Accutane

I am listing Accutane under the “Beauty” tab but the path to considering it and doing it is anything but beautiful!  If this is a post you care to read about, let me offer you my greatest sympathies for what I know has been an endless and frustrating struggle with bad skin.  While I am generally all about anything natural, I did a four-month treatment with Accutane for acne and it is an extremely powerful and effective drug.  It was grueling at the time but now, nearly two years since my treatment, I don’t regret my choice.

I had always thought I had decent skin, except that I would get an occasional deep cystic spot that would take over for a couple of weeks. It wasn’t only the unsightliness of these bumps that disturbed me but the fairly intense pain they would cause.  Like most people with problem or occasional problem skin, I tried just about everything regarding skin care products, personal health and personal hygiene to clear it up.  These occasional cysts at one point turned to full blown acne, with 1-2 new ones cropping up every day about 5 years ago.  It was a really difficult period in my life (early 30’s) and it’s possible it had to do with stress.  I did try to control the stress with yoga and acupuncture and…you name it, but it just wasn’t working.  At the time, I wasn’t taking birth control pills so I think the lack of those hormones in my body wasn’t helping matters.  The Pill makes me cringe nowadays but it does help keep problem skin under control.

Prior to my taking Accutane, I tried a medication called spironolactone (aldactone) in conjunction with antibiotics.  That treatment cleared up matters in this first bout of acne.  This drug is an anti-androgen so it is not suitable for men.  Often times women have a slight hormonal imbalance which the spironolactone “corrects.”  I eventually went off it and my skin was truly perfect for about a year and then, again at another stressful time, the acne flared up.  It was so painful, physically and emotionally.  I couldn’t stand to look in the mirror and honestly didn’t want to really leave the house.  After reluctantly returning to my doctor for more spironolactone and antibiotics, he suggested that since my acne seemed to be long-term and not responding particularly well anymore to the previous methods, perhaps I should try Accutane.  He admitted it was a bit overkill but said that if I did the drug, my skin would be perfect forever.  He was mostly right thus far and I’m still trying to decide if it was worth it.  But I guess that’s easy to say from the other side, with nice skin.

As I understand it, there are a few different types of acne.  Some are more surficial and clear up after a certain amount of time when hormones, etc. dissipate but the cystic kind is the one that Accutane is used for.  This cystic acne occurs when the cells lining the sebaceous glands are faulty.  While the cell walls normally allow for passage of sebum (oil) to the surface of the skin, a person with acne has extra sticky cell walls and the sebum is not able to make its way to the surface.  In addition to the sebum being trapped, the bacterium P. acnes that lives on the skin has a little party in this poor clogged pore.  This explains why antibiotics and drugs that reduce the stickiness of the cell walls (like spironolactone) eliminate acne.  But it is a temporary fix.  It keeps them clear while you are on the drug, but skin reverts to its original condition when the drugs are ceased.  Accutane (isotretinoin) is the only drug that actually cures the condition of true acne.  It is basically a controlled form of Vitamin A poisoning that forever changes the lining of the pores.  One of the side effects of Vitamin A is that it basically makes your body stop producing oil.  This is one of the reasons that Accutane is so dangerous.  It stops it in your skin but also affects all the joints, etc. that require lubrication.

Granted, my cystic acne wasn’t nearly as bad as most people for whom this drug is prescribed, but it seemed to be the only thing that was going to clear it.  My doctor, who Chief refers to as “Dr. Strangelove” with his potions, was one doctor who was willing to prescribe it for this slightly more cosmetic fix.  I guess anything related to acne is cosmetic though.  The condition doesn’t really hurt your health but can cause scarring (physical and emotional) and is really uncomfortable and frustrating and annoying and can really mess with your self-esteem.  When you have acne, the fantasy of being able to look perfect without make-up is incredibly alluring.

Dr. Strangelove prescribed me an initial dose of 30 mg/day to be taken twice/day to see how I responded and then planned to up it to 40 mg/day if I did well.  He thought a four-month course should be sufficient to completely clear the acne.  I read a lot of forums in which people did much lower doses over longer periods of time but it often seemed that some of the long-term side effects were associated with people who did that method.

If you are a woman of childbearing age, you MUST not get pregnant.  It will almost unequivocally cause birth defects if you become pregnant while the drug is in your body.  So one month prior to beginning the course of treatment, you must take a blood pregnancy test.  Once that comes back negative, you are issued an iPledge card that you must present in order to fill your prescription.  The iPledge program mandates that you take a quiz each month regarding how to prevent pregnancy while on Accutane.  You must use redundant forms of birth control.  You are then tested each month for pregnancy at the dermatologist’s and also monitored to make sure your liver is healthy.  Once the pregnancy test comes back negative, and the quiz has been taken, your prescription is called in and there is a small window during which time you must pick up the pills.  They can be extremely expensive but I was fortunate enough to have them mostly covered under my healthcare plan.

The primary side effects from taking Accutane are dry, itchy and flaky skin, and dry lips.  There can be far worse consequences, which you will find anywhere you Google Accutane.  I guess that is an issue with any prescription really though.  My doctor basically said it would suck and I would feel kind of old when I was on it (some neck and back pain) and that my skin and lips would be really dry.  He said the main thing to watch out for was headaches, with the severe ones not being at all normal.  I began taking my pills and within the first couple of weeks, I noticed major changes.

The first change I noticed was that I had a severe and humiliating breakout.  I guess this is pretty common and is generally termed the “Initial Breakout” or IB in Accutane forum language.  I Googled extensively to figure out when it would go away.  It seems most people saw it disappear by the end of the first month, but others had bad skin nearly the whole time they were on the drug.  Looking at some of the pictures of other brave souls who had posted their initial breakouts actually made me feel better about my own condition.  I mean, I looked terrible but some of these other people truly looked like sorrowful little festering monsters.  I guess it is basically turning your pores inside out so everything that was brewing beneath the surface that was eventually going to become infected reveals itself.  This was horrible and on top of that, I began to get intensely itchy skin, including my scalp.  It was absolutely maddening.  I found out later that my new place had a flea problem too, so I don’t know how much of these things were related to each other.  My lips and hair dried out a lot too.  I had to place Aquaphor (which seems to be the only thing that works for lips) in every corner of home, work, car, and purse.

There is also a side effect of the drug that can result in depression and even suicidal thoughts.  I was slightly concerned about this because I had a bout of depression at one time in my life and I was scared about slipping back in to it.  I can’t say that I necessarily felt any but I think that during the course of the treatment, I wasn’t in the most jolly or energetic mood.  I would say I retreated from the world for a bit but part of that was because I was uncomfortable and initially, embarrassed of that first breakout.  I was also busy getting my new house settled.  The effects of the birth control pills I had to start and tiredness from my move cannot be discounted as possible factors contributing to this general feeling of wanting to withdraw.  I was also sore in a number of my joints and upper back and did just generally feel old.  I suspect this effect would not have been quite as pronounced had I not been 33 years old during the time of the treatment.  I tried to take it easy on my workouts while I was on it, but it was kind of frustrating because I was starting to get chubby from the stupid Pill too.

I stopped the treatment at about 3.5 months through, just two weeks shy of the 4-month goal.  I just couldn’t stomach taking another pill.  Apparently, a lot of people quit once their skin clears up, but they warn your acne will eventually come back if you do that, even if it’s in another year or two.  You have to take the full cycle for the Vitamin A to completely clear through the pores and mine them of everything that has been lurking beneath.  It is now nearly two years later and my skin is still great.  I will occasionally get a tiny spot but it will just be surficial and clears up in a couple of days.  I think it was worth it, assuming no problems with this crop up later in life.  It did take about 4 months after I quit the treatment to feel completely the same inasmuch as my joints were concerned.

I love having totally clear skin and I love being able to not worry about how anything I’m doing or applying to my skin may be causing a breakout.  I am able to focus with my aesthetician on keeping my skin beautiful with microdermabrasion and mild peels and not simply trying to excavate my face or solve the acne.  I regularly smooth pure oils, etc. all over my face.  I am glad that I did the drug overall, but I almost feel like it was a plastic surgery of sorts.  The acne, while painful, wasn’t causing me any harm except for feeling like an ugly misfit, and I did a potentially dangerous treatment to clear it.  It is hard to say what the side effects of taking Accutane for 3.5 months would be relative to others I know who are in their late thirties and for the last 10 years have been taking various antibiotics or drugs like spironolactone.  The thought of consuming all those antibiotics (through skin or stomach) is kind of frightening.

I also have to wonder what caused the acne.  As I mentioned in this post, acne seems to happen to so many of my girlfriends in their late 20’s and early 30’s.  Almost every woman I know has been on hormonal birth control at some point in her life.  Many others I know have had trouble getting pregnant and have done various different methods for helping them along.  So by controlling or causing pregnancy or just being pregnant itself and all the dips and turns and halts in hormones, I think the hormones entering and leaving the body must have an effect.

I have also heard some mention of acne being a result of the P. acnes bacteria being so strong.  Could it have been fortified to withstand an assault from the vast amount of antibiotics we have all been ingesting all our life in the name of health, or “safe” food or for cosmetic purposes to clear up the very thing that we are making resistant? I don’t know the answers but this seems to me to be a very modern-day phenomenon and I don’t discount there is some component to how we flippantly wreak havoc with our hormonal and bacterial balance.  I do have a lot of male friends that have struggled with this problem in their late 20’s as well, so I don’t think the hormonal component is the sole cause.

If you have read this whole long post, you probably have done Accutane or are considering it for yourself or someone in your family.  I wish you the best of luck and beautiful skin.  Please, please contact me with any questions I might be able to answer about my experience with it.  I posted this because it is so hard to find information out there.  I swear that I once saw an article by Dr. Audrey Kunin of the famous brand DermaDoctor about how she used Accutane but it is nowhere to be found on the web now.  Her testimony is one of the few things that made me OK with doing the treatment.  One of the only people I’ve ever seen actually talk about it is Elle Fowler of  AllThatGlitters21 on her YouTube video.  I love watching her make-up tutorials.  Again, good luck and I hope you arrive at the blessing of clear skin!

3 Comments

  1. Amy January 17, 2013 at 8:09 am · Reply

    I used Accutane for about 6 mos my freshman year of college (in the late 90’s) because I was tired of dealing with the constant acne I had all through high school. My doctor even prescribed a double dose based on what I needed for it to be effective. It eventually seemed to accomplish the goal; however, I continue to need to use anti-acne skin care products.

    Recently (in my mid 30’s) it had gotten pretty bad again. It was so frustrating. The only reason I can think of for it would be stress. I tried numerous different skin care routines, including adding the clarisonic, in my futile attempt to correct the problem. I think I have finally found the right combination for my skin (for now at least) and will stick with it. But as far as accutane “curing” acne forever I would have to disagree. Maybe having a baby a couple years ago threw eveything out of balance again or maybe it wears off after 15 years. Who knows?

    On another note, I developed vitiligo almost five years ago. I have done extensive online research and read countless forums about it. Basically, your immune system attacks your melanocytes because it thinks they are foreign and you lose any pigment in areas. It can be very mild or it can be very aggressive. Mine happens to be aggressive. During one of my research sessions, I ran across a forum where people were questioning the long-term wide effects of accutane. When it was originally developed, it was used as a chemo cancer treatment. That made me wonder if using accutane so long ago could have anything to do with my vitiligo. There is no way to know, but it would not surprise me.

    • Emily January 17, 2013 at 10:39 am · Reply

      Thank you so much for your thourough and thoughtful response, Amy. That sucks that you are still dealing with the frustration of problem skin. I know that for people who haven’t experienced it, it seems like a simple fix would be possible, but that is so far from the truth. It’s so hard to find a regimen that works and once it finally does, the spots seem to adjust and sneak around it, I swear!

      I appreciate your comment about Accutane not always “curing” acne. I agree that it seems like a lot of people I know do seem to have a reccurence, often times 10-15 years after their first round. I have my fingers crossed that it will hold out on me since I did it in my 30’s.

      I think you’re right that the recurrence probably had somehting to do with stress or pregnancy…I guess the two things are often related in certain ways! It seems like 30’s can be a really overwhelming time trying to juggle career, children and relationships and I know how hard you work to succeed at all those things. That might be a reason (instead of or in addition to hormones?) that so many of the women I know struggle with acne at this age, or have a recurrence at this age. I definitely noted a correlation between my acne and stressful periods of my life.

      The thought that accutane could be responsible for your vitiligo is a scary one. I guess there are so many cause-and-effect things, especially long-term, that are possible with anything we ingest… especially if it fundamentally changes the way our bodies work. I honestly feel this way about the Pill too and that’s why I question it frequently in this post. Again, I hope nothing crops up with me, but I know it’s not outside the realm of possibilities.

      One thing about acne is that it always looks/feels worse to the person who has it on their face than the person who is looking at their face. Beauty shines through a few spots but it can hit you as far as feeling confident and carefree, I know. I’m sending you love and glowing happy skin, my dear! xoxo

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