The first time I really noticed my acne, I was in the seventh grade at a sleepover with friends, and we were playing with makeup. I had just swept on baby blue eyeshadow and a hideous frosted lipstick. It was very Lizzie McGuire, and it was everything. But while checking out my masterpiece in the mirror, I noticed a small eruption of red pimples on my forehead and cheeks. I suddenly went from loving my makeup to wanting to bury my head under my pillow. Still, it wasn't the worst; I was comforted to notice that my friends had breakouts just like me. I figured it was a rite of passage—like bleeding through my pad or an awkward first kiss.
When high school began, my acne hadn't gotten any better, and it wore down my already low self-esteem. I felt so self-conscious that I would wake up first at sleepovers so I could cover my pimples with concealer. I turned down after-school plans when I didn’t have makeup in my bag to touch up, and I applied another layer of foundation before heading to my dance classes (which, looking back, probably contributed to the problem). After raiding the drugstore for over-the-counter treatments with little success, my mom finally took me to a dermatologist at the start of my junior year.
At first I went on a series of topical medications (not effective enough) before moving on to an oral antibiotic, which didn’t stop my acne completely but made enough of a difference for me to start to feel good about myself. My remaining breakouts were generally limited to my chin, but they were cystic, painful, and most irritatingly, constant. I always had at least two deep red pimples that would inevitably scar.
By the time I got to college, my acne was no longer just an insecurity but a huge factor in my worsening mental health. I felt trapped in my own skin, to the point where I refused to go out on weekends. I was constantly comparing myself to other women and feeling increasingly worthless. I had always placed value on my appearance and was preparing to enter the beauty industry. It weighed on me.
After a brief experiment with spironolactone, a blood pressure medication used to fight hormonal acne, that hit a wall, my dermatologist finally suggested I go on isotretinoin—commonly referred to as Accutane, a now discontinued brand. At the time I was about to graduate and desperate to try anything that could clear up my skin.
It's now a year after I finished my treatment. And ultimately, I'm so glad I did it. I wouldn't go so far as to call it life-changing, but it absolutely had an effect on my outlook and how I feel about myself. My skin today isn’t perfect, but it’s leaps and bounds better. It wasn't an easy process, though. Going on isotretinoin is a serious undertaking that involves pregnancy tests and flaky skin. The decision to go on this medication shouldn't be taken lightly. Read on for the nine things I wish I'd known before going on isotretinoin and what you need to know about Accutane side effects.
It works like a topical, but stronger.
Isotretinoin is an oral retinoid, so it behaves similarly to the way a topical retinoid would, just at a much higher strength. It regulates the way dead skin cells are shed, so there’s less build up and pore clogging. It also reduces oil gland size and production by up to 90%, which is why dry skin is such a common side effect.
You'll need to avoid alcohol.
Most doctors recommend avoiding alcohol during treatment, which is something to consider before committing to the medication. However, the level of strictness varies; some doctors suggest not drinking at all, while others are a little more lenient depending on your family history and other factors.
"The most common reaction is that alcohol can lower the effectiveness of the medication," says Miami dermatologist Loretta Ciraldo, M.D., FAAD. Most notably, she says "in larger volumes, the combination can result in liver damage"—even just drinking a large amount at one party. "My best advice is that if you do party often and know you cannot stay away from drinking alcohol on a regular basis, you shouldn’t take isotretinoin," she says.
I’m not a huge partier, but I started the medication during the holidays, and it was nearly impossible to ignore alcohol, so I did have a drink here or there. While I personally did not experience any effect on my liver, I drank at my own risk, and you should discuss your drinking habits with your doctor before starting the medication. That being said, I do wonder if drinking did lessen the effects of the meds, since my skin isn't 100% clear, so it's certainly something you should be aware of.
It might take awhile to see results.
In order to see the full effects, the FDA says, your doctor should put you on it for 15 to 20 weeks, or about five months—I was on it for six. I didn’t see the results I was hoping for until around three months in, after my derm upped my dosage. This is not uncommon, but Ciraldo says that you should see noticeable improvement around the six- to eight-week mark. She recommends taking selfies (full face, left and right sides) regularly. If you’re not seeing significant improvement by eight weeks, ask to increase your dosage.
Your skin might get worse before it gets better.
Mine certainly did. My acne was mostly contained to my chin, but after a few weeks on isotretinoin, I began breaking out badly on my cheeks and forehead as well. My doctor assured me that this would clear up—it did after a few months, but it definitely made the first half of my treatment harder. It also left me with some scars I’m still working on fading.
According to Ciraldo, I was in the minority of cases. Some people do experience worsening if they have long-standing acne. This is usually due to purging, in which the isotretinoin pushes out dead skin cells and debris. Because your skin can become red and dry, the medication sometimes makes acne look more inflamed and obvious. My reaction was probably a combination of purging and irritation, but it eventually cleared up. I just had to push through.
Potential side effects include changes in mood and serious depression.
Case reports of severe depression occurring with isotretinoin have been documented by the FDA, especially in younger teens, however it is unclear if this is directly linked to the drug itself or a symptom of the acne. To be safe, the FDA recommends prescribers check with patients about their personal and family history of psychiatric disorders, and patients should be monitored for signs of depression, mood disturbance, and psychosis during monthly appointments.
For me, I felt acne was directly worsening my mental health, but I was willing to do whatever it took to get clear skin. I'm not alone in this experience; a study published in the British Journal of Dermatology last year suggests that people with acne have a shown a 63% higher risk of major depression than individuals without acne in the first year of their acne diagnosis.
As a safeguard, I went to a therapist regularly during the six months I was on the medication. I didn’t experience severe changes in my mental health, but I did notice a change in how I express my emotions. While taking the medication and even after getting off it, I have become more prone to crying over things I wouldn't have cried about before. While this may not be directly linked to the medication itself, it was unexpected; however, it was ultimately not serious enough for me to stop taking the medication—just something my doctor had me keep an eye on.
Going on isotretinoin as a woman is an especially complicated and annoying process.
Isotretinoin puts your body through a lot, but for a woman it becomes even more complicated. There have been previous instances of the medication causing birth defects, so in order to obtain a prescription, you must register for iPledge. This is an FDA-regulated program that focuses on preventing women on isotretinoin from getting pregnant. To pick up your monthly prescription, you have to schedule a derm appointment to keep an eye on side effects, provide blood samples for blood pressure checks, take a pregnancy test, log into iPledge for a quiz confirming you’re not pregnant, and verify you’re on at least two methods of birth control.
It's a huge undertaking. I'm afraid of needles, and getting my blood drawn monthly took a lot of getting used to. Be prepared to invest a lot of time into the process.
Isotretinoin dries out more than just your face.
It was unexpected when I got a gushing nosebleed on the dance floor of a club, but that’s another side effect I experienced. Because the medication slows down your oil production, it’s common to experience extreme dryness all over your body—and yes, that includes inside your nose. Although it wasn’t anything like the snakelike shedding some patients experience, the skin on my face was super flaky. I also had eczema flareups all over my body, something I haven’t dealt with since I was 10. But the worst part was undoubtedly the random nosebleeds due to the mucosa of my nose drying out. And lest I forget, lips that cracked and flaked no matter which balm I used (but the Laneige Lip Sleeping Mask did help).
Your skin might not be perfect—but it should be better.
When I finished my course of the medication, I had the skin of my dreams. Despite some lingering scars, I was finally comfortable leaving the house without wearing foundation for the first time in almost a decade. Then after a summer of clear skin (and shortly after starting my first real job), I began breaking out again. While it’s nowhere near as bad as it was before, my skin isn’t as flawless as I had imagined it would be. I’m convinced it’s due to my new lifestyle—trying tons of products, eating too much sugar, and not getting enough sleep—but Ciraldo notes that the effectiveness of isotretinoin can also depend on the dosage in relation to your weight. If you're not satisfied, you can check in with your doctor about adjusting it.
It might be an option even if you think your acne isn't severe enough.
Since high school, I’d wanted to be put on isotretinoin but never brought it up to my derm. I thought my case wasn't severe enough; the "before" photos I researched tended to show acne that covered the patient's entire face, whereas mine was more concentrated. However, I obviously needed something stronger, as nothing else worked for me. “Isotretinoin is a valid option for someone who does not clear on antibiotics and other oral medications for acne,” says Ciraldo. Despite Accutane's side effects and complicated process, I wish I’d realized it was an option sooner.
Bella Cacciatore is the beauty associate at Glamour. Follow her on Instagram @bellacacciatore_.
