (p.acnes), the bacteria that causes acne,” explains Dr. Herrmann. (Or, basically: The reason you might experience severe dry skin on this medication is because it’s taking care of all the oil problems you had before.)
It helps to hear the science behind Accutane from a dermatologist. But as I’m deciding, it also helps to hear the experiences of women who've taken it and their advice. If you're in a similar situation, it may help you, too. Read on to get stories from 3 women we know on Accutane:
I started getting acne shortly after I got my period at 11 years old. It was most severe in the t-zone, but as I got older it spread and I was soon covered in blackheads and whiteheads. I tried everything to treat it—Proactive, Murad, Metro Cream (metronidazole), all of the Neutrogena line, salicylic acid, birth control pills, topical Retin-A, Spironolactone, as well as facials and laser treatments. Nothing seemed to work.
At 27, I finally decided to go to the dermatologist to get on Accutane. I didn’t have any fears about the medication—I just wanted something that would work. My dermatologist started me on an 8-month treatment in LA. When I moved to NYC, they moved my dose down to a 5-month treatment. I think it had something to do with how well my skin was reacting to it. I started noticing a difference after a month.
As far as side effects go, I experienced SUPER dry lips, and dry skin with little red spots when I didn’t moisturize every night and day. I used the entire Eau Thermale Avene skincare line—it was the soothing moisture I needed. For my lips, Dr. Dan’s lip balm was a lifesaver. EltaMD UV Daily Broad-Spectrum SPF-40 was my go-to sunscreen. I still use it. Just make sure to rub it in perfectly or the formula will ball up.
My only regret about Accutane is that I didn’t go on it sooner. My skin has never looked better. After 3 months, my natural oils started coming back, which was annoying. I had gotten so used to everything being dry on Accutane, so I rarely had to wash my hair. Oh, well. Clear skin is worth it!
THE #1 ADVICE CHRISTINA GAVE ME: If you think you need it, do it ASAP. And when you do, buy a ton of Dr. Dan's lip balm.
christina's post-accutane skincare routine:
“My acne started when I was 16 years old. There were a few large and noticeable cysts on my forehead, but it was worse around my jawline. It spread from my chin to my ear. My dermatologist had prescribed me topical creams and antibiotics (doxycycline) but nothing worked. She had told me about Accutane but I was scared to try it due to its side effects, especially on mental health.
I decided to finally get on Accutane when I was 20 because my acne started to interfere with my academic and social life. Sometimes, I would miss class because I didn’t want to be around people out of embarrassment. At that point, clear skin was worth any side effect. We started my dose as an 8-month treatment. The exact dosage of medication was determined by my weight and severity of my skin.
There were definitely side effects. First, I had some bad headaches, but I just drank more water, which seemed to help. There were also some gastrointestinal issues, which also required drinking more water. Olly Probiotics helped, too. In the beginning, I was also tired and easily worn out, but I’m a busy college student so that’s probably unrelated.
I didn’t experience too much dryness, probably because of the products I used. Morning and night, I cleansed with CeraVe Face Wash and used their moisturizing lotion. I also used the Drops of Youth Night Mask from The Body Shop after I showered. I carried a big tub of Aquaphor Advanced Healing Ointment everywhere I went. I used it once or twice an hour while I was awake (not kidding!) Dr. Dan’s chapstick was also a lifesaver, but I didn’t love the smell or taste, so I used it only when my lips were visibly cracking. I did have some red spots on my neck and arms and was prescribed a topical gel. As long as I made moisturizing an important part of my day, I was fine.
I started seeing results 4 months later. I am so happy with the results, even with the side effects. I still get some hormonal acne, but nothing like before. I am also proud of myself for sticking with the process that goes along with taking Accutane. (You have to take a blood test every month by law to make sure you aren’t pregnant.)
THE #1 ADVICE LINDSEY GAVE ME: Commit to taking the medication and know there will be a light at the end of the tunnel! Also don’t stress out about all the iPledge system requirements and very strict pregnancy and blood tests. Just write everything down (I even made a special “Accutane Calendar”) and you’ll get the hang of things in no time. The monthly appointment and tests actually became a very positive part of my month because I knew I was one month closer to having clear skin! Lastly, never feel bad if your skin isn’t showing the results you have been dreaming of. The medication definitely affects everyone’s skin differently as it is accumulating in your blood, so just wait it out! I promise at the end your skin will be better than how it started. You will also be very proud of the commitment you made to yourself and your self-confidence.
lindsey's post-accutane skincare routine:
I started getting acne when I was around 16 years old. It was mostly inflamed red bumps on my lower face and chin, with a few scattered over my the rest of my face. Over the years, I have been on a round of Accutane two separate times (age 23 and 31).
I found out about Accutane from my dermatologist. At that point, every medication (OTC and prescription) and treatment I tried had failed me: Retin-A, Clindamycin, Tazorac, Doxycycline, Ampicillin, birth control, and chemical peels. When I was prescribed, my only fear going into the treatment was that it wouldn’t work for me, just like everything else.
The dosage of Accutane is based on body weight (1mg/kg) and also severity. The lower the dose, the longer the treatment. The first time I was on Accutane at 23, I took it for four months. Then at 31, I took it for six months. Both times I saw immediate improvements within the first month. Not everyone has to take it multiple times, but this is just a reminder that it puts acne in remission, hopefully long enough for you to outgrow it. In other words, it’s the “closest thing to a cure”, not the actual one.
The only side effects I experienced were chapped lips, dry nose and eyes, and slight fatigue. To combat the dryness, I used the following mild skin care products: ZO Hydrating Facial Cleanser with a Clarisonic brush, Korean-based essence and toner, Josie Maran Whipped Argan facial moisturizer, CE Ferulic serum, Revision Intellishade Moisturizer with SPF, and Colorescience Sunforgettable SPF. (SPF is a must when you are on Accutane!) I'm very happy with both results and currently!
THE #1 ADVICE JULIE GAVE ME: Don't fear all the “negative” side effects that you read on the internet. Most people will only experience the dry lips, nose, eyes, and skin, it’s inevitable because that’s the way the medication works. The rare side effects of mood changes and inflammatory bowel disease are just that, rare. There have been isolated incidences but occurrence is very rare. I have patients who are clinically depressed on antidepressants do great with the medication without side effects. In fact, they’re happier because their skin is finally clearing up. If you already see scarring, don't wait too long to start the medication. Acne can be stopped with this medication, but scarring is more difficult and expensive to treat. Reminder that it is also not a “cure” for acne but that it puts it in remission hopefully long enough for you to outgrow, hence why I have taken it 3 times. This truly is a life changing medication that’s closest to a cure for acne. As long as the mediation is well monitored with monthly blood tests, most patients should do fine. Fear mongering due to few isolated incidents should not make patients afraid of this medication, especially when they can benefit from it. I have seen it both as a patient and a prescriber myself. I have worked in medical and cosmetic dermatology for 13 years now and have prescribed it for that long and never once have I seen any severe adverse events or not seen clearance of the acne.
julie's post-accutane skincare routine:
Do you have a personal experience with Accutane? I’d love to hear your story. Comment below or email me at firstname.lastname@example.org.