Vanity’s Bonfire: Thoughts on Accutane, post-treatment

I have a few thoughts racing through my head right now, all related to Accutane:

One: I think my skin hasn’t been this good since I was a teenager (I had nice skin as a teen. Of course.).


Three: I could really go for fucking a wall. Not on a wall. Fucking a goddamn wall.

I will explain.

But first, some Renaissance.

Ludwig von Langenmantel, Savonarolas Predigt

Let’s work some unasked-for Savonarola into this skincare blog

Girolamo Savonarola (1452 – 1498) was a preacher in Renaissance Florence. He’s most well-known for making some pretty apocalyptic predictions, organizing a bonfire of the vanities, and for being executed in the main square of Florence (there’s a metal marker in the piazza today marking the spot).

The idea behind the bonfire of the vanities was that people would voluntarily burn things like makeup, paintings, books, and clothes that they believed caused them to sin. The most famous bonfire was held on 7 February 1497, which was Shrove Tuesday aka Mardi Gras. Today is Mardi Gras, so referencing this moment in history seemed extra appropriate. Also I’m a fucking nerd.

When people think of the Renaissance, they often conflate fine art nudes or Machiavelli’s ruthless political theories with a rejection of religion by most people. That was absolutely not the case. Lorenzo de’ Medici, the great art collector and banker himself, was a Savonarola fan.

The rejection of vanity and objects that are intended to enhance appearance is woven into Western Civilization while at the same time the very same objects and beauty are embraced. No wonder people often feel both a desire to change their appearance and simultaneously feel deep shame about doing it — the weight of history is pushing from every angle here.

I’ve always taken a slow suffering approach to skincare. I guess I thought that if I was going to openly pursue vanity, I should make the process as fraught as possible. I didn’t seek pain per se, but it certainly didn’t put me off. Something about pain and effort felt right.

When I was in second grade, my mom cut off my (natural at that time!) long golden hair. She reasoned that I should learn how to manage it on my own, which would require it being shorter. And she said that I should never be just the girl with the pretty hair. The idea that if something makes you beautiful and reduced to some aspect of your appearance, you should cut it off is both a wise and empowering gift and callback to the bonfires that consumed Renaissance clothing and cosmetics.

Where I’m from, beauty is something that people think should spring forth more or less naturally, maybe with the help of some makeup, but too much grabbing for it is judged harshly. How much is too much is never clear. Talking about it, wanting it, working for it: a source of derision, proof that someone has lost their down-to-earth qualities.

But let’s be real: I am absolutely not fucking down-to-earth, and being told that my face had to change to save my teeth freed me from pretending I was.

Why Accutane is so hard to write about

I tried to write this post earlier, but I think the Accutane fatigue made it difficult to work up the energy to write. So that’s one element: no writing juice.

But the problem is bigger than just lacking energy. I’ve spent some time on Accutane Internet and accounts from real people who have used it seem to be passionately for or against the drug. I’m in the middle.

More than anything else in the acne and skincare universe, this drug is YMMV (Your Mileage May Vary). Young, extremely active people can be hit with very limiting joint pain early in their course. Other people can slide through with just some dry lips.

One of the problems with “Accutane accounts” in digital and glossy publications is that they’re often written by people who took the drug ages ago. In many cases, the person is decades into clear skin and memory of the side effects associated with isotretinoin have faded and all that remains is the knowledge that in the end, they got the prize of decades of socially acceptable skin.

I’m an obsessive planner. My job includes event planning, that’s how much I’m into planning things. With Accutane, you can’t know anything in advance. It was maddening. You can’t know if you’ll reach the skin promised land or end up needing another course. There’s really no way to predict which side effects you’ll experience. Everything is specific to your personal chemistry, but not in that seductive “it’s all just for you” self-care way.

We’ve sort of let out the Accutane beast without knowing the full extent of what it does to skin (and everything else). But that seems to be the case with many prescription drugs, so let’s not act too scandalized. Sometimes that means we discover that it does marvelous things like permanently reconfigure your skin microbiome.

To get a sense of the range of experiences patients have on Accutane, I recommend checking out the Accutane subreddit. The highs and lows and fears and pains are discussed daily; you’ll get a better sense of the drug’s impact by hearing from lots of voices.

About my course of Accutane

I was on Accutane for six months and I worked up to taking 80mg of Myorisan (generic isotretinoin) per day. That’s not a ton versus my weight, but my dermatologist wasn’t fixated on reaching a minimum dose; she wanted to see one month of cyst-free skin before taking me off the drug.

I took all of my pills at once, in the mornings, along with at least 20g of fat since isotretinoin is fat soluble and research shows that it is absorbed best with 1) food (for the sake of volume) and 2) plenty of fat. Getting enough fat while also trying to lose weight was a challenge! Starbucks egg bites and overnight oats with a full serving of peanut butter got me through it, but I’m looking forward to scaling back a bit on the fat intake at breakfast.

I see a lot of people second-guessing their derms when it comes to dosing and my recommendation would be to trust the expert in the room, not compare your dose v. weight to others, and see how your body and skin responds. In some cases, derms like to keep doses low to minimize side effects and they just keep patients on the drug longer. Tbh, if I had more time before jaw surgery, I would have been SO down for that, but my derm’s plan worked.

The things I hated about Accutane, ranked

Can you tell that I’ve been waiting for this moment?

1. I ended up needing five courses of pretty strong antibiotics for pneumonia and multiple fights with tonsillitis. The scholarly literature isn’t as clear about a link between bad bacteria growth and Accutane as it is about some other things, so my doctors weren’t rushing to yank it. Eventually, when I was deeply out of fucks and very done with taking pills, I asked my ENT doctor again if I should stop taking it for good and he gave the nod. By then, after being so sick so often, I was relieved, even if my skin might have benefited from a bit longer on ‘tane.

2. While immune issues are less clearly linked to taking ‘tane, lower back and joint pain is mentioned right in the massive sheet of possible side effects and whatnot that comes in each box. About 1/3 of Accutane patients experience lower back and joint pain according to the sheet that came in my Myorisan box. To deal with this, I went to physical therapy for months for massages and exercises (shoutout to Amanda Sachdeva at SPEAR Physical Therapy for getting me through this and dealing with the scheduling nightmares caused by my constant illnesses).

To put this in perspective, I went from walking around all weekend for funsies to feeling like an arthritic 70yo. I don’t like taking pain medication, so I mostly skipped Advil, but sometimes I needed two to deal with the discomfort, especially if I was also dealing with pain from braces adjustments.

I still have some lingering lower back tightness, so I broke my “no fucking yoga” rule to do some fucking yoga and wow WOW, it’s magical. YouTube has lots of options in the “yoga for pain relief” category. I did this video last night and I feel amazing:

3. The logistics of getting the drug: NIGHTMARE, especially at first. My low-impact birth control plan? Scrapped due to the iPledge administrative requirement that women of childbearing age use hormonal birth control, an IUD, or be sterilized plus use another form of birth control as back-up. My attempt to use the low-drama lab near fan-b hq? Scrapped because my lab prescription was written for 1x per month and I was coming before 30 days had passed in order to get the results in time.

I eventually got a system together and got my blood drawn once per month on Mondays so the results could be printed in time for a derm appointment on Wednesday so I could pick up the drug on Thursday or Friday if the pharmacy was out of stock — all necessary due to the requirements of the iPledge system.

4. Exhaustion. There were points where I was so tired despite sleeping constantly that I felt like I’d never be well-rested again. I’d put in a solid 10 hours on the pillow, get 8.5 hours of sleep according to my Fitbit, and basically feel like a ghost behind me was secretly sucking out my life energy.

5. Shocked and confused by sudden dry pussy. It lasted for about a week until a gif of Kai bodyrolling reset things.

6. Closed comedones: some are still in the building wtf. Despite months of positively punishing my skin in hopes of driving everything in it to the surface in a fantastical purge of epic proportions, I still have what an esthetician once called milia-not-just-around-my-eyes. For some reason, I get these pore plugs of the hard, intractable sort that usually form in the eye zone due to oil and whatnot except they’re…everywhere. Not around my eyes, weirdly enough. My derm said that some might need to be extracted later. DO YOU KNOW HOW HARD IT IS TO ACCEPT THE IDEA OF EXTRACTIONS AFTER ALL THAT ‘TANE SUFFERING?!?! Most people don’t have heirloom clogs like I do, but just be aware that the end of treatment might not be The End of Treatment. Scars persist, hyperpigmentation from healed spots persists, some pores just won’t be unclogged without intervention from some metal.

99456. Dry lips. They bled and cracked, but in the grand scheme of things, nbd once I bought so much lip balm that I had tubes in every room and bag.

Should you take Accutane?

lol you know I’m not going to answer this question for you, you know your life best.

[I want to interject one caveat here, though: it’s my strong belief that Accutane patients should have an established, professional sounding board when taking the drug. Ideally your derm. When the side effects hit, most people get very very worried.]

Looking back, I decided to start ‘tane at a point where there was so much bad information hitting me about my body and so much potential danger due to surgeries anyway that my decision boiled down to “fuck it, sure.” Had I been in another place, I’d have passed. I’m down with vanity, not down with the fuckton of side effects.

I’m happy to have this skin and Accutane absolutely worked for me. That said, if I was whisked back to the exam room again, knowing everything that was to come, I probably would have declined the drug. Pneumonia was terrifying, I spent a week with a literal roar coming from my lungs each time I opened my mouth. That lasted until my GP gave me the antibiotic used to treat the motherfucking PLAGUE.

In the time since finishing ‘tane, I’ve started using azelaic acid, a topical medication that’s used to treat acne and rosacea. I’m not experiencing any side effects, it’s fairly easy to buy from abroad, and it’s even pregnancy safe. If I had been in a more logical frame of mind, I’d have given azelaic a try before going through the pains of Accutane.

It’s not that I regret Accutane so much as I surprised myself by using it. This whole blog has been about long, slow suffering for the sake of getting clear skin and I went with the nuclear option due to a whole lot of other stuff going on. I’ve made enormous life changes to try to minimize the number of pills I need to take in the future, and I made a decision in about 15 seconds that put me on not only isotretinoin but hormonal birth control (it doesn’t really agree with my system) for over half a year. It’s a lot.

Live footage of me and Virgil last summer.

The truth is that I felt bad for myself and I wanted to work less hard on my skin.

Let’s do some math. I started this blog in 2014, when I was dealing with the worst skin of my life. In the five years between then and now, I added Curology to my routine, introduced daily acids, tried straight Retin A, discovered the wonders of Differin aka adapalene, used spearmint capsules to try to regulate my hormones, and did several acid peels so strong they made my skin shed like a snake.

How much did that cost? Let’s not talk about that.

As you can imagine, by the time I was in the exam room, I was very very tired of thinking about my skin. My skin wasn’t in the perfecting stage or nearing glass skin #goals, but still actively surfacing randomass zits despite so much effort sunk into it. As I mentioned in my About section, I don’t even feel a strong draw to skincare; I love makeup.

There’s a concept in the travel hacking community called “be your own data point.” Meaning, try it, report back to us. I’ve been my own data point for five years and by now, I would really like to not serve as my own science experiment.

I wanted to be done. I wanted to rip out the threads of shame woven into the pursuit of vanity and grab at it openly. I wanted a happy ending and some closure. In one sense, I got that.

The good part

I leave the house without base makeup on now.

Let me repeat for the people who couldn’t hear over the rumble of the crowd. I LEAVE THE HOUSE WITHOUT FOUNDATION OR BB CREAM ON MY FACE.

I still wear base sometimes, but not because I feel like I must. I can slap on skincare, end my layers at sunscreen, brew some coffee, and get out the door faster.


That’s been the goal, though modest, all along: just leave the house most days gloriously base-free, comfortable in just my own skin and some SPF.

The bad part

I have lingering lower back tightness and my tonsils refuse to stop blowing up like bacteria-infested nutsacks parked in my fucking throat, so they need to come out. Have you ever tried scheduling a tonsilectomy around a jaw surgery? *scalpel emoji*

The NSFW part

Now that I’ve been off Accutane for a month and got to stop taking hormonal birth control…

I feel alive again and by alive I mean I could really go for *bus passes by loudly*

Seriously tho, I’m *traffic intensifies, downing out all sounds*.

Just lock me in a small room for a bit, don’t mind the flames.

ANYWAY! Off to braise in my vanity…