I was 16, lingering in the kitchen of my childhood home before taking a dip in the pool, when my mom touched my cheek and winced. “Oh, honey,” she said. “You’re so broken out.” At that time in my life, I would normally have been mortified if someone criticized my skin. The fact that I was bare-faced — going swimming was one of the few daytime occasions during which I wasn’t spackled with makeup — should have made me feel even more vulnerable. But the way my mom said it, she sounded like how I felt, too: disappointed, frustrated, and bewildered. And, sad. Not long after that, I started taking Accutane. And, eventually, took another full course. And another after that, and another after that. The American Academy of Dermatology says that about 85% of people who are treated with one course of isotretinoin (marketed as Accutane, Sotret and Amnesteem, among others) see their moderate-to-severe acne cleared. Like, for life cleared. Those people — my brother, for instance — go from “pizza face” to “Korean skin-care ad” in a matter of months. Experts generally agree that no other acne treatment comes close to touching isotretinoin’s game, making it a miracle drug by mostly anyone’s standards. When my dermatologist prescribed Accutane the first time, I was 17, and really needed a miracle. I had already tried and failed to treat my acne with drugstore face washes, spot treatments, toners and lotions; homeopathic remedies like tea tree oil and green tea; the full battery of Proactiv products; two prescription antibiotics; a birth control pill; vitamins and supplements; and two prescription topicals. You can probably imagine why I thought taking one daily pill sounded awesome. It cannot be understated: A few months after I started taking Accutane, and several months thereafter, my skin looked fucking incredible. Not only was I completely pimple-free after about a month — my post-acne dark spots also quickly diminished. (Accutane curbs acne by drying up your skin’s supply of sebum, calming inflammation, reducing bacteria and unclogging pores. It also triggers skin cells to turn over more rapidly, so your skin looks better, faster.) After two or three months, my face was smooth, even-toned, and luminous. Pre-Accutane, my oily skin always needed a touch-up by second period. Now my skin was porcelain, powdery perfection from morning to night.
Isotretinoin’s failure to definitively cure my acne was, for almost a decade, one of my biggest frustrations. Yet, Accutane was also my saving grace."
A handful of months later, though, the acne came back. I panicked, but my dermatologist assured me this was pretty normal and would probably be resolved with one more full course of isotretinoin. So I took it, got better again, and relapsed again … and again. When you’re a teenager, taking Accutane is so commonplace it’s dull. When you’re old enough to be making regular 401(k) contributions and you still have to beg your dermatologist for a hit of the good stuff, it’s depressing. I went through two more rounds of Accutane, when I was 19 and 22, with roughly the same results. My skin would be great for a couple of years, and then, suddenly, that gift would be taken from me. Isotretinoin’s failure to definitively cure my acne was, for almost a decade, one of my biggest frustrations. Yet Accutane was also my saving grace. I’ve basically tried every acne treatment supported by science, and while I still use some of them in my skin-care regimen, there isn’t one treatment that has done nearly as much for my skin as Accutane has. I would have loved to be a part of that lucky 85% who took a pill for four months and never had to think about her skin again, but that’s not the card life dealt me. I didn’t get a life of good skin, but I had a few years. And what happened in those years? I remembered what a healthy self-image looked like. I made out with boys without worrying how I looked at close range. I started being warmer to other people because I no longer assumed they were judging my skin, and they were usually warm in return. I stopped wearing a full face of makeup at the beach or during sleepovers with girlfriends. I stopped needing to take two or three showers a day in order to feel less dirty. When self-loathing didn’t take up so much of my energy, I was amazed by how much I was able to achieve. Accutane didn’t cure me. And taking Accutane was tough, too. I remember the painful side effects: dry skin, achy joints, and chapped lips that split open and bled if I laughed too hard. I remember the indignity of checkups at my dermatologist’s office, being forced to take monthly pregnancy tests in exchange for medication refills. (The tests are a safeguard against the severe birth defects caused by Accutane, and they’re also humiliating overkill when you’re a 17-year-old virgin.) But my gratitude for Accutane outweighs the complaints. Now I’m in my 30s and I still get bad breakouts if I’m not on medication. However, I’ve been able to get off the Accutane train. When I was 26, a dermatologist recommended I try spironolactone, a blood pressure medication that’s used off-label to treat hormonal acne in fully grown women. It has succeeded in giving me pretty clear skin for the long-term. If I ever decide to have a baby, I’ll have to stop taking spiro. (You can’t take it when you’re pregnant or trying to conceive either, but you don't have commit to a pregnancy test every month — thank gawd!) My skin is going to suck and I can’t say I won’t dread it. But I will remember that the misery is temporary, and every day with clear skin is something to be grateful for.