How Accutane Changed My Life

Illustrated by Elliot Salazar.
I first developed severe acne at the horrifically awkward age of 10 — a plethora of bumps sprawling across my nose and forehead. Little did I know, many of my teenage memories would be colored by my skin condition: constant teasing from my older brother, being late to my boyfriend’s house because I was sitting in my car and applying another thick layer of cover-up, sleeping in my makeup at slumber parties, too ashamed to reveal my skin to my friends.

At 17, I caught a classmate laughing at a photo of me, mountains of forehead acne entirely visible despite the picture being black-and-white. That was the day I knew I wouldn’t leave my doctor’s office without a prescription for Accutane in hand.

Why It Works
Many consider accutane (isotretinoin) a miracle drug. “Just shy of the point of exhaustion and give up-edness, Accutane will swoop in like a superhero,” says Hillery Sklar, a Brooklyn-based aesthetician. How? “Accutane is essentially [slowing down] the oil production in your sebaceous glands and shrinking those glands down to the size of a baby’s,” she says. As a result, patients who sign up for the Accutane regimen — which typically involves taking the drug once-daily for five or six months — often report never or rarely having to undergo acne treatment, such as topical medication or antibiotics, again.

In 2009, brand-name Accutane was taken off the market, but the several generic options still available — such as Absorica and Amnesteem — work in the same way. “Although the exact mechanism through which [isotretinoin] works to treat acne is not known, it’s believed the active metabolite [in the drug] binds to a specific retinoid receptor, acting on the oily sebaceous glands, which causes them to atrophy, or die,” says Rachel Nazarian, MD, a dermatologist with Schweiger Dermatology Group in New York City. “The patient then experiences a decrease in sebum and oil production, in turn decreasing P. acnes, a bacteria thought to be related to acne production. The follicular unit, which forms the hair follicle and the pores of the skin, also experiences a normalized cycle after starting isotretinoin.” Ultimately, she says, it’s likely a combination of these effects that treats, and cures, acne.

Controversies
A drug with such dramatic results is bound to get wrapped up in some pretty heavy health skirmishes. Thousands of lawsuits have been filed against the manufacturer of Accutane, Roche Pharmaceuticals, claiming that the drug causes a number of severe side effects, among them muscular and skeletal pain, night blindness, and depression and suicidal thoughts. However, Dr. Nazarian counters that these effects are very rare. “There have been multiple studies evaluating the effects of Accutane on mood and mental illness,” she says. “Rather than increasing depression, studies show that when patients see an improvement in their skin and acne, their self-esteem and mood benefit, and rates of depression decrease.”

Recently, a New Jersey jury awarded $2.1 million to a woman in California who claimed Accutane had caused her to be diagnosed with inflammatory bowel disease (IBD). But, the verdict was reversed at the end of last year, primarily as a result of the lack of evidence linking Accutane and such diseases, which include Crohn’s disease and ulcerative colitis. “A study published in the American Journal of Gastroenterology last spring examined isotretinoin and the risk of IBD,” says Jennifer Chwalek, MD, a dermatologist with Union Square Laser Dermatology in New York City. “It examined over 7,000 cases of IBD and found isotretinoin was not associated with increased ulcerative colitis risk. Interestingly, there was a trend toward decreased Crohn’s disease risk in the population treated.”

Although no causal relationships have been found between isotretinoin and such conditions, many doctors remain cautious about writing up prescriptions for it. “I carefully review all the potential side effects with patients, and I follow them closely during the treatment course,” says Dr. Chwalek. “I avoid using this medication in patients who have a history of depression or psychiatric disorders, or anyone with a personal or family history of IBD.”
Illustrated by Elliot Salazar.
Why It Worked For Me
By now, most people have heard about how tricky isotretinoin can be to get. There are the rounds of blood tests, the required two forms of birth control for female patients — one primary method, such as the pill or an intrauterine device, and one secondary method, like male latex condoms or diaphragms — and even a mandatory program called iPLEDGE in which the patient answers questions about the requirements and fills out her chosen birth-control methods (as isotretinoin can cause miscarriage and birth defects). Despite it all, going for it was an easy choice for me to make, especially since my acne type made me an ideal candidate for the drug: “The best patient for Accutane is someone who has recalcitrant, nodulocystic acne that has failed topical medications and oral antibiotics,” says Dr. Chwalek. I was ready for the red, painful breakouts deep under my skin to be gone, forever.

Over my five months on Accutane, I experienced only one, typically unavoidable side effect: extreme skin dryness, which lasted until treatment ended. My tube of Aquaphor became my new best friend, which I slathered lovingly not just on my lips and body, but also on my face. This dehydration kicked in about two weeks after I took the first pill. After two months, all signs of new acne were gone. Some moderate acne scarring remained, but even those marks disappeared by about month four. Perhaps most amazingly of all, the only care my skin required was a simple, twice-daily gentle cleansing with Cetaphil. And, though I found the monthly blood tests, new birth-control pills, and having to avoid alcohol slightly annoying, my slowly clearing skin was constant reassurance that it was all worth it.

I watched my skin gradually evolve until, one day, it was absolutely, breathtakingly immaculate. My confidence soared. Suddenly, I felt not just comfortable, but proud leaving the house without a stitch of makeup. I had always had a crippling fear of public speaking, to the point where I would often be in tears by the end of a presentation for class. But, post-Accutane, I was no longer afraid to speak in front of my peers.

That year, I even fell in love for the first time, with a guy I met in my P.E. class (read: while wearing no makeup). I firmly believe that because my skin was finally clear, he was attracted to — and fell in love with — my confidence. My skin was no longer something for me to be ashamed of, but a means of putting my best self out there.

I remained pore- and blemish-free for about a year, and then gradually plateaued to the “normal skin” I’ve had since I got off Accutane five years ago. Now, at 22, my skin is not too oily, not overly dry — just prone to everyday wear-and-tear, which I can successfully treat with over-the-counter products. I occasionally get a pimple or two. Thanks to Accutane, though, I’ve now had the opportunity to build my confidence and then deal with any recurring acne, not the other way around. I swipe on concealer and move on with my day, head held high. I wouldn’t trade that feeling for the world.
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