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Since its introduction, Accutane has been a hot topic in dermatology. That goes not only for the physicians who use it but also amongst potential consumers seeking to treat acne. Although the promise of acne free skin is enough to make anyone jump on board, Accutane is not a quick fix. It can be a long and uncomfortable process. While I support and have encouraged people to consider Accutane, I am also open about my not so pretty experience. If you are being recommended Accutane by a friend or physician and are currently weighing whether the treatment is worth it, keep reading. By sharing my personal experience, I hope you will come out with a better understanding of the treatment process and be able to make a confident decision as to if it is right for you.
A quick disclaimer: everyone’s experience with Accutane is unique. Everyone has different skin, different reactions to the medication, and a different relationship with their acne. This information is specific to my situation. By no means should my experience be used as a guideline for your Accutane journey. It should only be used to help qualm some of your fears about Accutane or concerns about things you may or may not experience. If you experience any side effects, you should still report them to your doctor and seek advice for treatment.
What Is Accutane?
Accutane is a trade name for the drug Isotetrinoin. It is a vitamin A derivative, which is actually produced in small quantities by the liver. Produced synthetically, this potent medication is often thought of as a holy grail for people diagnosed with severe or adult acne. It is specifically made to treat acne that is unresponsive to conventional therapies. Due to the serious and severe potential risks of taking Isotetrinoin, it previously had a “black box” warning before the Accutane Pregnancy Prevention Program, eventually called iPledge, was implemented. While Accutane is the most recognized brand name, you may receive another. Some will be cheaper depending on your insurance. These include Amnesteem®, Claravis™, Myorisan®, Absorbica®, and Zenatane™.
There are inherent risks to any medication, but the process to obtain approval to use Accutane is strict. In my opinion, that’s with good reason. Before I list just a few of the side effects, let me explain what you will experience if you have yet to approach a dermatologist about Accutane.
The dermatologist will first and foremost want to determine whether you are a candidate. Not everyone is, but if you are turned away, don’t be discouraged. I was at first too. The physician is simply looking out for your best interests. They do not want to put you on a harsh medication, such as Isotetrinoin, without first trying every other option.
I was only approved once I had unsuccessfully tried multiple rounds of other medications, including Epiduo, Differin, and Minocycline. That’s just to name a few. At the age of 24, I was still experiencing moderate cystic acne. It was only after I had exhausted my other options that I was approved for Accutane, and this was mostly due to the fact that it was beginning to cause scarring.
When I visited my dermatologist for my first appointment, I was quickly disappointed. She explained to me that I would not receive a prescription that day. Instead I would have to take a pregnancy test and another one at the follow up appointment. Only once I had passed both would I receive a prescription. During this month, I would also have to confirm that I was on two forms of birth control. You can choose which forms, and there are many options which can be discussed with you. You will receive an iPledge folder, which contains your ID and an entire booklet about the risks of Accutane. Their primary concerns are the following:
That you get pregnant.
Taking Isotetrinoin while pregnant is known to have a high risk for severe birth defects. This comes directly from that book: “Birth defects which have been documented following isotretinoin exposure include abnormalities of the face, eyes, ears, skull, central nervous system, cardiovascular system, and thymus and parathyroid glands. Cases of IQ scores less than 85 with or without other abnormalities have been reported. There is an increased risk of spontaneous abortion, and premature births have been reported.”
Your liver function.
Isotetrinoin can lead to liver alterations. More specifically, it can raise the level of fats and cholesterol in your blood, causing fatty liver. Your physician will perform lipid and liver function tests regularly and adjust your dose as needed.
Your mental health.
Isotetrinoin can cause serious mental health problems and worsen problems for those known to have mental health problems. There is no test for a physician to check your mental health. It is up to you to communicate your experience and concerns. You need to be open with your doctor at all times. Isotetrinoin has lead to depression, psychosis, and suicide.
Aside from these risks, there are countless others. The one that most concerned me was damage to your eyesight. It can cause blurry vision, decrease your ability to see at night, and even permanent loss of eyesight. There is of course no way to bypass these risks. It is up to you to weigh the risks against the benefits. I chose to proceed.
After I left the appointment, I was instructed to log into the iPledge system to input by birth control methods and answer a series of questions. The answers can be found in your iPledge booklet. You have to pass all of the questions in order to be approved for your prescription. If you don’t pass, you just retake it. Once you pass, the prescription will be approved by your physician, and you can go pick it up.
The first month is very much a learning process. You have to take your meds at the same time every day. I chose to set an alarm to remind me. It is also recommended that you take it with a food high in fats to help absorption. I had much better results after actively including fats. I often ate nuts, peanut butter, or an avocado. It can be tough to get a hang of the process and get a good schedule down, but things eventually come together.
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Returning to my dermatologist, I was extremely excited. I first completed my pregnancy and liver function tests. I was lucky enough to have a dermatologist who performed these tests at their office. You may have to go to a lab. Afterwards, my physician had me enter my two forms of birth control into the iPledge system. You have to choose your primary and secondary form of birth control in the same order every time. She decided to start me off on a 20 mg dose.
At this time, I expressed a concern for swallowing the pills. If you have the same problem, I promise you can do it. Just practice until you find a method that works. Mine ended up being chewing a crunchy food like cereal or nuts before tossing the pill in at the last second. No, you cannot cut open or chew the capsules. The medication can cause serious damage to your esophagus and stomach.
By the end of the first month, I was not having any considerable side effects. I noticed that the skin on my face had started to become more dry, but just a little extra moisturizer went a long way. My problem areas were primarily my jaw and cheeks, so these were the areas I would pay the most attention to.
At my monthly appointment, my physician performed the routine blood tests. She asked if I had noticed anything different, which I had not – nothing physically or mentally. I was sent on my way with an increased dosage of 60 mg. She did encourage me to start drinking a lot more water to combat any side effects I would likely soon experience.
When I returned to the physician to start my third month, I was experiencing a few common side effects. First, there were nose bleeds. I typically had a nosebleed here or there, and at first I assumed it was the shift to winter weather. When I began to get almost nightly nosebleeds, I knew it was the meds. They were often very drawn out. I tried to combat this with a saline nasal spray almost three times a day. It did very little to stop the nosebleeds, but it did make my nose feel a little better. I also put a little bit of Aquaphor into my nose.
My face had become much dryer, so my dermatologist recommended that I start using the Cetaphil Gentle Skin Cleanser and this Moisturizing Lotion. Finally, my lips were starting to crack, especially at the corners. At this point, I grabbed an Aquaphor Lip Repair.
An odd side effect that I also noticed occurred when I worked out. If I was in the sun, I did have some sensitivity, but sweating caused an almost burning sensation. I like to run, and so this did become a problem for me. I started being careful to not touch my face when I worked out, as it would set off the burning sensation. Instead, I immediately splashed my face with cool water afterwards and would pat dry with a soft towel.
By the end of the third month and starting the fourth, I was very uncomfortable. My acne had actually gotten way worse. As usual, the doctor informed me that “it would get worse before it got better.” My skin was very inflamed and dry, literally peeling off in sections. At this point, I switched to Cerave, which I found to work much better. It seemed to be a lot more moisturizing and less stripping. I also began to rely on Belif The True Cream Moisturizing Bomb.
It is one of the most moisturizing products I have ever used. My lips were constantly split, right down the middle, and very cracked at the corners. No matter what I did, they would split open. I tried to brush my lips weekly with some petroleum jelly and then lathered on some Vaseline Cocoa Butter Lip Therapy. I was still experiencing nosebleeds, often multiple times a day. And, I was drinking water like my life depended on it, but I can’t say that I felt any physical relief from it. All of these things were more so providing relief than stopping any of the discomforts.
At this point, my physician recommended we up the dose again. This would be almost the peak of my treatment, so we went up to 80mg.
During this month, my previous side effects persisted. I also had a new and more unsightly issue, which was a full body rash. It started on my arms and hands before moving to the tops of my legs. It was very similar to Rosacea, forming in red patches with small bumps. These patches were incredibly itchy and painful to the touch. I did inform my physician about this, and she prescribed me a topical cream. It was in combination with aquaphor and provided some relief but did not clear it. I started using a lot of body moisturizer at this point, specifically Cerave, which comes in very large pump bottles.
For my last month on Accutane, I was still just trying to find relief and power through the discomfort. My dermatologist lowered by dose back down to 40 mg, since I was seeing significant improvement. At this point, I was no longer having large clusters of acne; rather a pimple might show up here or there. My jaw was completely free of acne for the first time in years, which was the most noticeable area of improvement. I still had a bit of inflammation and so was a little red and dry, but this was not as much as previously. My nosebleeds had slowed, and my lips weren’t as bad either. Although I did have my rash still, no new patches had formed.
My Mental Health on Accutane
My mental health before and on Accutane was relatively the same. I was really grateful for this, as I know others who weren’t so lucky. I have anxiety and take 10 mg of Escitalopram daily. This medication significantly helps with my anxiety, and so I was worried that Accutane might worsen it. Thankfully it did not, but I did have some down days and times, which is typical.
I had a lot of anxiety about the overall process, and I did get frustrated sometimes. It can feel a bit bothersome or like a chore, as it is so intensive. On multiple occasions, I went to two or three locations to get my prescription filled because one pharmacy didn’t have enough in stock.
My biggest issue was when my acne worsened in the middle of the treatment. I wasn’t expecting it to be cured overnight, but I wasn’t mentally prepared for it to get so bad. I came to understand that it was my skin pushing everything out, but at the time it was really difficult.
While I had become pretty adjusted to having acne after almost 13 years, I really got my hopes up about this treatment. I think a lot of people probably experience the same thing by the time they land on Accutane. For most people, it really is a last ditch effort, and because it is pretty much guaranteed to work, it is upsetting when you feel like the opposite is happening to you.
Although I didn’t have any especially scary mental health issues while on Accutane, I wholeheartedly recommend that you inform the people around you that you are on Accutane along with the potential side effects it can have on your mental health. If they know what to look for, they can encourage and help you seek treatment.
I am now around 6 months post accutane and am happy to say that I am completely acne free. Since my treatment concluded, I have maybe had two or three small pimples. In addition, my skin is much less oily, and the pores are visibly smaller. In the first month following my treatment, all of my side effects subsided. However, I did continue using lots of moisturizers for my body, face, and lips.
I now routinely continue to use CeraVe Foaming Facial Cleaner and CeraVe Daily Moisturizing Lotion. At night, I use CeraVe PM Facial Moisturizing Lotion, and my dermatologist also prescribed Epiduo. I now also use sunscreen on a daily basis, as I still experience some sensitivity. My favorite is Elta MD, but if I’m running, I just use a Sunbum Sunscreen Face Stick. Over time, my scars have slowly healed, but I do have some larger divots. To combat these, I will be getting multiple ViPeel treatments.
Altogether, I am much happier now than I ever have been. I did adjust to my acne, but I feel less like I’m convincing myself when I call myself beautiful. I also noticed that as much as I loved playing with makeup, I was doing it primarily to cover my acne instead of a simple love for makeup. Now I almost never wear any makeup, but when I do, it’s because I’m actually accenting my features instead of trying to hide my acne.
While not everyone’s experience will be the same as mine, I do recommend it. I think that if you have consistently struggled with acne, Accutane may be exactly what you need. I can’t say that it was an easy process or that it wasn’t scary at times, but it was certainly worth it in the end.
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