As I announced last September, with the encouragement of my dermatologist, I started an Accutane regimen. I was on the drug for a total of five months, starting in mid-July and ending in mid-December.
Before I say anything about my experience, I want to underline the importance of taking this decision seriously: Isotretinoin (the proper pharmaceutical name for the drug; Accutane is technically a brand which is no longer on the market) is a very serious drug and it took me a lot of personal research and soul-searching to decide if the potential risks were worth having clearer skin. I felt personally reassured by the confidence of my doctor, New York's Dr. Bobby Buka, and I factored his years of experience and advice as a medical professional into my decision making.
As I mentioned in my original post, I've suffered my whole life with breakouts, not just on my face, but on my chest and my back. Anyone who has back acne knows that, unlike facial acne, it's damn near impossible to treat. Despite being a common issue, it embarrassed me and also kept me from wearing anything that revealed my back, even during miserably hot summer months.
Ultimately, that feeling of self-consciousness, plus the reassurance of my doctor, is what got me to try Accutane, and I'm so thrilled I did. If you're thinking about starting an Accutane regimen, I'm sharing all the tips and tricks I picked up during my time on the drug, based on the questions I originally asked Dr. Buka before starting.
What kind of side effects can I expect?
DRYNESS. Sweet merciful moisturizer, so much dryness. Stock up on everything moisturizing you can get your hands on -- my products of choice were plain old Cetaphil, which was super gentle on my sensitive face, and St. Ives Oatmeal and Shea body lotion (despite the fact that it almost landed me on a national terrorism list) because it's cheap, so I could use a lot, and it worked really well. I also really love Fresh Sugar Lemon body lotion but I was going through it too fast for the $22 price tag.
And I should have taken stock in Chapstick before starting because I burned through that stuff at an alarming rate. Initially, I started with Aquaphor, but I didn't like the tacky texture, so I swapped for Chapstick I stole from my brother (sorry, Hunter). I had to give up lipstick -- my lips were just too dry and too flaky -- so if I wanted color, I used Fresh Sugar Lip products.
The unexpected upside of the dryness was that my typically oily scalp dried out so much I could go a full week without shampooing my hair, which was downright incredible considering I used to have to wash it nearly every single day. I used a lot of dry shampoo -- Psssst! is a good drugstore option -- and got loads of compliment on my hair because it looked fuller. After going off the drug, I can go about three days shampoo free, which is still better than it was before.
A weird tip: I found I didn't dry out as badly if I took the drug on a full stomach. No, I couldn't tell you if that's true or not, I don't know science. But maybe because my body didn't absorb the drug as quickly, it wasn't as extreme?
Also, for about the last month or so, I had pretty bad joint pain, especially after working out. I already have a bulging disc in my lower back, and the dryness exacerbated it, so I had to more or less give up the gym for that last period. That has completely gone away since I've been off the drug.
I had absolutely no emotional or mental side effects, though I know people who say they felt terribly depressed on Accutane. I have to wonder if it helps that I did my treatment as an adult rather than a naturally more emotional teen.
Is there a time of year that’s better to take the drug?
Dr. Buka joked that it was like picking your poison, and he was right. I started mid-summer, and that sun sensitivity is no joke. I went to Los Angeles for a week at the beginning of August, where I spent about five hours outside at The Grove with a friend of mine. Despite hyper-vigilant sunscreen re-application (50 SPF more than once an hour) and trying to stay in the shade, I still turned very, very dark.
It's worth noting that, thanks to my Irish and Scottish heritage, I burn more easily than I tan, so I was already coming from a place of high sun sensitivity. Still, after that experience, I didn't dare attempt any pool or beach trips.
On the flip side, as the temperatures dropped in NYC during the fall, my dryness got more severe. I would have dry patches on my arms and legs that were actually painful; I had a creme prescribed to me to combat those spots. I had to apply extra moisturizer at night and in the morning.
Since most of my treatment happened during the fall, it wasn't too terrible. I'd definitely recommend spacing out treatment, if possible, so that the majority of treatment happens during spring or autumn.
Can I drink while on Accutane?
I just wouldn't. I know, boo.
That being said, here's the truth: I totally did. I even got drunk, more than once (mostly accidentally -- will explain in a bit), despite the fact that Dr. Buka recommended no more than two drinks per sitting. I'm not a medical professional, but here's what I noticed: I got drunk much, much faster than I normally would. Perhaps it's because, as Dr. Buka said, both the Accutane and alcohol process through the liver, but after just one or two drinks I would find myself tipsy. And, once at the tipsy point, going over that two drink allotment became a lot easier/more likely.
The next day, my hangovers, normally fairly mild, were wicked. Not to mention the fact that while falling asleep I would be incredibly paranoid that I would probably die because I wasn't supposed to be drinking, which -- it goes without saying -- is a completely unpleasant way to fall asleep.
So, all in all, I recommend going completely dry for the duration of treatment. Sorry.
Should I use anything else to mitigate breakouts while on Accutane?
Definitely, definitely not. First, I noticed a difference after being on the drug for just a few weeks, so I found I didn't really need anything extra. Once, though, I made the mistake of slathering on some Retin-A I had leftover from my old regimen. Never, ever do this. It burned very badly, and made my face red for about two days.
There were even times that my very mild cleanser of choice, Cetaphil, would sting my face.
The one thing I allowed myself, despite the doctor recommending otherwise, is an occasional blast with a Clarisonic face brush. I did this max three times a week, using no soap or cleanser (just warm water), with the softest possible brush (I used the Sensitive Brush Heads) just to help clear away some of the dead skin that was flaking off.
Will my acne come back?
This one is a bit tricky for me to answer. I've been off for just over two months, and I have to say, I haven't had any big problems. I still occasionally get a pimple on my face, but it's always after I've fallen asleep in makeup (bad, I know), and they're small, painless things as opposed to the deep, painful ones I got before. I haven't broken out on my chest since, and I had one zit on my back but I think that was due to a too-tight bra.
Overall, as I said, I've never been happier with my skin. Now I do some mild Retin-A treatments for discoloration left behind and to pre-treat for wrinkles, but otherwise, my skincare routine has stayed really simple.
I definitely feel that I benefitted strongly from taking Accutane -- I joke often that Accutane should have been paying me to take it. Even makeup artists backstage at fashion shows commented how clear and glowing my skin looked. And while it might have been the juice (I was drinking a lot of Juice Press and Organic Avenue) it's just nice to feel confident about my skin. I even occasionally go out without any makeup -- something I never would have done before -- and my concealer hasn't been touched in ages.
Now, if this endless winter ever goes away, I can break out the tank tops.
My Accutane Survival Kit: