Research shows that adult acne affects women at higher rates than men – a difference dermatologists believe likely exists because menstruating women are subject to much more complex hormonal patterns.
From oral antibiotics and contraceptive pills to topical creams, women who deal with breakouts often exhaust a number of treatment avenues before they set their sights on isotretinoin (aka Roaccutane). It is a drug that combats acne by inhibiting the body's production of sebum (an oily substance produced by skin) and keratin (outer scales of skin that block hair follicles). Because Roaccutane comes with a long list of potential side effects, including dry skin, headaches and general aches and pains, dermatologists often consider it a 'last resort'.
Even so, the drug isn't guaranteed to make your acne go away forever – something I learned the hard way. After I started taking Roaccutane, my skin had never looked clearer and I felt confident for the first time in years. That all changed the summer after I finished my first course, when my acne came back with a vengeance. My experience isn't exactly rare: studies suggest that relapse rates in Roaccutane patients can range from 10-60% depending on a number of factors.
According to Dr Anjali Mahto, consultant dermatologist at Skin 55, underlying hormonal conditions such as polycystic ovary syndrome (PCOS), age, individual metabolism, dosage, drug absorption and family history may all have a role to play. Her advice? "Find yourself a friendly, approachable consultant dermatologist and treat your acne as early as possible before scarring sets in." Dr Mahto adds: "Look after your skin and remain on topical retinoid therapy between courses." Retinoid skincare products, such as adapalene or Differin, can be prescribed by a GP (this can also be done online) or a qualified dermatologist if you'd prefer private treatment. Dr Mahto continues: "Try and find acceptance that acne may indeed be a chronic, long-term issue for you and learn to enjoy the good periods – your acne does not define who you are or what you are capable of achieving."
Ahead, four women who have experienced post-Roaccutane relapses share their experiences on the drug, and how they are now learning to both manage and accept their acne.
"My experience on acne drug Roaccutane was good; nothing intolerable. During the summertime, I just had to make sure that I wore sunscreen and stayed out of the sun. You have to be very cautious because you will get sunburned.
When I took Roaccutane, my acne cleared up and I did not think it was going to come back. Doctors do tell you that there is a chance, though. After my first round, my face was clear for about a year or so, and then I started to get little bumps, which then spanned across my entire face. I thought, Okay something has to be wrong, since my doctor told me that Roaccutane should clear up my skin for a couple of years or more.
When Roaccutane didn't work the first time, I was bummed. I've been on it three times since then and I always feel the same because it's my face — it's the first thing people see. Adult acne can be really disappointing and what people don't talk about is that when you have acne, your face hurts. Those big cystic pimples are painful and you're just uncomfortable with yourself in general. Nobody wants to feel uncomfortable in their own skin.
When I headed back on Roaccutane for the third time, I stopped taking it during month three because my face was clear. That's probably one of the biggest mistakes I could have made. If you're going to take Roaccutane, you have to take the full round.
After that, I wanted to invest in my skin by doing things a little differently: eating differently, using skincare products dermatologists recommend and having more facials. Right now, my skin is better. I do still get breakouts on the sides of my face but I see a difference after Roaccutane and the bumps are bearable. I've tried all kinds of products but I now know which ones to lean on. I use a lot of Dermalogica, especially their Precleanse before I wash my face. I also like the Clear Start Breakout Clearing Foaming Wash, Ultracalming Cleanser, Breakout Clearing All Over Toner, and moisturiser."
"The first time I was on Roaccutane I was about 16 years old and experiencing a lot of cystic acne and whiteheads. As well as on my face, it was all over my back and chest, and that was devastating as a teenager. I had tried everything before Roaccutane. I had been on antibiotics for years and Retin-A skincare, so Roaccutane was a last resort. My first round of Roaccutane went pretty well. My acne improved and the only real complication I had was that it made my hands, lips and feet so dry. It worked for a year, but the acne came back.
In the years that have followed, I've continued to struggle with my acne. It is now just on my chin and it's rare for me to get acne anywhere else, but it's still that same cystic acne. I have been on female acne drug spironolactone for maybe five or six years now and for the most part it really keeps it at bay. [Spironolactone works on adult acne in women as it takes action on hormones, namely testosterone, which is responsible for excess oil production and therefore breakouts.] I haven't really experienced any side effects. I don't think it's great to be on an extra oral medication but it's definitely helped me. That said, there are still times I have terrible flare-ups but I'm sure they are linked to hormones and stress!"
"I took isotretinoin (Roaccutane) at the age of 11 and my course lasted three years and seven months. After a year, I noticed acne on other parts of my body I hadn't experienced it before. It was difficult and extremely uncomfortable, and some side effects haven't gone away, like dry eyes and lips.
I think I always knew the medication wouldn't change the way my body is completely. Roaccutane isn't a magic pill, and it's important to note that romanticising isotretinoin like it's some kind of 'saviour' or making taking it look like an easy decision is misleading.
Growing up, I was the only girl in my immediate environment with cystic acne and that made me feel alone. There were the kids with two or three breakouts but they would always be negative about it in front of me. If they were acting like that because of some pimples, how was I supposed to feel about my cysts? That said, having a strong online community which I can relate to tremendously has been so empowering. These stories and experiences have made me realise that I am not alone.
The way we see our skin, and ourselves, is determined by other people's thoughts and ways of thinking. That's the reason why searching for a supportive and healthy environment is extremely important when it comes to our mental health and wellness. My advice would be to cut off toxic people and their backhanded, sarcastic comments and negative thoughts! Someone that truly loves you will love you without any excuses."
"I was on Roaccutane twice during my teens and early 20s. The first time I used it, it worked great, although I did have dry, cracking skin and I was nauseous for the first two months. Looking back, it was super difficult, but it did clear out my skin.
Five years later, however, my cystic acne was back. It wasn't as 'bad' as before, but it was definitely there. I also attributed the breakouts to hormones, as I have polycystic ovary syndrome (PCOS). I was surprised when I relapsed because I never knew acne could come back after Roaccutane, and that really frustrated me. It really got me down because I had an idea of what clear skin felt like.
In my early 20s, a doctor prescribed me Roaccutane again. I thought it was going to get better because the first time I was prescribed the medication, I was on it for over 11 months and it got worse before it improved. But it was only getting more and more painful, so I stopped taking it. Now, my skin is doing a lot better. I've changed my diet and I'm taking contraceptives. I feel like some people need to try multiple things to see what works for them."