By Kali Kushner
What would you say if I told you that you could take a miracle pill for 4-6 months that would cure your acne for LIFE? Bring it on, right? Well if you're a severe cystic acne sufferer like me who has literally tried everything from antibiotics to light therapy and grudgingly failed, you'd probably say "where do I sign up??" and "why haven't I heard about this before?!" At least that was my initial reaction when I first heard about Accutane.
I can remember clearly as the day the exact moment I KNEW I wanted to go on Accutane. I was on vacation in San Diego with my husband visiting family; I had just washed my face and I was getting ready for bed. My skin had been bothering me for a year up until this point, I was 20 years old and just started developing cystic acne out of the blue. I had tried everything to get rid of it, from antibiotics and light therapy to good ole fashioned toothpaste.
During that time, I was trying a new technique- acting like it wasn’t there. I thought maybe If I just ignored the fact half of my face was engulfed by these fiery red cysts then they would just disappear. Anyways, I had just walked out of the bathroom without any makeup on, keeping my head down low hoping no one would see the pain I was in when my nephew yelled "what's on your face? Why is it dirty?" Ouch, immediately punched in the gut, salt in the wound feeling is the best way I can describe it. He was like two, by the way, kids speak whatever they see you know? Although it didn't carry malicious intent, after that incident I was very determined to figure out what the heck was going on with my face. I scheduled a dermatologist appointment as soon as I got home from vacay.
WHAT IS ACCUTANE?
First things first, "Accutane" is a brand name that's no longer on the market -- its pharmaceutical name is Isotretinoin -- but since that's how most people know the drug, that's the name I'll be using.).
Isotretinoin, the drug that revolutionized acne treatment, is the only medication that can clear acne and produce long-term remissions. Since its introduction in 1982, it continues to be a vital and widely used acne medication worldwide. It is used mainly for severe, recalcitrant nodulocystic acne as well as recalcitrant moderate acne
Isotretinoin, also known as a form of Vitamin A, reduces the number of oil glands in the skin and helps renew your skin more quickly. Accutane can have serious side effects, so it must be supervised by a specialist doctor.
WHAT TO KNOW ABOUT ACCUTANE
- Accutane is available only under a special program called iPLEDGE.
- Taking vitamin supplements containing Vitamin A while taking Isotretinoin is not recommended.
- Sharing this medication with another person is not recommended or advisable, even though they share the same symptoms with you. Accutane should be stored at room temperature and away from heat, moisture, and light.
- Accutane should be taken as prescribed by the doctor. Do not take this medication in small or large amounts or for longer than it is recommended. Follow the directions as shown in the prescription label.
WHAT IS ACCUTANE MADE OF AND THE DOSAGE?
Isotretinoin, a retinoid, is available as Accutane (isotretinoin) in 10-mg, 20-mg and 40-mg soft gelatin capsules for oral administration. Each capsule contains beeswax, butylated hydroxyanisole, edetate disodium, hydrogenated soybean oil flakes, hydrogenated vegetable oil, and soybean oil.
The dosage to be prescribed to you is based on your medical condition, weight, and response to treatment.
HOW EXACTLY DOES ACCUTANE WORK?
This drug’s Vitamin A ingredients helps prevent breakouts by reducing acne bacteria on your hair follicle making it an inhospitable breeding ground for acne bacteria. Thus preventing clogged pores, inflammation and acne!
This medication should be taken with a glass full of water to prevent the capsule from getting stuck or melting, which could cause irritation. Do not suck or even chew on this. Accutane may also be taken with food or milk. Take Accutane for an entire length of time as prescribed or recommended by your doctor. Recovery time from acne may be long upon taking Accutane but it should improve.
It is best to get your blood tests and liver function done to ensure that this acne medication is not causing any harmful effects.
IS ACCUTANE FOR YOU?
Accutane is usually prescribed to teens or adults with severe, scarring acne that have exhausted or did not see good results with other acne medication.
Before taking Isotretinoin (or Accutane) , it is best to inform your doctor if you have/are:
- Mental health illness (e.g. depression)
- Pregnant (or suspecting you are) /breastfeeding
- Liver or kidney disease
- High cholesterol levels
- Crohn’s disease or ulcerative colitis
- Heart disease
WHAT TO AVOID WHEN/WHILE TAKING ACCUTANE
- Taking vitamin supplements containing Vitamin
- Donating blood for at least 30 days after stopping or quitting the medication. This is not recommended as donated blood which is later given to pregnant women may cause or lead to birth defects in the baby if the blood contains any levels of Accutane.
- Using wax hair removers or even dermabrasion and skin laser treatment for at least 6 months after quitting Accutane. This may cause scarring.
- Exposing yourself to sunlight/artificial UV rays (e.g. sun lamps or tanning beds). Taking Accutane may cause your skin to be more sensitive to sunlight, resulting in sunburn. It may also cause vision impairment, especially during nighttime. Also, avoid driving or doing anything that requires clear vision.
CAN YOU RELAPSE AFTER ACCUTANE?
Isotretinoin is a heavy subject for acne sufferers all around because it clears some people's acne for life, others have to do multiple courses, and there are a handful of those straight up against it. It can be dream shattering to go through a course of Accutane, be completely acne free and then one day have all your spots magically return. If this has happened to you, know that you aren't alone! It is actually quite common to relapse within your first few years of being off of Accutane.
Since its debut, Accutane remains to be the most effective acne medication on the market, period. Although I can't find any actual statistical data supporting this, my dermatologist once told me that Accutane clears about 85%-90% of acne in all patients, and that only 15% need a second course. What I have come to realize over the past few years is that the figure she provided me is wildly incorrect. Relapse rates are all over the board and although Isotretinoin holds promises of clear skin for life, that isn't always the case.
If severe acne returns after your first course of Accutane, a second course of treatment may be started after you have stopped taking the drug for 2 months. However, it is not recommended to consume it for long-term use. Do not take more than the recommended dose!
MY PERSONAL EXPERIENCE WITH ACCUTANE RELAPSE
From what I have personally experienced and observed within the Instagram acne community over the past two years is this: Accutane DOES work but it usually isn't 100% permanent. What I mean by this is that your acne may return, but typically in a much lesser amount. Let's say you had severe cystic acne that covered your entire face, once your course is completed you may still get a cystic spot once a month or even once every two months. Most people wouldn't consider that as relapsing- however if you were someone who only had a few cysts a month and those few cysts returned once your course was completed, you may think of it as a relapse. Statistically relapse rates fall anywhere between 10% and 60% because there are so many different variables that play into relapsing; most of which you cannot control. Some of the biggest factors that can increase your chances of relapsing are:
- Severity of acne
- Age of patient
- What food or drink Accutane was taken with
- Being of male gender
- Hormonal imbalance like PCOS (Polycystic Ovarian Syndrome) in women
- Whether or not the patient was on anti-androgen treatment.
- Not reaching a cumulative dose of 120 mg/kg
HOW MUCH DOES ACCUTANE COST?
Want to know how much is Accutane? Accutane is usually covered by medical and insurance plans, but pharmacy coupons or cash prices may be lower. The lowest good Rx price for the most common version of generic Accutane (60 tablets) is around $197, 83% off the average retail price of $1,182.
SIDE EFFECTS OF ACCUTANE
For most the idea of being free of such a heavy, life impacting burden like severe cystic acne sounds like a dream come true. Trust me, as a fellow acne sufferer I know how debilitating severe acne can be and how tempting it can be to say screw it all, I'm going to jump right into this new life of blemish free skin! No more makeup? No more feeling self-conscious in public?! Gimme, gimme, gimme! But let's be clear about one thing- there are a wide range of side effects that can occur while taking the drug.
If you choose to take this drug you WILL experience some side effects. The severity and longevity of those effects is what will vary from person to person. So, while I can't tell you exactly how your body will react, what I can say is this - when you take Accutane you are taking a gamble on your health. I'm not saying that to frighten you or discourage you from taking it; I just believe that anyone who is planning on taking Isotretinoin should be fully aware of the side effects that can happen while taking, or even after taking it. Here are just a few side effects that are typically short term, but can be long term as well
Common side effects from Accutane:
- Dry skin
- Dry nose
- Dry mouth
- Dry lips
- Cracks in corners of mouth
- Dry eyes
- Joint pain
- Back pain
- Hair loss
One of the side effects that I personally experienced was dryness of the skin! I recommend the Banish Vitamin C Creme (for morning) and Banish Oil (at night) to keep your skin moisturized! These products also contain Vitamin C to help fade hyperpigmentation and will help with acne scarring as you treat your acne.
Other Side Effects / Rare side effects from Accutane:
- Aggressive Behavior
- Abnormal Liver tests
- Decreased night vision
- Fast heartbeat
- Thoughts of suicide
- Hearing loss
- High blood sugar
- Inflammatory Bowel Disease
- Mood changes
- Muscle Pain
- Pink Eye
- Sudden Blindness
- Swollen Lymph nodes
- Excessive Hairiness
- Inability to have an erection
- Sensitivity to light
WILL ACCUTANE GET RID OF ACNE SCARS?
No. Accutane will not get rid of old acne scars however it can in some cases prevent new acne scars from forming. The way to get rid of scars should be determined by your doctor. Many treatments exist that should take care of it, depending on your type of scarring and how severe it is.
However, while Accutane is not always a sure thing solution, and relapse after Accutane may occur (it is usually less severe), it does offer patients a much longer remission time than other treatment options available to them, sometimes several years. Further courses of therapy are usually successful when required, and each subsequent course generally further reduces the risk of relapse. There are no reports of cumulative toxicity from using repeat courses and tachyphylaxis has not been noted.
So, it's not that Accutane didn't "work" - it's that there may be variables that affected the long-term remission of your acne. Don't be discouraged - there's still hope!
SAFETY PROCEDURES WHILE ON ACCUTANE
Though side effects are common, there are important safety procedures in place to monitor the patient while taking Isotretinoin.
- I pledge: Many people believe once you have taken Accutane you cannot get pregnant. This is simply NOT true. A few friends tried to tell me, "you can't take that! You'll never be able to have kids!" While it IS true that you shouldn't get pregnant while taking isotretinoin, once it is out of your system a few months later- you are in the clear to have a completely normal, healthy baby. If you are a woman who chooses to take Isotretinoin, you must answer Ipledge questions every month as well as have a monthly blood test to prove that you are not pregnant. You should avoid getting pregnant while on Accutane at all costs, because it has been proven to lead to extreme birth defects in children. Ipledge requires women to use two forms of birth control as well as answer about 10-20 questions a month on safe sex or abstinence before they're allowed to pick up their prescription for that month.
- Blood work: It is required to have monthly blood tests done while on Accutane to monitor both your triglyceride levels and your cholesterol. Accutane has the ability to raise both of these which can lead to things like metabolic syndrome or heart disease.
- Alcohol Consumption: You should not drink on Accutane. For some reason this is one safety procedure people seem to take lightly and I will never understand why. Anytime I see or hear of someone drinking on Accutane I'm like "oh no honey, what are you doin?" Drinking on Accutane can cause permanent, irreversible liver damage. Isotretinoin is metabolized through your liver, so once you begin to drink on top of that your liver starts working double overtime. Both alcohol and Accutane can increase the amount of triglycerides in your blood, which again, can be dangerous. I turned 21 during my course of Accutane so I had one drink during my entire 6-month course. Bad decision. The next day I felt like I was hit with a ton of bricks and I could barely move without feeling nauseated, it was hands down the worst hangover of my entire life. 10/10 would not recommend it.
With all things considered, Accutane remains the most powerful acne fighting drug on the market today. There may be extreme side effects and a chance for relapse BUT for some, yours truly included, it is worth the price of clear skin. If you're reading this article because you are trying to decide if you want to take Accutane or if it's worth the risk, my advice is to talk to those who have taken it. Most people who have taken Accutane understand the way it works will have mostly positive things to say, while those who haven't taken it will have mostly negative things to say. I took Accutane in 2015 and even with all of the side effects and dreaded monthly tests, it has been completely life changing. I did relapse but, I don’t regret it. Not even one bit.
We are all following our own path when it comes to our skin concerns, especially with acne, because acne is caused by many different factors. Be true to yourself and your own journey. Whether you decide to take medication, or heal your skin naturally, please know that you are beautiful as you are - with or without acne!
So to those asking if Accutane is worth it? Accutane can be a strong medication and is considered to be a dangerous drug, in some cases, but I can prove its worth. If you have plans of using this medication for your skin concerns as well, heed my advice: make sure you do plenty of research beforehand, ask your dermatologist loads of questions and talk to supportive people around you as they will really be a big help. Always remember to be kind to yourself whilst on the medication and drink loads of water!