I have had acne for about as long as I can remember. When I was ten years old, peers would point out the zits on my face, while theirs had yet to be assaulted by the woe of puberty. For the most part, it was uncomplicated; some annoying cystic acne here and there, oily skin, some hyperpigmentation. In high school I would cover it up with foundation or concealer and largely forget about it until it came time to wash my make-up off. It wasn’t until I was about 23, and starting my first career-enhancing job, that suddenly all hell broke loose on my face, and my acne went to uncomplicated to SEVERELY complicated.
People who don’t suffer from acne often don’t consider the toll it takes on your mental health. To be honest, I was never truly self-conscious about it until it went haywire. Suddenly, I was receiving all of this unsolicited advice from well-meaning friends and family: “Have you tried facials?” “Maybe you need to change your diet?” “Drink apple cider vinegar; seriously, I’ve heard it works wonders!” “Stop wearing make-up, that’s what’s causing it.” “Maybe you’re washing your face too much/too little.” The list goes on, and needless to say, it really impacted my psychological well-being. At its very worst, there were days when I considered calling in sick to avoid going to work, because I just didn’t want anyone to see me. Going to the hair salon became something I dreaded, because in the beauty industry, EVERYONE notices your skin problems. I even avoided looking in the mirror for a long time, and applied my foundation without looking (and if it looked bad, people were probably too polite to comment on my make-up skills).
Let me be up-front in saying that turning to the controversial drug, Accutane, was not my first choice. I’m not even exaggerating when I say I tried EVERYTHING before I came to that decision. ProActive, astringents, over the counter cleansers and ointments, prescription topical creams, vitamins, birth control, no make-up, cutting out certain foods, and various and sundry natural remedies. Nothing worked, so I finally went to my doctor to get referred to a dermatologist. She did warn me that they were more than likely going to suggest Accutane, about which I had some very mixed feelings, but I was so desperate that I agreed to hear them out.
For those who aren’t aware, Accutane (isotretinoin) is an oral form of vitamin A that works directly on your oil glads to unclog your pores and basically make your skin uninhabitable for acne bacteria. Some of the controversy surrounding it comprises its correlation with depression and suicidal thoughts, pancreatitis, and other serious side-effects such as impaired vision, hearing loss, rectal bleeding, severe headaches, and chest pain. Presently, this drug is no longer available in the US, and some dermatologists are determined to seek alternative forms of therapy. When taking this drug, you are required to get your blood checked monthly, as well as check in with your dermatologist at least every six weeks to keep up on top of how it might be affecting your health. The duration of treatment varies, depending on the doctor and the severity of the patient’s acne, but as it tends to worsen acne before it gets better, it is typically prescribed for a least a few months. Finally, you absolutely CANNOT take Accutane if you are pregnant, as it is guaranteed to cause birth defects. That said, if you’re a woman who is able to bear children, you can bet you’ll be prescribed birth control along with it, if you are not already taking it.
I was told that the majority of people only require one go at Accutane for their acne to completely go into remission. The truth is, I went through 3 regimes of Accutane before I saw results. The first regime was for 5 months, the second for 6 months, and the final, for 7 months. After the fire two regimes, my cystic acne returned within a handful of months; not quite as severe as before, but bad enough that it hurt to touch parts of my face. And even now, a few years after finishing my last regime, I still get zits. But they’re manageable, they don’t occur in painful clusters anymore, and my skin isn’t quite as oily as it used to be.
As for the side effects…
I must say, I felt pretty lucky during my Accutane therapy. I did not experience any depression or suicidal thoughts (if anything, my mental health improved, because I didn’t feel as self-conscious about my skin), and my bloodwork always came back fine. I did experience the a good deal of dryness, not just on my face, but regarding my eyes and the rest of my body. I had to switch to a moisturizing shampoo for a while, because my hair had really dried out, and I was applying moisturizer like it was going out of style. But honestly, I liked the fact that I could be in the sun (with LOTS of sunscreen!) and not feel greasy within 5 minutes. Even when I worked out and sweat, I didn’t feel as oily in the aftermath.
It wasn’t until after all of my treatment was over that my skin suffered some weird afflictions.
The first oddity occurred when a pyogenic granuloma began to grow on my left index finger. It began as a bump just under the second knuckle from my palm, and I ignored it for months, until it seemed to break through the skin and began to bleed. And I mean it REALLY bled. Because pyogenic granulomas have so many blood vessels leading up to them, they bleed excessively when ruptured. Every time I would grip something a little too hard, I’d suddenly find my hand covered in blood (which is super awkward when you’re at a store and have to buy something because you bled on it–true story). I became accustomed to wearing bandages ALL the time, until I finally sought out medical advice. The first time I went to the hospital, they snipped the growth off and cauterized the site, because it was far too big to cauterize with a nitrate stick. The very next day, the site ruptured, and it began to grow back. When I next returned to the hospital, this time they cut the pyogenic granuloma right out of my finger, but the resident must have missed a little bit because it came back for a third time within two weeks. Finally, the plastic surgeon himself did the cutting and the stitching, and round three must have been successful because it hasn’t grown back since. (WARNING: if stitches make you queasy, scroll past the upcoming pics).
Pic 1: My first round of stitches
Pic 2: My second round of stitches
Pic 3: After my finger FINALLY healed
While there is no way to prove that Accutane was responsible for this occurrence, it was the only conclusion that I could come to. Typically pyogenic granulomas occur following an injury or trauma to the skin, but I had never injured my finger; it had literally just appeared one day, and continued to grow. The surgeon didn’t even have an answer for me, but he said that for a drug that is designed to affects your skin, it is entirely possible.
The weirdness didn’t stop at that, though.
Shortly after finishing my third round of Accutane, I began to get styes and chalazia along my eyelids. While styes and chalazia are rarely serious and go away on their own, mine didn’t, and landed me in the opthamologist’s office. He commended that my eyelids were “a mess”, and that I even had scar tissue beneath them (wtf?), all which he attributed to the oil glands in my lids not working properly. I was put on a low dose of an antibiotic that has been found to help issues such as these go into remission, and I was on it for at least eight months, along with putting hot, damp compresses on my eyelids three times a day. This all occurred in January, and my eyelids didn’t fully clear up until May or June, and I didn’t end up going off of the antibiotics until September.
And then, after about 4 months of reprieve from weirdness, I once again found myself in my opthamologist’s office.
Seemingly out of nowhere, I developed a small cyst beneath my right eyelid. It had started off looking like a zit, and so I had treated it as such, but it continued to grow, until make-up could no longer cover it (about the size of a lima bean). My opthamologist scheduled me in to get it drained, and in the interim I wore a band-aid below my eye because it was so embarrassing. Ultimately, I was lucky enough that it drained on its own with from hot compresses, and did not end up requiring day surgery, but it did leave me with a small scar. After consulting with my opthamologist about all of that weirdness, he did confide that it was not the first time he had seen cases such as this following an Accutane regime. It must be rare, as the long list of side-effects did not mention anything about styes, cysts, or chalazaions, and when I asked why my dermatologist down-played so many of these possible occurrences, he explained that the field of dermatology still widely believe “the benefits outweigh the risks”.
When people ask me if I’d have agreed to Accutane knowing the trouble it would cause later on, however, the answer is simple: yes, I would have.
When my acne was at its very worst, so was my quality of life. I was anxious and depressed, I didn’t feel attractive, didn’t want people to look at me, didn’t even want to go outside. Ultimately it wasn’t my skin, but my mental health that drove me to give Accutane a chance. While the issues with my finger and my eyes were indeed troublesome, they were manageable. They had a direct path of tried and true treatments, and they went away. My acne was NOT manageable; nothing was helping it, no one could give me helpful advice, and I’d have far worse scarring on my face today if I hadn’t gone the extreme pharmaceutical route. However, this path of treatment is not for everyone, and there are a good deal of risks associated with it.
So, for anyone considering pursing this method to treat their acne, this is the advice that I offer:
- Try other paths of treatment first. I only went on Accutane because my skin wasn’t responding to any other treatment available to me. It all depends on your skin and the type of acne you have. For some women, oral contraceptives can get hormonal acne under control. Other people respond well to prescribed topical creams, or even over the counter treatments. And if you have any medical spas in your area (coming from a small down, I did not), there are even certain chemical peels that that send acne into remission. If one method doesn’t work, try another one, and maybe another; finding the right path of treatment can take time. Just don’t pull out the big guns until your other guns run out of ammunition!
- If you decide Accutane is for you, do your research BEFORE seeing the dermatologist! I’m not saying go and consult Dr. Google until you’re read so many horror stories that you’re scared out of your wits; just make sure you’re informed about what you could be getting into. Any good doctor should give you the long and short of any type of pharmacological therapy, but you can’t take that for a given, particularly if they believe the benefits of a drug outweigh the risks. But that is for YOU to decide, not them. So do some of your own research and write down your questions to ascertain you get the most honest and informative answers from these specialists. When in doubt, even ask your pharmacist for a second opinion; sometimes, they know more about these medications than the doctors who prescribe them.
- Finally, if you choose to go on Accutane, make sure you are doing it for YOU. Don’t let others pressure you into any one form of treatment, though it is easier said than done. It can be emotionally taxing when people comment on how ‘bad’ your skin looks, and I have an abundance of people who were actually okay with their acne before family and friends nagged them to get it treated. The truth is, having acne is completely normal, and learning to accept it plays a part in body positivity. In fact, even the unforgiving realm of fashion is beginning to accept and reframe acne in the context of beauty. Treating acne because it hurts to sleep on the side of your face is one thing, but never feel that you have to do it to make the rest of the world happy.
(And, as an aside, while this article is categorized under Cruelty-Free Beauty and Skin care, please note that pretty much any prescribed medication is not cruelty-free, and that I made this choice years prior to committing to a more cruelty-free lifestyle).