I Knew Accutane Was Going To Be Rough, But Holy Hell Was It Awful
Last Updated August 21, 2016, 2:00 PM
Accutane: It’s one of the most singularly contentious words in the skin-care conversation, both feared and praised. That’s because the drug is both potent and potentially dangerous — and just happens to be the savior for those with severe cystic acne.
Accutane is the brand name for a drug called isotretinoin — a vitamin A-derivative. It was approved in 1982 for the treatment of severe acne that is unresponsive to conventional methods like topical medication and oral antibiotics. In 2009, the company behind Accutane pulled the drug from the market for unspecific economic reasons. So while we still call isotretinoin drugs Accutane, that actual name-brand drug does not exist anymore. Instead, you can be prescribed Absorica, Claravis, Myorisan, Amnesteem, or Zenatane. According to dermatologist Dennis Gross, MD, isotretinoin is the "closest thing to a cure [for acne that] we have."
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“What Accutane is doing is destroying the [oil] glands that cause acne," says Dr. Gross. He explains that in people with acne, 80 to 90% of the oil glands on the face are healthy and functioning. But 10 to 20% are “sick” and overproducing oil. Accutane targets the cells where acne keeps coming back over and over again and kills them off.
Now, all of this sounds very straightforward and sensible. However, it’s not that simple. Bring up the drug to anyone who had or has acne, and you’re bound to get a response of either, “It changed my life,” or, “Oh my god, do NOT go on that poison.” With possible side effects that range from depression to birth defects, it's understandable why people have such a visceral reaction to it. I, however, am not one of those people. After a year and a half of suffering through the most brutal cystic acne my face had ever come up against, I didn't hesitate when Dr. Gross brought up the drug.
But besides the “don’t get pregnant — no, seriously, don’t” caution you hear repeatedly, I knew very little about what being on Accutane actually entails. With that in mind, I put together a diary documenting my experience, with all the nitty, very gritty, and sometimes TMI tidbits that everyone thinking about Accutane should absolutely know.
The grown-up guide to dealing with acne. Read more from The Acne Diaries here.
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Dr. Gross sent me to have a blood test to check for pregnancy and monitor my triglyceride levels and liver function — Accutane carries a risk of raising your cholesterol. The FDA does not require the liver tests, but Dr. Gross says he orders it to be tested, alongside tests on the kidney and bone marrow. "I do like to do blood tests for a person on Accutane just to make sure other things aren’t happening, like a lower white-blood-cell count. I’m very careful about my blood tests."
I was then given an iPledge form. iPledge is a document that you and your doctor sign attesting to the fact that you will not get pregnant while on Accutane and promising to use two types of birth control. You are registered in the iPledge system, which you need to set up online, then given a basic true-or-false quiz on Accutane best practices.
When my blood test came back clean, I was prescribed a 50-milligram monthly dose. Dr. Gross notes that doses are determined by a patient's weight — a very important point he insisted on hammering home. "Right now, doctors are giving little pills for extended periods of time and it’s wrong. If a woman weighs 120 pounds, then she needs 60 milligrams for 20 weeks — that’s how it works," he says. "But some doctors may give a 120-pound woman a 20-milligram pill for three months. She’s never going to get cured unless you follow the technical numbers here. You don’t want to give them a low dose for an X number of months, make them look good, and they come off it and it comes right back."
Once my prescription was filled at the pharmacy, I had a week to pick it up. After that, the prescription legally had to be returned and a new one written.
One thing I wasn't aware of — because I stupidly didn't fully read through my iPledge form past the "do not get pregnant" part — is that you have to log into iPledge and take a new quiz before picking up EACH prescription.
I took my pills home and prepared to start my slow march toward (hopefully) clear skin.
I was then given an iPledge form. iPledge is a document that you and your doctor sign attesting to the fact that you will not get pregnant while on Accutane and promising to use two types of birth control. You are registered in the iPledge system, which you need to set up online, then given a basic true-or-false quiz on Accutane best practices.
When my blood test came back clean, I was prescribed a 50-milligram monthly dose. Dr. Gross notes that doses are determined by a patient's weight — a very important point he insisted on hammering home. "Right now, doctors are giving little pills for extended periods of time and it’s wrong. If a woman weighs 120 pounds, then she needs 60 milligrams for 20 weeks — that’s how it works," he says. "But some doctors may give a 120-pound woman a 20-milligram pill for three months. She’s never going to get cured unless you follow the technical numbers here. You don’t want to give them a low dose for an X number of months, make them look good, and they come off it and it comes right back."
Once my prescription was filled at the pharmacy, I had a week to pick it up. After that, the prescription legally had to be returned and a new one written.
One thing I wasn't aware of — because I stupidly didn't fully read through my iPledge form past the "do not get pregnant" part — is that you have to log into iPledge and take a new quiz before picking up EACH prescription.
I took my pills home and prepared to start my slow march toward (hopefully) clear skin.
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I started off month four in the same funk I ended the previous month. With every new pimple, my spirits sagged a bit more. Wasn't I supposed to be showing some signs of improvement? What was wrong with me?
In our monthly consultation, Dr. Gross told me he was really happy with my progress — I started to think he was just being extra nice to me so I didn't get even more depressed. He explained to me that another medicine I was on for my migraines actually had a side effect of breakouts. Cool.
Because of this, my breakouts were taking longer to fully absorb the isotretinoin into my bloodstream and overpower those oil glands. "We might need to extend your course of treatment a few extra weeks," he explained. Just what I wanted to hear. Not only was it not working, but I was apparently in the remedial class and needed extra help.
I left his office, had a brief crying jag in the Uber to R29 HQ, and then stuffed it all in the back of my mental fridge and ignored it, like that one forgotten, shriveled-up lime hiding behind your mustard.
But then, something crazy happened. The pimples started to disappear. By the end of that week, I suddenly had semi-clear skin. The bumps I had began to shrink up. I woke up with only a few whiteheads, and the relentless, typhoon-like wave of blackheads had receded.
Did I accidentally make a bottle-and-a-half-of-wine drunk deal with some Ursula-esque sea witch to cure my zits? I didn't really care — the stupid drugs were finally starting to work!
To make things better, the dry patches on my arms cleared up almost immediately, my bacne became more infrequent, and that bloody lip-cracking thing came to a halt.
Suddenly all those shitty side effects seemed worth it — friends and coworkers (knowing my recent struggle) commented on how much better my skin was looking. One beauty-editor friend told me that, confidentially, she had been worried about me but now she was so happy for me.
That's not to say I was pimple-free. I still had new breakouts and blackheads throughout the month, along with the occasional cyst on my neck or cheek, but it was nowhere near as agonizing as it had been.
I turned a corner, finally. Let's just hope this sticks...
In our monthly consultation, Dr. Gross told me he was really happy with my progress — I started to think he was just being extra nice to me so I didn't get even more depressed. He explained to me that another medicine I was on for my migraines actually had a side effect of breakouts. Cool.
Because of this, my breakouts were taking longer to fully absorb the isotretinoin into my bloodstream and overpower those oil glands. "We might need to extend your course of treatment a few extra weeks," he explained. Just what I wanted to hear. Not only was it not working, but I was apparently in the remedial class and needed extra help.
I left his office, had a brief crying jag in the Uber to R29 HQ, and then stuffed it all in the back of my mental fridge and ignored it, like that one forgotten, shriveled-up lime hiding behind your mustard.
But then, something crazy happened. The pimples started to disappear. By the end of that week, I suddenly had semi-clear skin. The bumps I had began to shrink up. I woke up with only a few whiteheads, and the relentless, typhoon-like wave of blackheads had receded.
Did I accidentally make a bottle-and-a-half-of-wine drunk deal with some Ursula-esque sea witch to cure my zits? I didn't really care — the stupid drugs were finally starting to work!
To make things better, the dry patches on my arms cleared up almost immediately, my bacne became more infrequent, and that bloody lip-cracking thing came to a halt.
Suddenly all those shitty side effects seemed worth it — friends and coworkers (knowing my recent struggle) commented on how much better my skin was looking. One beauty-editor friend told me that, confidentially, she had been worried about me but now she was so happy for me.
That's not to say I was pimple-free. I still had new breakouts and blackheads throughout the month, along with the occasional cyst on my neck or cheek, but it was nowhere near as agonizing as it had been.
I turned a corner, finally. Let's just hope this sticks...
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