Accutane: The good, the bad, and the fabulous

Acne Studios is the name of a fashion-forward Swedish clothing brand, but it might has well have been my nickname throughout my acne-riddled adolescence and adulthood.

I had severe, relentless acne from the tender age of 12. For years, I tried every other topical and oral treatment known to man (benzoyl peroxide, tea tree oil, salicylic acid, laser treatments, antibiotics, birth control pills, Chinese herbal medicine) and saw little to no success.

Thanks to my stubborn acne, my teen and early adult years were overrun with memories like these:

Hauling an enormous bag of anti-acne products to summer camp
Scouring the web for acne solutions late at night in my college dorm room
Leaving a big foundation stain on a friend's white shirt after giving him a hug
Freaking out about my red, bumpy face before every job interview

THE GOOD
Finally, my dermatologist prescribed Accutane (orally-ingested isotretinoin) when I was 24, and it changed my life. My skin was no longer an oily, inflamed mess, and I could step out of the house without a thick layer of foundation on my face.

On the left: Hiking in Palo Alto in 2009, wearing a TON of makeup. Despite layers of foundation, concealer, and powder, you can still see acne on my cheeks, forehead, and chin, plus my skin was extremely oily.
On the right: From my trip to LA last weekend, wearing just a touch of NARS Radiant Creamy Concealer in Ginger. Even though I ended my last course of Accutane in 2012, my skin is still relatively clear today. Also, I’ve aged.

I’m a huge advocate of Accutane for anyone who is frustrated with their acne. Essentially a large dose of vitamin A, Accutane shrinks sebaceous glands and slows the production of oils. With less oil, hair follicles and pores are less likely to clog, eliminating breeding grounds for acne-causing bacteria. The result? Clear, smooth skin.

Despite Accutane’s efficacy, people have a lot of qualms about it:

There are claims that Accutane causes depression and suicide.
Accutane was originally formulated as a skin cancer chemotherapy drug. It’s perceived as too extreme of a measure for a cosmetic condition like acne.
One of the most common side effects of taking Accutane, dry skin, is assumed to be too painful to endure for a lifetime of better skin.

Here’s a qualm-by-qualm breakdown of why I still recommend Accutane:

There’s no scientifically-proven causative link between Accutane and mental issues. Anecdotally, I felt more unhinged when I was on birth control pills (and I tried pretty much every brand on the market) than when I was on Accutane. Once my skin started clearing up, I felt more positive and emotionally free than ever.
While it’s true that Accutane was originally formulated as a skin cancer drug, Accutane's had clinical clearance from the FDA as a safe anti-acne medication since 1982. Moreover, acne is not merely a ‘cosmetic’ condition: it is a very visible problem that can cause psychological and social scarring, so it makes sense to get advanced medical science involved. And under the guidance of a board-certified dermatologist that you trust, taking Accutane is perfectly safe.
Accutane does cause dry skin, but it’s temporary and can be mitigated by using emollient lip balm, a deep facial moisturizer, and healing body ointment throughout your Accutane course.

Most importantly, most of Accutane's side effects can be mitigated by easing into it with small dosages that gradually get bumped up.

The efficacy of Accutane comes not from daily dosage amounts, but from the cumulative amount that you take over one continuous course. For example, if your dermatologist prescribes a 14,400 mg cumulative course (this amount will vary based on your height, weight, and severity of acne), you can take 60 mg daily doses for eight months, or you can take 120 mg daily doses for four months–so long as the cumulative dosage is the same between the two paths.

In order to mitigate the side effects mentioned above, I highly recommend the former path: I was on a mild 5 mg daily dosage for a month before eventually graduating up to 60 mg daily in my ninth month, and I experienced virtually no side effects (I was surprised because I am typically hyper-sensitive to most medications a la my experience with birth control pills).

THE BAD
Before you embark on your Accutane journey, please note these drawbacks:

Accutane causes birth defects when ingested by pregnant women. Any woman of child-bearing age who is prescribed Accutane must present two negative pregnancy tests before starting the medication and use two forms of birth control throughout the course. I recommend latex condoms and a non-hormonal IUD. Hormonal birth control can alter the skin-clearing effects of Accutane, and every time I’ve tried a hormonal birth control method, I’ve had horrible breakouts.
Accutane requires monthly monitoring of the liver due to its high vitamin A content. This requires visiting the doctor once a month to have your blood drawn and evaluated throughout the course of your Accutane treatment. The monthly trips to the doctor are manageable and absolutely worth it – remind yourself that you’ll only have to do them for a few months and then you’ll be DONE.
Accutane makes your skin more susceptible to sunburn. Daily sunscreen application is an absolute must (but this should be the case anyway even if you're not on Accutane).
Accutane does not eradicate all acne forever. Even after completing an Accutane course, I still get a couple zits from time to time. But armed with topicals from the dermatologist's office, my favorite retail skincare products, and a rigorous skincare regimen, I have control over my acne (rather than it being the other way around).

STILL FEELING FABULOUS
Despite these drawbacks, the vast improvement in my skin (and my confidence) from Accutane was well worth it. My only regret with Accutane was that I didn’t try it sooner.