July 31, 2016

Let's Talk... Accutane

If you've ever experienced problem skin or breakouts, you've probably spent hours researching cures online and hundreds of dollars on prescription and over-the-counter treatments. Like me, you may have even considered the slightly controversial gold-standard: Accutane.

I've decided that rather than do a series of posts about my experience with Accutane that I would instead continue to update this post over the six month course of my treatment and then publish it when I'm finished. As this is the complete "diary" style version of my experience, it's LONGGG, but I thought this might be helpful for people considering or currently taking Accutane.

Backstory
I never had any problems with my skin throughout high school, but I was always proactive and was a regular at my dermatologists. About two years ago I started developing occasional problems with my skin, but nothing major. I had been on Proactiv for about seven years as a preventative measure, and thought that maybe my new skin problems were a result of over-use of the Proactiv and drying out my skin. I decided to stop using the Proactiv and instead switched to an almost entirely Dermalogica skincare routine. My skin still wasn't back to being perfect using the Dermalogica so I started researching all-natural skincare products and decided to switch to a line by Sumbody that essentially contained only tinctures and oils from different plants (rooibos, witch hazel, tea tree oil, tamarind oil, jojoba oil, etc.). My skin actually started to get worse, but I thought that maybe this was an initial clearing out or "purge" that we so often hear about, so I faithfully continued with my natural products. That's when my skin just got out of control. The spots that I would get were so persistent, absolutely nothing was working for me. Even when I started using more medicated, "non-natural" products, I couldn't get rid of them. My regular doctor prescribed oral antibiotics (minocycline), which I had taken in the past, and a different birth control pill (Tri-cyclen lo), but this only helped a small amount. As far as problem skin goes, I am fortunate enough to never have had any scarring, and to have my spots limited to the t-zone. I did, however, develop some cystic spots (the under the skin variety that take forever to go away). I was reluctant to go on Accutane because you hear so many horror stories about the negative side effects, but my dermatologist assured me that it would be the best route to take and that most of the side effects you hear about are overstated.

First Appointment (June 2, 2014)
At the initial appointment with my dermatologist to discuss Accutane I gave her a bit of a backstory on my skin (similar to what I described above) and showed her the skincare products I was currently using. She agreed the products I was using were good, and that sometimes skin just gets too inflamed and "out of whack," and that Accutane can help "reset" the skin. She was confident that this would put me back to the perfect skin I had before. I left that day with a requisition for blood work as well as two new skincare products from a medical grade line they carried in her office, Zo Medical Foamacleanse and Cebatrol cleansing pads (like a very expensive, and assuredly better, version of Oxy pads).

Second Appointment (June 11, 2014)
After I had my blood work done to check my triglyceride levels, I went back to my dermatologist. My results were normal and I was prescribed a low-dose (20mg/day) one-month supply of Accutane. I will be on the medication for six months but you are only given a one month supply at a time because you have to go back every month to have your blood work checked. I had read a lot online about needing to have a negative pregnancy test and enroll in the "iPledge" program, but I didn't have to do any of that - perhaps that is only in the US. After making sure I didn't have any history of depression, she went over the side effects that could occur while taking it. The main things she glossed over were that people can occasionally become more irritable (related to depression), I might feel a little achey at times (like after a workout), increased sun-sensitivity (she described this as burning in 18 minutes, rather than a standard 20), and some skin dryness. The other three things she warned me about were birth defects (use two forms of birth control), don't drink alcohol in excess (1-2 drinks is fine), and that if I develop bad headaches I should stop taking the medication and make an appointment to see her. I also asked her about my hair falling out (internet horror stories, anyone?) and she said she'd never see it happen to anyone and she has thousands of patients on Accutane. The worst that would happen is a little dryness or thinness that would reverse itself when I stopped taking the medication. She had really high hopes for complete effectiveness and after listening to her I was excited to get the treatment started. There was only one problem, remember that minocycline I was taking? It was completely incompatible with Accutane and I would have to wait 1-2 weeks after stopping it before I could start Accutane. Bummer. So I stopped taking the minocycline that day and would start my new pills in a week. She also prescribed me a different oral antibiotic (erythromycin) that was compatible with Accutane that would help alleviate any initial "flare-ups" I might experience.

First Month
About a week into treatment I noticed the skin on my chin and around my mouth has become quite dry and flakey. I'm not sure if this can be attributed solely to the Accutane because I haven't been on it that long, so it's probably a combination of everything I'm taking/using. The erythromycin can also cause dry skin apparently (go figure). I've picked up two new moisturizers (CeraVe and Dormer spf 30), started taking omega 3, 6, 9 supplements, and started using a humidifier in my room at night to try to help alleviate the dryness, although I've been told it will probably happen regardless. It's super annoying because it's near my mouth so it's very noticeable. Peeling dry skin is SO much more difficult to hide than a blemish. Sigh. I've also noticed a few more spots along my jaw, but the rest of my skin is actually looking better (again, my skincare products might be to credit rather than the medication). My lips are also becoming quite dry, I'm applying lip balm almost every hour. They don't feel chapped, but they do feel kind of tight, as though the lip products I'm applying aren't really sinking in. Products that work: Fresh Sugar Advanced Lip Therapy balm, Fresh Sugar Shine Lip Treatment, Bite Agave Lip Mask, Jo Malone Vitamin E Lip Treatment. The best thing I've found to work is to apply a thick layer of a moisturizing lip balm (like the Advanced Lip Therapy) and then top it with an even thicker layer of a moisturizing gloss (Shine Lip Treatment and the Bite Agave Lip Mask). It works because the gloss seals in the balm and keeps your lips moist. So while they do feel dry when they're bare, they look and feel perfectly healthy and plump with product on them. I did drink a fair amount over the past weekend at a wedding (around 6 drinks), even though you're not really supposed to. I didn't feel any different the next morning than I usually would after drinking, although I did notice my skin seemed a little more dry. However, I won't be making a habit out of drinking on Accutane because your liver is going through enough without the added stress of processing alcohol.

One Month Appointment (July 15, 2014)
Today was a super quick appointment. My blood work came back great and she said my skin was already looking a lot better. Apparently the first month they have you on a low dose to make sure you respond well to the medication, so my new prescription is for 40mg/day.

Second Month
During the first month I was seeing gradual improvement. The second month, however, was kind of a shock. I experienced some breakouts and my skin seemed extra dry and flakey in certain areas. I'm guessing this was from the increased strength of the accutane. I also developed dry patches on my arms, but this was quickly remedied with the amazing (albeit expensive) Kiehls Creme de Corps body lotion. By the end of this month I finally feel like I've found a routine that works for me to minimize any side effects (namely the dryness). I still use my regular Neutrogena SPF 45 moisturizer, but I add a little bit of the First Aid Beauty Ultra Repair Cream, which really seems to help with the flakiness. I also sleep with a humidifier on full blast every night and take a generous amount of Omega 3,6,9 supplements (every little bit helps, right?) 

Second Month Appointment (August 13, 2014)
Another quick appointment today. She was impressed with my skin's improvement and my blood results were great. I asked if responding so well and so quickly to the medication was an indication of positive permanent results, but she said that it wasn't and that pretty much everyone responds well. To be honest, hearing that was pretty discouraging. Yes, my skin looks good now, but how will it be once I'm no longer on Accutane? I was given another prescription for one month of 40mg/day, which is what I will be on for the remainder of my treatment.

Third Month
Praise the pharmaceutical gods! I'm finally starting to feel like myself again. I have maybe one or two tiny active spots, and really am only dealing with the light pink marks left over from old spots (which are fading quickly). I still wouldn't go out in public without makeup yet, but that's more due to me being a perfectionist. My only regret at this point is not doing this sooner. The one and only side effect I've experienced is dry skin, and really, at the end of the day, who cares!? Dry skin severely pales in comparison to breakouts. Yes, it's a shock going from combination/oily skin to dry, but it's nothing that wasn't fixed by upping my moisturizer game and being more diligent. My hair has always been on the dry side, so I can't exactly pinpoint when the dryness increased with the Accutane, but I definitely don't need to wash my hair as often.

Third Month Appointment (September 12, 2014)
The standard quick appointment. She was really impressed with my skin and double-checked that it had only been three months because most people don't clear up so quickly. Granted, I was wearing makeup so any little pink spots were concealed, but she knew that and could still see the condition of my skin. I had her okay the First Aid Beauty Ultra Repair Cream moisturizer that I have been mixing in with my Neutrogena and she said it was fine. I also had her okay that it was fine to use my eye makeup remover (Rimmel Gentle Eye Makeup Remover) to remove my foundation/concealer before washing my face and she said it was fine as well. Bloodwork was great and I received another one-month prescription for 40mg/day.

Fourth Month
This is going to sound weird, but I'm starting to get nervous because this treatment has gone so well. I've had the odd tiny spot here and there, but they are generally gone within a day or two and my skin is really looking great. I'm feeling like the me I was two years ago before I'd ever had a spot and didn't worry about waking up every morning and looking at my skin in the mirror. So why would I be nervous? Because knowing how good this feels makes me realize just how awful it used to be and how much I dread ever going back to that. Otherwise, nothing has changed, my skin just keeps getting better! I also started using the Aquaphor Healing Ointment just on the sides of my lips where I was prone to dryness or flakiness and it has been awesome. It has a similar consistency to Vaseline so it keeps the skin very moist and free from flakes. I was nervous about my skin becoming more dry as winter approaches, but I think this will combat that nicely. I would not recommend applying this to your whole face as it is very thick and might clog your pores and make things worse. I definitely would not have used this in the earlier months of my treatment as my skin was still very susceptible to spots.

Fourth Month Appointment (October 15, 2014)
Another quick appointment. Bloodwork great, skin great. On to the next month!

Fifth Month
Nothing really new to report this month. I've been working out a lot lately so during/immediately after my sessions my face has been quite pink. A few tiny spots here and there, but nothing major. Still super happy with my progress and skin overall. Again, the right products and routine really make all the difference in the world.

Fifth Month Appointment (November 12, 2014)
I don't want to say "quick appointment" again, but that's what they always are! I asked her if redness (almost like blushing) was normal, especially after a workout, and she said it was. The skin is more sensitive because of the medication and when you work out or have a shower, even more blood rushes to the surface, making the skin even more flushed. Apparently this is also really beneficial as it speeds healing (hit the gym!). She said it would go away as soon as I came off the medication. She also said she wanted me to do an additional month (seven total), just to be on the safe side. And she reassured me that the occasional small spot was normal.

1.5 Years Later
It's been a little over a year and a half since I finished my Accutane treatment and I'm happy to report my skin has remained beautifully clear. I occasionally get a tiny spot, but they go away within a day and are really nothing at all to be concerned with. I'm still using the exact same skin routine and products (Zo Normacleanse, Zo Cebatrol Pads, Neutrogena Healthy Defense SPF 50, and First Aid Beauty Ultra Repair Cream). Sticking to this routine has been SO important for me. I think a big part of the reason my skin freaked out in the first place was because I was trying so many products and doing so much to it. The routine I have now is gentle, but effective. The only downside is that they are on the expensive side, but as anyone who has ever experienced problem skin can attest, money is no object when it comes to maintaining clear, healthy skin.

Verdict?
If you've tried all the conventional products and treatments for problem skin without success, I cannot recommend Accutane enough. My only regret is that I didn't do it sooner! Don't let horror stories dissuade you, there's a reason it's the gold standard in acne treatment. Yes, it absolutely sucks having really dry skin for the course of your treatment, but the end result is definitely worth it. As always, discuss every symptom and concern with your doctor to make sure it's right for you.
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