If you’re human, it’s likely that you’ve experienced acne at some point in your life. It’s almost impossible to escape high school and beyond without the clutches of acne grabbing ahold of your skin and self-esteem. Acne is by far the most common skin condition, affecting “up to 50 million Americans annually”, yet is something that can make you feel incredibly isolated (American Academy of Dermatology). It’s also a condition that many of us falsely equivocate solely with adolescence, even though acne can affect people into their 50s. I for one bought into this notion, and held onto the hope that once I hit my early 20s, my skin woes would be on the decline. I wasn’t expecting a miracle, but from everything I had heard there was no reason to believe that things wouldn’t improve. What I didn’t expect, however, was for my acne to get much worse.
Due to the myth that acne is simply a side effect of being a teenager, I felt the isolation that so many of us do when my breakouts became worse with age. I had already spent much of my youth agonizing over my skin and making frequent trips to the dermatologist. My main concern then was rosacea, a condition that causes the skin to flush and look red and inflamed. And of course, acne isn’t going to help with that. I started wearing foundation at twelve years old because my skin had become so red that kids at school would ask why I was so sunburned. Through all of this, I couldn’t wait for the day that adulthood would bring some relief.
It sounds so trivial, but studies have proven time and again that acne has psychological effects. According to the American Academy of Dermatology, “researchers have found in study after study that people with acne can also develop depression, anxiety, low self-esteem, decreased quality of life, and a feeling of being all alone”. These psychological effects have consequences in the real world, beyond the obvious decreased quality of life that they bring acne sufferers. Each year, lost productivity due to the inherent debilitating effects of acne amounts to hundreds of millions of dollars. Clearly, the narrative that acne is an adolescent problem is just plain wrong.
By the time I hit 25, my acne had turned cystic and was the worst it had ever been. At that point, I had tried just about everything. Prescription creams, antibiotics, retinoids, diet changes, stripping down my skincare routine to the basics, you name it. Some of it worked for short periods of time, or at least kept the worst of it at bay. But as soon as I thought the problem was under control, it would return with a vengeance.
I had hit my breaking point, and that’s when my dermatologist suggested it was time for isotretinoin, otherwise known as its former brand name, Accutane. I had never considered it as an option. Despite dealing with breakouts since my early teens, my impression with Accutane was that it was for only the most severe forms of acne. However, my doctor explained that since my acne was cystic and I had failed all other alternatives, it was actually a realistic option for me. I’d like to say that I was cautious and took my time in deciding to go on a powerful drug with heavy side effects, but I jumped at the opportunity. At that point, I was willing to try anything.
ACCUTANE – NOT FOR THE FAINT OF HEART
Accutane is a derivative of vitamin A that can cure acne by shrinking the oil glands in the skin. These sebaceous glands can get clogged and attract acne causing bacteria. For many people, it is a cure. Some may have to do a couple 4-6 month rounds of the drug, but generally, it is extremely effective in putting almost a complete stop to acne. There are a number of risks that come with taking Accutane, which are important to discuss with your doctor before starting the medication.
- For women, or females that can bear children, isotretinoin can cause severe birth defects. Due to this, it is mandatory that women use two forms of birth control and take monthly pregnancy tests. Before you even start your prescription, you have to have 2 negative pregnancy tests one month apart. So, don’t expect to get on the medication the day it’s prescribed. There’s no way around this 30 day waiting period.
- In order to get your prescriptions each month, you’ll have to jump through a few hoops:
- Schedule an appointment with your doctor.
- Get bloodwork panel done (this is for your pregnancy test and to monitor your cholesterol, which can be affected by Accutane).
- Take the iPledge online quiz after your appointment. iPledge is the pregnancy prevention program for Accutane. Both doctors, patients, and pharmacies are required to use it. Each month, after your doctor inputs your negative pregnancy test, you will have to take a short quiz that basically proves that you know the risks.
- Pick up your prescription within a 7 day window. If you miss this window, you will have to take another pregnancy test.
The Side Effects
Accutane comes with a multitude of side effects that can range from pesky to downright debilitating. Of course, if your symptoms veer towards the latter, it’s important to check in with your doctor.
Common Side Effects (Mayo Clinic):
- Bone or joint pain
- Burning, redness, itching, or other signs of eye inflammation
- Difficulty with moving
- Scaling, redness, burning, pain, or other signs of inflammation of the lips
- Skin infection or rash
- Crusting of the skin
- Difficulty in wearing contact lenses (may continue after medicine is stopped)
- Dryness of the eyes (may continue after treatment is stopped)
- Dryness of the mouth or nose
- Dryness or itching of the skin
- Headache (mild)
- Increased sensitivity of the skin to sunlight
- Peeling of the skin on palms of the hands or soles of the feet
- Stomach upset
- Thinning of the hair (may continue after treatment is stopped)
- Moisturizer. The most common side effect of Accutane is extreme dryness. This was definitely true for me. Using a gentle, thick moisturizer on my face and body daily was essential, and did help to keep flakiness at bay. This is the moisturizer I swore by while on the medication – and let me tell you, it works. I got comments from people that it didn’t even look like I was on Accutane because my skin didn’t look flaky. I put it down to this wonderful cream.
- Aquaphor. Sometimes thick creams just didn’t cut it, especially in the winter. I had patches of eczema pop up on my hands and arms at times when the weather was particularly cold and dry. Aquaphor was a saving grace for not only that, but my frequent nose bleeds. Yes, you read that correctly. I had to moisturize the insides of my nostrils daily, as well as use a humidifier.
- Heavy duty balm / mask for your lips. Mine were constantly peeling and cracking, so I was constantly reapplying lip balms. Your average Chapstick isn’t going to cut it here. I used this one on the regular, and sometimes even layered them.
Dealing with these uncomfortable side effects was an easy trade off for me, and I’d do it again. It’s important to consider how Accutane will work with your daily life and routine before taking it. Since I had already exhausted all other resources, choosing to take the medication despite its risks was a no brainer. After I started seeing major results at around month four, I knew I had made the right decision. By the end of my 6 month treatment, I had experienced two months completely breakout free. I couldn’t remember the last time that had happened – it had certainly been well over a decade.
For me, Accutane was a miracle drug. I’m feeling more confident about my skin than ever, and am already wearing much less makeup. The mental burden of worrying and feeling “other” because of adult acne is real and shouldn’t be downplayed or ignored. Talk to your dermatologist if nothing has been working for you. You deserve to feel beautiful and confident in your own skin.