I sometimes giggle to myself over the fact that I look pretty good for someone who needs the equivalent of a gut renovation on my face. Tomorrow, I’m having surgery to remove my adenoid (not supposed to be there!) and make sure it’s not hanging around for nefarious purposes. At the same time, my surgeon will fix the nose damage probably caused when I got kicked straight in the face while playing soccer as a kid. I’m excited that I might finally be able to draw breaths in time with meditation apps (at this point, my nose can’t hoover air fast enough to keep up).
Then there’s next year’s jaw surgery, which I’ve already written about.
I’m a medical minimalist. I think we all are, if possible, right? I don’t know many people who aim to spend tons of time at the doctor for fun. I was a bit on the extreme side, though, and well into my 30s, I only went to the doctor to get a prescription for something urgent like an ear infection.
I still remember having terrible, untreated acne and calculating the distance between my house and the nearest derm. Too far, way too far, I thought. The office was practically visible from my porch, but it was cognitively too far for me at that moment because I was broke, unsure about how to take time off from work for something like medical care, and worried about what would greet me in the examination room.
I started trying to treat my acne with these sketchy “peels” from Amazon and eBay, shudder. Next, I discovered kbeauty, but my skin got worse after trying Benton products (2014 wasn’t a great year for the brand). Curology, then called Pocketderm, was my lifeline, my first attempt to really attack the problem — it was prescription medication minus the in-person office visit, bingo. My early prescription contained my first dose of tretinoin, a drug that has delivered miraculous results for some skin, but made me almost turn inside out due to the irritation and itching (probably from one of the inactive ingredients).
I tried the new drugstore 0.1% concentration of Differin and it was magical. It wasn’t enough to clear my acne, but the gel formula clicked with my skin. After an episode of alopecia areata, I finally had a derm and I tried a stronger dose of tretinoin, then the prescription strength version (0.3%) of Differin.
Differin aka. adapalene is the most wonderful thing. The gel feels fine on my skin and it turns my clogs into rockets that either shoot out of my face or shoot into the skin covering them, often with significant inflammation. At first it sent clogs pounding to the surface in clusters. Now they just come up endlessly, usually solo, but sometimes in twos and threes and even fours.
Endlessly. The whole experience feels endless. I’ve spent more than four years trying to peel and cleanse and apply prescriptions and my skin is certainly better than it was before (and I have fewer fine lines, BONUS!), but the end isn’t in sight.
My Differin routine is a bit dramatique. I take a shower and cleanse. Then I apply Differin all over my face while wrapping my robe around me in a way that leaves my body covered, but my neck and chest bare so that the fabric can’t transfer the gel beyond the line of demarcation. In cases where I’ve failed to do that, my neck has promptly been burned so badly that it looks red and a bit like cling wrap. After about an hour of holding my head carefully so my jaw doesn’t touch my neck or chest, I take a second shower and rinse the Differin off thoroughly and cleanse my neck to wash away any traces of the medication.
After drying off, I slap on some Dapsone, an antibiotic and anti-inflammatory gel that seems to zap the life out of any spots where skin has been broken.
I’ve become excellent, god-level even at extractions.
I can do a peel that would make most skin shed like a snake only to re-emerge perfect.
I’ve spent…gah, let’s not even go there.
I am also wanting to do some other things with my time; 90 minutes is a lot of time to spend each night on skin that isn’t anywhere near clear. The rest of me could use some attention and time and care.
All of this is to say that when my dermatologist looked up from my chart after completing my annual skin examination and said “You’re seeing me to get clear. Do you want to try Accutane?” I wavered in a way that I’ve never wavered before.
I tend to prefer the longest, most minimal route possible. I once fired a nutritionist when she suggested that I see the hospital’s weight loss surgeon due to a Trump-related weight gain (I’ve since lost 50 pounds, mostly out of spite).
Accutane is a famously gnarly drug. It can cause major birth defects in fetuses conceived while a patient is taking the drug or in the month after. Muscle weakness. Joint pain. It has been linked to depression and even suicide. In one instance, a woman’s old nose job grew bone spurs. Skeletal muscles that are healing after surgery can develop necrosis due to the patient being on Accutane. The process of getting the drug, if you’re a woman able to get pregnant, is mind-bendingly complicated. Like, I manage budgets and large-scale events at work and I have several documents noting when various tests have to get done and my windows for getting prescriptions.
“Do you want to try Accutane?”
Yeah, so I obviously said yes.
Not sure if there’s research on this, but I feel like there’s a danger threshold, and once someone hits that, every other decision is like “well, whatever, fuck it, let’s just do it.” General anesthesia, a rogue adenoid, and the idea of my jaw getting sawed up and plated back together wore me down and by the time my derm slid the acne nuclear option across the table, I pounced like Alessandro joyfully taking out a mouse that made the unwise decision to try to slide down the pipe in the living room.
And the thing is? I want clear skin and I wanted it four bloody years ago, not four years from now. I can feel the deep clogs embedded in my jawline still. I have in places what a facialist called milia except not around the eyes, just…on my jaw. Over time, the amount of inflammation and oil seems to have changed the way my skin works in some ways, keeping my skin in a holding pattern since I hit a breakthrough in April 2016.
Barring some sort of unexpected halt to the plan, I’ll get my first dose of isotretinoin in early August. I hope to document the journey here and review some products from the perspective of someone with dry skin for the first time. You can follow the journey on here and on Instagram Stories (I’m @fanserviced).
Now, uh, time to box up my precious acids for the *checks watch* next year. EEP!
I hope it goes well for you. It sure did for me!
Topical skincare and medications did help me (mainly BP, azelaic acid and BHA; my skin hated differin and tret unfortunately), but never got me completely clear. The problem was, I had hormonal cystic acne. I’d manage to fight my way to almost clear skin for less than a week every month, then my cycle would screw it all up – the new cysts would start forming and eventually make their way to the surface. And by the time they surfaced and subsided, new ones would already be forming – thanks hormones!
I resisted accutane for a long time, mainly because I was terrified of the mental health side effects (I have generalized anxiety disorder and recurrent major depression). Until, finally, I got a doctor I truly trusted who basically said “look, you’ve tried everything else (except hormonal birth control), the link between accutane and depression is far from clear, and newer research suggests low dosages can work just as well as the traditional dose with less side effects – why don’t we just try it, on a low-dose and do weekly check-ins, and if you have bad side effects we can take you off the drug immediately.” And so we did. And I was fine!
While I was on accutane, I had very minimal side-effects – a little dryness in general, increased thirst, my eczema on my body flared up until I switched out my body wash for a shower oil; but really, constant dry lips was the worst one. I went through a lot of lip balms and used the lainege lip mask a lot. I think my routine mitigated most of the dryness, tbh. My doctor was shocked at how good my skin looked throughout the whole process, LOL. Honestly, that was the best skin I’d had in my life. Pretty much perfect. Even my pores looked tiny without any actives haha.
Now, it’s been 7 months since I finished accutane and my skin isn’t quite as perfect as it was while on the drug (I get a few tiny pimples/closed comodones on occasion) BUT I haven’t had a single cyst, or even a big pimple, since. And I don’t even break out when my period comes! I started with oily skin, had normal-to-dry skin during the round of accutane, and now have normal skin. Still stick to pretty much the same routine but added back to my actives (AHA/BHA/Azelaic acid) now, but mainly just for helping fade PIH and working on small CCs.
Honestly, If I could go back, I’d take it at least 5 years earlier and save myself a lot of time, money, and pain. Maybe even do it in high school, because my acne caused me so much grief as a teen.
Both my daughters have used Accutane and their skin is remarkably improved by it. The oldest (she’s 23 now) has gotten acne back on her face, but no big cysts or anything, she’s just a bit spotty. Her chest and back are clear. The younger (21 yrs now) completely cleared up and has had good skin since, except she has scarrring from the previous acne. Her skin was def worse. 🙁 I’m so glad for them. I hope your treatment works out too. It’s the cysts that are the devil, aren’t they.
Good luck! I took Accutane (two, back to back rounds) in 2002-03. The dryness of my lips, feet and hands was a whole other thing, but you find the right products to deal eventually. For me, during and even immediately after I was never 100% clear but that may have had more to do with me being lazy and a high schooler at the time. I’m 32 now and I do feel like some of the effects “wore off” in my mid-20s, but I’m positive its the reason I don’t have significant, noticeable scarring today. I’m never going to have skin that doesn’t make clogs, but its at a level now where I can mostly manage it. Full disclosure: I absolutely experienced depression during my treatment and had to carefully monitor that, but I was well informed at the beginning so I knew it could happen. I also have some suspicions that my terrible night vision and rapid advancement of astigmatism are related to my treatment. I don’t have good science to back it up just my anecdotal experience, but maybe get your eyes checked beforehand and regularly during treatment.
My biggest tip for the whole thing though is find a highly moisturizing lip balm WITH SPF and buy 30 of them right now. Stash one anywhere you spend more than 5 minutes a day.
Hi Tracy,
Love your blog, and GL with Accutane. I would be interested in reading about it! I wanted to mention really quickly that my esthetician mentioned that milia specifically can sometimes be a side effect of food intolerances. She mentioned she developed milia on her cheeks from dairy as a teenager. Not sure if that’s relevant to you, but maybe something to look into.
Cheers,
Nadia
Saw this on Kind of Stephen’s blog: “Is Oral Omega-3 Effective in Reducing Mucocutaneous Side Effects of Isotretinoin in Patients with Acne Vulgaris?”
https://www.ncbi.nlm.nih.gov/m/pubmed/30002675/
It’s been over 20 years since my round of Accutane. I still had painful, horrible cystic acne in my mid-30s. It was amazing. Just a little dryness but otherwise no side effects. One great side effect, though is my seborrheic dermatitis completely cleared up while taking the medication. After one round, my acne was cleared and has not come back. I don’t know any one who was sorry s/he took the meds. I hope it goes great for you.
I also took accutane in high school, so 10 years ago now. I’m not going to lie, the experience was mildly traumatizing. My skin was incredibly dry,I developed eczema on my arm which required a prescription cream, among other side effects like incredibly dry lips. I was only on it for 4 months when my doctor yanked me off the treatment because I came down with strep throat and a staff infection in my nose while I was traveling. Despite this horror story, accutane did amazing things for my skin and I would do it all over again if I had to. I wish that I was older during treatment though to better monitor the side effects, I was only 17 at the time and not very well informed.
P.s. I found your blog tonight when I googled a dupe for Good Gene’s, it was so informative! Thank you!
Honestly, as a longtime reader this decision was sort of surprising to see. When I first found your blog I remember you saying you didn’t want to take birth control pills, so when you announced your decision to go on Accutane I found it interesting.
I suffered with hormonal acne for a long time and was slapped with a prescription for birth control pills as a quick fix. And it did help, no doubt about that. I was so baffled that any woman with hormonal acne wouldn’t just take the tiny pill and be done with their skin struggles. I scoffed at people that questioned the safety of hormonal contraceptives and shrugged off talks of increased cholesterol, high blood pressure, depression, etc. Literally all it was nothing but quackery to me. Until I hit 30 and decided to come off of it.
Hormonal acne and hormonal imbalances are quite obviously connected, so unless that gets addressed, the birth control is nothing more than a bandaid. They really don’t tell you that. They also don’t tell you that when you do quit the pill, the majority of us see our hormonal acne come back because not only has the imbalance been left untreated, but because birth control pills also kill off good gut bacteria and can cause micronutrient deficiencies, the issue is often worsened. So all this being said it makes no sense to me why a doctor would put a woman with hormonal acne on Accutane rather than suggesting they first dive into what’s going on internally. It’s a bit frustrating to read.
I was convinced I was doomed to deal with my hormonal acne until I finally addressed the actual imbalance at the advice of other women that struggled with the same issues. It still kind of of blows my mind that I don’t need birth control to have clear skin and the added energy and weight loss was awesome too. I don’t mean to sound preachy, and I completely understand the desperation to once and for all get clear skin, I just genuinely hate to think that women are being put on something that causes liver damage, IBS, etc to get clear skin, all the while not seeing the actual culprit addressed, and simultaneously being put on hormonal birth control (which can add even more complications for women suffering with hormonal imbalances)
It’s your body and you have every right to do what you think you need to do to be happy, 100%. For all I know you’ve heard all of this already. I’m saying this only as a woman who deeply sympathizes with what you and other women dealing with. Best of luck no matter what you choose.
Ok but how did you “address the actual imbalance?” And what were the issues shared by other women? I was on birth control a few different times, but I decided to go off years ago and my skin has been steadily declining ever since. It’s a wreck.
Good luck! I hope it works for you
35+ years. That’s how long I fought and struggled with severe hormonal cystic acne, and now, joy of joys, I get to fight it, and the consequences of it, along with aging. The consequences, you ask? Yeah, like icepick scars and other types of scarring, all over my chin (where I had it the worst, month-in and month-out) and on my formerly-glorious cheekbones, where I’d also get it. So now, I get to try fillers and other products, to hide the exceedingly unattractive scarring remaining on my face, from hormonal acne. (I was a working fashion model, in NYC, as a teenager–not a spot of acne in my teens. This showed up when I was 22, and in hindsight, I’ve had happily taken typical teenage spottiness, rather than this horror show. Now, thanks to the scars, I don’t get to “age gracefully.” I get to wish that Accutane had been available for ME.)
I, therefore, say, GO FOR IT. Yes, there are possible consequences and side-effects, but you won’t know how light or heavy those will be until you try it, and NOBODY should have to suffer with this cursed condition if they can find a way NOT TO. Good luck, Tracy.