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A Skin-Care Obsessive's Dilemma With Going on Accutane

Why does the idea of turning to this common acne treatment make me feel like a failure?
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Just some models with perfect skin. (Photo: Imaxtree)

Just some models with perfect skin. (Photo: Imaxtree)

When I decide I like something, I throw my entire six-foot frame behind it. I obsess over whatever it may be for days (this new Korean lunch spot that delivers to my office), weeks (Janelle Monáe's Dirty Computer), months (the Lifetime Movie Club app), or years (Britney Spears). I read, listen and watch everything I can until I become a self-designated expert on the matter.

So, just like a lot of people, when society began to really unravel, I turned to skin care as a means of trying to control a small part of my universe and feel good about myself. I belabored Steph with incessant Gchats about serums and essences. I read everything Fashionista and The Klog have written about getting clear, glass, honey — whatever skin was not mine.

I started going to a dermatologist who has pumped Who's and Them's with injectables. I carefully built extensive, double-digit-step routines (separate ones for morning and night, naturally) comprised of freebies I'd nabbed from the beauty closet, products I spent too much money on and various prescription topicals. I started taking a massive dose of spironolactone.

And it worked. My skin began to clear up. The mounds of cystic acne shrunk; I started to glow without copious amounts of highlighter. I came to be regarded as a skin-care expert amongst my friends. They'd slide into my DMs, asking for cleanser recommendations or advice on how to spend their treasured Sephora gift cards. I became known as a sheet mask obsessive. It became a part of my identity: "Oh yeah, Liza has tattoos and likes bagels and skin care."

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But then my skin plateaued. It's less prone to breakouts than it was when I started this journey, but it's not fully clear. I wake up with an errant zit and pick and pick and pick, against my better judgement. I get lazy (thanks, bipolar depression) and won't do my routine. I get manic (thanks, again) and try too many new products at once, teetering on the edge of a home chemistry experiment gone wrong.

So I've finally approached my last-resort option: I've decided, under the advisement of my dermatologist, to start a round of Accutane (the commonly-known brand name for isotretinoin, an orally-administered vitamin A derivative). And I can't help but feel like after getting this far, I failed.

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To put it bluntly: The experience of taking Accutane notoriously sucks. It dries you out from the inside until you're SpongeBob begging for water at Sandy's. It makes you more susceptible to nasty sunburns, something I'm already too familiar with, given that my skin is the color of computer paper. There's a risk of depressive, suicidal thoughts. The effect it has on pregnancies is terrifying. The amount of time inevitably spent dealing with blood work and insurance questions is maddening.

But it works, I'm told. And while having acne-ridden, pockmarked skin is by no means the worst thing in the world, it's certainly not the best. I want (and deserve!) to look in the mirror and be happy with what I see.

The irrational, loud part of my brain is telling me that once I take that first pill and give up on the skin-care regimen I've so carefully honed, I will have officially failed. That all the time I've spent studying lotions has been a waste. That I've been unable to solve the issue on my own, and now I need a metaphorical white knight to come sweeping in to save me. That maybe, and worst of all, not even Accutane will work, and I'll be stuck in this self-conscious, zit-plagued boat forever.

Is there one more exfoliating acid I should try before having to pledge to take two different types of birth control ("my IUD and celibacy, because men are trash," which my dermatologist loved, or at least pity-laughed at)? Is there one more spot treatment I should obsessively read reviews about for hours before I ultimately give up trying to do this on my own?

The rational, quiet part of my brain knows this is absurd and dramatic. I know none of my friends will care, that they'll probably still ask me questions about skin care, and they will still be (hopefully) pleased with the results of their own experiments. Logically, I know nobody in my life will give me going on Accutane even a single moment's thought and yet, here I am, feeling like turning to this last-ditch, heavy-duty prescription negates my previous dermatological knowledge and reveals me as some kind of fraud.

I know I'm not alone in this. While a lot of people are doing the work to try and destigmatize acne, my anxiety and feelings are intrinsically tied to my self-worth. There's nothing wrong with doing things that are harmless to others to feel better about myself. If this were any other medical issue, I'd have zero issue with taking the medication I need to feel better. So why is this different? I'm not sure (and will probably pay a therapist thousands in copays to find out in a few years), but if putting these words out there can make even one person feel less crazy about one of their own skin-related existential crises, I'll be glad I did it.

I might have fallen down a rabbit hole, but at least maybe, by the time I hit the bottom, I will have clear skin. Oh, and if anyone out there has any moisturizer recs, please DM me.

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