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July 26, 2010Author: Paula Begoun - 19 CommentsTags: Accutane, Acne, isotretinoin, Paula Begoun, Skin Care
Accutane was a brand name for an oral, anti-acne medication that is no longer being prescribed, but the active ingredient in it (isotretinoin) is now available as a generic. Accutane/isotretinoin has the potential to cure acne or at the very least make it go away for awhile. Once a round of isotretinoin is done, the acne may still return; however, if it does, it is rarely as bad as before.
Regrettably, isotretinoin is a difficult drug. There are lots of serious side effects such as elevated cholesterol, liver problems, loss of hair, unbelievably dry skin, birth defects if you get pregnant while taking it, depression (though that side effect is controversial), headaches, bloody nose, and on and on. But for me, my acne was even more difficult than all of those health risks, which is why, once I was fully informed about the risks, I still opted to take this medicine to help my acne.
Prior to Accutane, every morning for me was a living nightmare of having to look in the mirror to see what had happened to it overnight. It was agonizing and it was rarely good news. And then during the day I could feel eruptions developing as I touched my face or felt the small throbs where swollen bumps were growing. I even hated the word “pimple.” I found it embarrassing and insulting. I am sure anyone struggling with acne knows just how I felt, and how strong the desire for clear skin becomes.
When I finally decided to try Accutane it was with utter abandon. I would do anything to not have this struggle of seeing red, inflamed, white dotted lesions on my face.
When I started my prescription I noticed a difference within the first week. I’ll never forget the moment when I touched my face and felt nothing that I was so used to feeling. All I could feel was smooth skin! Much to my continued surprise, it remained that way for weeks. I had some of the side effects I was told about, including bloody nose, dry lips, and headaches. No one tested for liver function and cholesterol levels in those days and I was beyond getting pregnant so there is much I don’t know for what did or didn’t go wrong for me internally. What I do know is that it was the first time in my life since the age of 11 that I liked looking at myself in the mirror.
At the three month point I started experiencing hair loss and that freaked me out. As a result, I stopped taking the drug and, as expected, the hair loss stopped. The trade-off for stopping too soon to save my hair was my acne came back about two months later. I did a great deal of research and found that the dosage and timing was a big deal. A lower dose taken over a longer period of time seemed to be far better. I discussed this with a new physician and started another cycle of Accutane. Thankfully, it went much better the second time around.
Today, almost 17 years later, I still struggle with breakouts but nothing like I did before Accutane. I sometimes think I should have taken another treatment cycle but never did, not because of the risks, it was just that I never got around to it and I was happy enough with the results two rounds of Accutane provided.
Given everything known about isotretinoin/Accutane my only personal regret is that I waited so long to take it. I can only guess what my mornings would have been like in my 20s and early 30s had I taken the drug back then, and not wasted so much time and money on irritant-laden products that made matters worse not better. Like many of you, I just didn’t know any better and just kept buying product after product hoping something would work.
Everyone has to weigh the pros and cons of many things they do in life; for me, Accutane was a no-brainer. Whether you feel the same way is a decision only you can make, but if you decide to take isotretinoin, be certain you’re fully informed of the risks, particularly if you’re a woman of childbearing age.
19 Comments until nowGwenSAJuly 26th, 2010 (#):I took Accutane when it first came out in 1981/82. At that time I was in my mid-twenties and starting to get cystic acne on my neck of all places. I also had facial and back acne. My dermatologist told me about this new drug and I decided it was worth a try. It was expensive back then, as I remember, and the pharmacist said ‘good luck’ when I went to pick it up. I developed dry skin, lips, and eyes from taking it, but it was worth it. I also had sore hip joints when I walked, but the side effects went away when I was finished with my treatment. I’m not sure how long my treatment was. I have been told by my present dermatologist that the dose they were recommending back then was probably a lot higher than it needed to be.
Flash forward (to about a year ago), I took my daughter to my dermatologist for facial acne that was definitely going to cause major scarring. He told me that in order to prescribe Accutane now, there is a lot of red tape. Doctors need to pay to belong to a group that must follow ‘the rules’ to prescribe the drug. Girls need to take a pregnancy test before they start, and be on birth control meds during, and still need to be tested for pregnancy periodically. I don’t recall what he said the requirements for boys were. My doctor doesn’t belong to that ‘group’ so he gave me the name of a pharmacy in Turkey that sells the drug online. I believe the drug they were selling was made in France by LaRoche. It’s not called Accutane anymore because the patent ran out, but chemically it’s the same drug.
Even with all the new requirements in place for getting a prescription in the US, it appears that the number of unwanted pregnancies on isotretinoin/Accutane has not changed. My daughter and I have prescriptions for topical Retin A to keep any further breakouts under control.
LeslieJuly 26th, 2010 (#):I too took Accutane in my 30’s. I suffered for years before that with horrible cycstic acne. It was my last resort after years of agonizing trips to the dermatologist to get them injected. It was a nightmare. After one month (I had some of the side effects, but it was worth it, even if I did lose some of my hair), my skin was GORGEOUS. I’ve never regretted taking this miracle drug and would definitely recommend it for people who are suffering with this kind of acne. It gave me back my self-esteem and made me like to look at myself again.
KathrynJuly 26th, 2010 (#):Hi Paula. My experience with acne was very much the same as yours. I was to the point where I, a college student (this was about 11 years ago), was missing classes because I couldn’t bear to leave the house. No amount of concealer or makeup could disguise what was going on, and I would have nightmares about my acne. I’d wake up sick to my stomach wondering what new breakout would greet me in the mirror that day. I walked with my head down, didn’t look people in the eyes. I had tried everything from topicals to antibiotics to birth control pills, and I was at the end of my rope. Then, finally, I was told I could try Accutane, probably a year after I should’ve been put on it to avoid the scarring that the acne produced and the psychological toll it took. I took the pregnancy tests, got monthly bloodwork done…and I probably would’ve juggled with knives just to get something that would work. Within the first two weeks, I was in tears when I realize I wasn’t getting new breakouts. My face didn’t feel hot and itchy and painful anymore. I was dry as a bone, and my lips were like two pieces of sandpaper, plus I got nosebleeds, but it didn’t matter when I could look in the mirror and not want to cry. It was like a miracle. I know it is a drug that can cause depression, but in my case, it was the exact opposite. I came out of my shell, wanted to get out and live. I could finally look people in the eyes and not think “are they staring at the whiteheads and big red bumps?” I had to go on it twice when my acne reoccurred about a year after the first course of treatment (that’s how aggressive mine was), but each time, it was worth jumping through hoops just to feel the relief of finally killing those zits.
I have a baby daughter now, and I fully plan to watch her as she hits adolescence to make sure she doesn’t go through what I did. As a late bloomer, I’d say my acne didn’t really flare up until I was about 19, but it’s always been there and continues to be minor and occasional, so I know it could be an issue for her. If she begins showing signs of having serious breakouts, I’ll know from my experience what to try and for how long before we go to the big guns, as in Accutane. I would monitor her along with her physician or dermatologist for any signs of problems, but I think knowing how acne can physically and mentally scar you, I won’t mess around, and I’m thankful a drug like Accutane exists for those of us whose acne does not respond to other treatments.
Thanks for posting your experience, Paula. I think people need to be educated about this drug and know the side effects and requirements before asking about it. I often see a lot of fear and misinformation associated with Accutane, and I understand some of it, but education is important. Just like any prescription drug, you should do your research, and if you need to go on it, know what to expect and what is not going to happen. It’s not something to be taken lightly, but it can be a miracle drug if you find you can’t fight breakouts any other way. It can be a lifesaver, in my opinion.
LeeAundra KeanyJuly 26th, 2010 (#):My experience was blessedly non-eventful. Took it when I was 13 in 1983. My docter did give me a pregnancy test though I remember thinking with my awful skin, what boy would even want to kiss me much less… I had blood drawn every month to test for the liver stuff. My lips did dry up and I went through tubes and tubes of Blistex.
But it was SO worth it – nothing short of a miracle! My skin was blemish free with little upkeep for at least ten years. When the acne did return it was nowhere near as severe. In fact, now that I think about it, that’s when I discovered Paula’s Choice 
I would never second guess medical protocol and if the red tape has been deemed necessary, then so be it. But I hope that alone doesn’t dissuade someone from taking it. I won’t say it changed my life because even with clear skin, I was still a scrawny, four eyed, redheaded geek but my teen years would have been incalculably worse if it had not been for Accutane.
SimoneJuly 26th, 2010 (#):Paula-I usually don’t comment on blog posts but I felt compelled to comment on your post regarding your experience with acne and your decision to treat it with Accutane. My experiences were almost identical. My acne was worse in my 20’s and 30’s than it was in my teens. It was excruciating & it left me with permanent scars on my face. I tried every medication & laser out there to the tune of thousands of dollars, but nothing worked. I knew about Accutane but shied away from it because I had heard stories about patients on Accutane becoming so depressed that they committed suicide. I finally consulted a dermatologist who told me that the suicide link was bogus & that gave me the courage to try it. I suffered virtually no side effects from Accutane. My only side effect was dry lips. If only I had taken Accutane sooner! I could have prevented significant facial scarring. At least, my skin is now much clearer. When I do suffer an occasional break out, they aren’t nearly as severe as they used to be, and I can treat them effectively with the products in your Acne Care Line.
JoniJuly 26th, 2010 (#):I developed cystic acne while I was pregnant with my first child. Never had had breakouts before and it was SO depressing. Painful too. (This is when I learned about Paula’s Choice and I think of my acne as a blessing in disguise since it taught me about sunscreen.) After my second and third child, I went on the mini-pill and it caused another terrible bout of cystic acne each time. (I blame all the sleepless nights for why I took the mini-pill the second time around.)
I was living in England at the time and the GP took one look at me and said, “Have you considered Accutane?” It took me 3 months to get in for a specialist appointment but they put me on Dianette in the meantime which REALLY started to work. When I finally took the first dose of Accutane, within a week I had the best skin of my life. Glowing. Clear. Oh my gosh, I’m still nostalgic about it. I took a very low dose for 5 months and would have done a 6th except I moved back to the US and I was only able to get 1 month at a time after “passing” the pregnancy test.
I put off getting Accutane the first time around because I was afraid of getting pregnant. In retrospect, I should have decided on abstinence if I was really that concerned. Going on Accutane was the best thing I ever did. No one can appreciate how huge it feels to feel that your acne is cured unless you’ve had it happen to you. You have to be careful with Accutane and I’m grateful that there is a lot of oversight. But I’m like Paula. My only regret is that I didn’t take it sooner.
KatherineJuly 26th, 2010 (#):Such a timely article. My son, who is 16, has just started his first dose. He had blood tests done and tight monitoring, but we have high hopes. I took the drug myself about 20 years ago with wonderful results. I had severe cystic acne and reading about the way you dreaded the mirror in thee morning, brought it all back to me. I feel bad that my son inherited this tendancy from me but I am so happy for him to be taking it now at 16 rather than as an adult. I feel the drug saved me from depression rather than caused any, so it was a life altering drug for me. I can’t wait to see the same results for my son.
JuliaJuly 26th, 2010 (#):My 16 yr old son just finished a 6 round dose of Accutane. His acne was hereditary on his father’s side. (My husband took accutane when he was 35 yrs old). His face went through a ‘got worse before it got better’ type of case. He had so many imflamed pustules, cracked, swollen lips…I felt SO sorry for him! By the time he hit the 5th month, his face just miraculously cleared up! He didn’t have 1 pimple on his face! It’s taking a bit of time for the red scars to fade, but his self confidence has skyrocketed! The derm doc he went to checked his blood monthly for any liver problems. He sailed right through the treatment without any unusual side effects.
I strongly encourage parents to put their children on this drug if there is an acne problem. Having to deal with hormones, puberty, school and ACNE, Accutane is a miracle for all those suffering with dibilitating acne.
CourtneyJuly 26th, 2010 (#):I took Accutane when I was about 14 years old. Sadly it did nothing. However, after reading your blog it is quite possible that I don’t get as bad of breakouts today because of it. I guess it’s hard to tell almost ten years later if it really helped or not.
CaroleJuly 26th, 2010 (#):Paula, as always, we appreciate your brutal honesty about such experiences. You’re really doing such a great public service by writing about these things.
I had two rounds of Accutane treatment, both in my late 30s. What was so absurd was the requirement (FDA? The law?) that all women of childbearing age have a negative pregnancy test as well as that we certify in writing that we were using *two* methods of birth control. “Absurd” in my case because I had a hysterectomy and zero need to pay for a pregnancy test and of course no need for any type of birth control. There didn’t seem to be any exceptions for women in my prediction.
So ….. I refused the pregnancy test — the lab didn’t know what to do about that but my doctor (a woman, and bless her understanding heart) prescribed the Accutane in spite of the requirements. However, during both treatments at full dosage, I never got dry skin, chapped lips, none of the usual side effects. The dermatologist was quite surprised and said I should look like a prune after the eight weeks of Accutane, especially during the 2nd eight week treatment cycle. For some reason it never had that effect on me, so it just shows how each individual responds differently to medical intervention.
To this day (I’m now 60) my forehead is still quite oily but with Paula’s products and my due diligence I somehow manage to have nice skin. Actually, I’d say it’s totally due to Paula’s skin care and makeup line. Since I’ve started on Paula’s products and regimen I can actually appear in public without makeup for the first time in my adult life. Thanks Paula, you rock!
MajJuly 26th, 2010 (#):Thank you for sharing Paula, I think people need to talk about accutane openly. I had an almost identical experience. After years of cystic acne and trying all the other options I finally had 2 rounds of accutane about 12 years ago. I had joint pain and dry skin and some bad advice from my dermo’ saw me use the wrong skincare products while on it which didn’t help, but it did work. Although I still get the odd very painful lump before my period it is nowhere near as bad as it used to be and thanks to your truly amazing skincare(which I have been using for 10+ years) and sage advice, I have skin that is the envy of my friends. I am nearly 40 and have not one line or wrinkle. I can’t thank you enough Paula, you are a wonder, thank you thank you thank you.
Natalie - regular poster from OzJuly 27th, 2010 (#):One of the reasons I felt drawn to Paula’s work was because she finally gave me the REAL knowledge on how to deal with my persistent, adult acne. Paula seemed to be the only person on earth who understood that acne can develop in adults – and that it wasn’t something to be ashamed of!
I tried almost everything available, high-end, low-end products, salons (where treatments left me with faint scarring), everything you care to name. Regrettably, I wasted so much money – enough for a deposit on a home, I should think.
In hindsight, I should have gone to a dermatologist, but I thought that cosmetics could get rid of my acne, since I was conditioned into thinking that way. Looking back, that is very sad.
But, thanks to Paula, my occasional breakouts are usually only as a result of hormones, stress and copious use of natural sunscreen. But they are quickly diffused with standard, over-the-counter products. And, thankfully, daily use of a good BHA and benzyl peroxide product (recommended by Paula, of course) has again made my skin beautiful, as it was in my teens, before the acne struck – and now I’m in my 40s. I owe it all to Paula – truly!
muhammedJuly 27th, 2010 (#):I almost cried Paula reading this. Regrets…Regrets…: (…I’m from the Philippines and was living in the province when acne struck. With such a young ignorant mind with no internet/resource materials around aggravated by rural myths on acne, my face was like acne with a face. We’ve been through the same path, (wasted so much time and money on irritant-laden products that made matters worse not better)at some points (for 10 years now) treatments from dermatologists worked but inconsistently! So frustrating…money is scarce but I dont wanna go to that misery again. I’m clear right now using some of your products plus a prescription retinoid from my current dermatologist. But there are times that when a pimple develops, I get depressed and anxious, a phobia of history repeating itself. I manage to procure your products by shamelessly asking friends and family abroad to buy them for me as I don’t have the necessary budget. I’m considering taking Accutane right now as I’ve been motivated by the results of two friends I’ve known. I have mild scarring right now, and severe oily skin you could fry an egg on it, literally; but no more major breakouts though. The what-if’s, I’m a vain person, I just wanna scream for perfect effortless skin as I’m tired of applying products on my face.
( Imagine for 10 years, who could not get tired ). Controlling acne severely affected various aspects of my life, I just want it to be simple like a face wash then sunblock/serum/moisturizer then off I go live my life and don’t have to worry of oil slick throughout the day or a new pimple popping out. Should you suggest I use Accutane Paula? : (
Accutane changed my life. I had pimples (acne) from puberty on, but it turned cystic in my mid 20s and I had to go to the dermatologist to get the painful cysts deflated. All they had to offer through my teens was tetracycline, more tetracycline and the “blue grenz room” (some kind of sunlamp). My brother was on Accutane but had to stop because of elevated triglycerides (this was the early 80s). I declined it from one derm because I thought he was too cavalier about the risks (”Why didn’t you ask me about birth control?” I asked. “You’re not married”, he replied). Once I took it my skin changed from the inside out. All kinds of comedones sloughed off and the top layer of skin was fragile and peelable. Not only did my acne GO AWAY FOREVER (okay, occasional minor zits) but as advertised, my skin kep improving after I finished the dose, and my acne scars continued to heal. There are a lot of scare tactics used against this drug but its power to change lives is understated.
michelle komnenovichJuly 27th, 2010 (#):I am currently taking accutane. I don’t have cystic acne – I do or did have very clogged pores on the nose, chin and under the jaw line. My dermatolgist prescribed it for me for my rosacea that was progressively getting worse. I tried all the meds and IPL treatments. Nothing – just an increase in sensitive skin. The results are amazing. However, I have a few questions that no one can seem to answer. I did have oily skin now it is somewhat dry with flaky patches that come and go. Do I treat the dryness? Do I actually use moisturizer? And can I use your toners and maybe the BHA lotion? I feel I need the antioxidents and exfoliation. What to do? Also, what is your recommendation for windburn? I play golf – but not now in 100* Texas ( Can we just say stingy stingy burn) I do wear your mineral sunscreen and a big hat. But afterwards – stingy stingy – after playing in windy Ireland.
Love you and your products!!
Paula BegounJuly 28th, 2010 (#):@Muhammed- All these posts are extremely poignant and meaningful for all of us. However, I cannot tell you anyone what to do on this topic. Accutane is a decision you have to make for yourself by weighing out the pros and cons. If you do decide to give it a try then you must find a doctor who will help you through the process. -Paula
BryanJuly 28th, 2010 (#):@Michelle: We’re glad isotretinoin is keeping your rosacea in check! This drug isn’t often used to manage rosacea, but you went through all of the other options and isotretinoin is working wonders! We are surprised you still have oily skin despite being on isotretinoin. You should be seeing less oiliness. Perhaps that will happen in time. You do need to treat the dryness but without making the oily areas worse. Paula’s Choice Skin Recovery Toner is a brilliant option for dry, flaky patches, and you can follow up with our Skin Balancing Moisture Gel. This is what I do to manage my finicky skin and it works great! Adding a Paula’s Choice BHA option is also a good idea. Start with the 1% BHA Lotion or Gel and see how your skin responds.
As for windburn, a good approach before you know you’ll be in windy weather is to apply a silicone serum beneath your sunscreen. The silicone will feel light and silky and offer a protective layer to help shield your skin from the wind. A good one to try that shouldn’t aggravate your rosacea is Elizabeth Arden Ceramide Gold Ultra Restorative Capsules. Apply the contents of one capsule and you should see a lot less damage from windburn (and don’t forget the sunscreen)!
AntonJuly 29th, 2010 (#):Thank you Paula for blogging on this. I had a feeling this would be something many people wanted to hear about and talk about. More importantly, it goes to show how many people have struggled with this condition, and how they appreciate it when others (like Paula) share their experiences about what worked and what didn’t. I’m definitely looking forward to your next blog talk radio show on acne again.
GuyAugust 4th, 2010 (#):Hi Paula,
I’ve never commented before but this post nearly brought tears to my eyes. I went though every single emotion and feeling you described here.
I managed to survive the teenage years with only mild acne, but began to suffer red, angry breakouts in my early 20s (just as all my peers had
outgrown it!). It sounds so melodramatic on reflection, but having such bad acne had to be one of the most emotionally painful and soul-destroying experiences of my life.
It was only after discovering your website that I learnt about Accutane (thank you Paula!) and like everyone else here, it changed my life. I had side effects galore though – dry lips, itchy scalp, skin that would scrath and bleed easily, bloody noses, a terrible initial flare up when I began taking it; the absolute worst though was when my hair began to fall out. However, even with all that I can honestly say I would do it again in a heartbeat.
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