According to Dr. Alexiades-Armenakas, these risks include birth defects in any female who gets pregnant while on Accutane. Liver damage or even liver failure is another important complication to look out for and is why frequent blood tests are drawn. Blood counts can drop while on the drug, putting people at risk for infection or anemia. Other problems include bone pain, rare instances of spinal abnormalities caused by the drug, and pseudotumor cerebri — a condition where fluid accumulates in the brain causing headaches and dizziness. "Depression and suicide are also reported risks; the son of a senator commited suicide while on the drug so now a whole page of the consent form is dedicated to this issue," she adds. All that for clear skin? Yeah, think we'll pass.
The problem is, as anyone who has ever suffered from a horrific case of cystic acne can tell you, having severe acne can be an emotionally debilitating experience. "For anyone who gets cystic breakouts, it is embarrassing and makes work meetings and social events very upsetting, as you cannot hide the cysts with makeup," says Dr. Alexiades-Armenakas. "Women in particular suffer from adult acne more commonly than men, such that its implications in the workplace are far greater. In addition, the use of makeup and powders exacerbate acne in women, as does the menstrual period, making it even harder to get under control."
But, just because you're not willing to sacrifice your health for no pimples doesn't mean you are relegated to a zit-filled existence. According to Dr. Alexiades-Armenakas, there are some simple switches you can make that will help create a drastic difference in your skin. "The use of occlusive makeup and powder is a vicious cycle,"she says (occlusive here meaning those that block your pores). "Oftentimes, women cover up their mild acne with the wrong makeup or with powder, which worsens the acne, which results in more and more application of the exacerbating products. You need to break this cycle and put women on the correct non-comedogenic makeups and quit the powders. Creams can do it too, especially those with petrolatum or oils." She recommends her 37 Extreme Actives face cream, which is formulated to be devoid of petrolatums or oils and to be completely non-acnegenic.
In addition, she also says to avoid tanning the skin — while the sun may initially fight bacteria, tanned skin thickens and ultimately causes more clogged pores and breakouts. In addition, she also says you should be using a medicated cleanser, then the appropriate acne medicine on your skin twice daily. Talk to your dermatologist to determine which type is best for you, since not everyone's skin responds to the same medication in a positive way. Finally, for those with hormonal acne, Dr. Alexiades-Armenakas says a simple switch to their oral contraceptive can usually cure it.
Bottom line: You shouldn't turn to Accutane unless you have literally tried everything — and we mean everything else. Try topical products, in-office treatments, prescription medication, and laser or light therapy first, and if all the different variants of those options don't make a dent in your acne, then and only then should you approach the topic of Accutane with your doctor. But, remember, the risk of these serious health problems is very real, so you need to be aware of them and decide for yourself if you are willing to take those risks in your quest for clear skin.
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Photographed by Erin Yamagata