By Halcyon Orvendal
I have struggled with acne since I was twelve years old. I spent much of my adolescence cycling through different over-the-counter products and prescription medications that claimed to exfoliate my skin, recycle cells, disrupt my hormonal cycle, kill microbes, occlude moisture, rebuild my skin barrier, promote lymphatic drainage and a slew of other functions which were ultimately in vain. After years of veganism, different oral prescriptions including several types of birth control and more than a few adverse reactions, my acne persisted.
This summer, I started isotretinoin, a prescription medication colloquially known by its original, now-defunct brand name: Accutane. The drug’s horror stories, FDA black-box warning and tedious approval process were not enough to deter me — such is the case when you have been dealing with cystic acne for so long.
After some research, tons of dermatologist appointments and some good old-fashioned experimentation, I consider myself a bit of a pro in managing an Accutane lifestyle. I am honored to share my divine wisdom with the masses of pimpled students likely comprising The Mossy Log’s readership here at Lewis & Clark.
Before we get to my classy Accutane advice, I want to clarify that I do not think anyone should feel pressured to get rid of their acne. I truly believe that acne is beautiful and the shame around it is rooted in patriarchal and capitalist beauty ideals intending to control and exploit people for their physical appearance. I have pursued clear skin for so long due to the physical pain of my cystic acne and my desire to escape some of the shame I have felt for it being very visible. Using Accutane to address acne is a serious decision and not to be considered lightly. There are very real risks associated with this drug, so being honest with yourself about why you are actually interested in taking it is crucial.
With that said, for all my brethren in the same boat, here are some tips and tricks that have helped me survive Accutane.
Skincare and Combating Dryness
One of the most common side effects of Accutane is dryness. Your lips are dry, your eyes are dry, your skin is dry. Basic daily moisturizers likely will not be enough to keep your skin hydrated. Look for moisturizers and skincare products designed specifically for very dry skin and eczema. I personally use La Roche-Posay’s Triple Repair Moisturizing Cream all over my face in the morning, along with a layer of Aquaphor on top. At night, I wear Weleda Skin Food, though be aware that this is not specifically designed for use on the face — if you choose to use this, I suggest a patch test before daily use. Do not use products with retinol, benzoyl peroxide or salicylic acid. Along with that, avoid chemical exfoliants which tear the skin. Make sure to do some research on every product you are using — I recently gave myself contact dermatitis when I tried to integrate vitamin E oil into my routine.
Though I do not consider myself to be as much of a dehydrated baddie as I was in my youth, Accutane has made me feel like the sentient embodiment of powdered milk. In my first week on the medication, even before the skin dryness set in, I started getting daily headaches from lack of water. If you can, try to double your water intake. It will not only help your overall health but will also help mitigate dermal dryness.
Keep moisturizing eye drops handy for dry eyes. For nasal dryness, I recommend the NeilMed NasoGEL for Dry Noses. However, a dab of Aquaphor in each nostril before bed would also work. Keeping your nostrils moisturized is the best way to prevent the dreaded Accutane nosebleeds — take it from someone who has never had one.
Perhaps most importantly, bring Vaseline or Aquaphor with you wherever you go. Your lips will be drier than you have ever experienced and if you do not moisturize them regularly, the corners of your mouth will crack. But regularly applying a thick occlusive layer will keep your lips moisturized all day.
If you experience hair dryness, a moisturizing shampoo and conditioner should ease that. I am also a big proponent of using oil to moisturize your hair — I recommend argan oil.
Sunscreen
I started Accutane in July back home in Colorado. I had to apply sunscreen roughly every twenty minutes to avoid getting burned, and even then, I often got home from work with a cherubic red blush all over my face. Elta MD, Vanicream and Neutrogena all have great sunscreens for Accutane users with very dry, sensitive skin.
If you are someone who is not in the habit of wearing sunscreen every day, now is the time to start. Sunscreen is, in general, good for skin as it slows signs of aging. On Accutane, your skin is much more sensitive to the sun than usual, so taking an extra few minutes to apply and reapply sunscreen is a must.
Thankfully, I have noticed that after being on the medication for several months, I do not experience the level of sensitivity that I did when I first started it. Being in the Pacific Northwest with winter on the horizon also helps, though clouds do little to block UV rays. Even on cold, cloudy days, you should still wear sunscreen to protect your sensitive skin.
Pregnancy Prevention
If you are someone who menstruates, one of the strangest aspects of being on Accutane is pledging to not get pregnant. If you get pregnant during or within one month of taking Accutane, you significantly increase the fetus’ risk of developing congenital conditions, miscarriage, preterm birth and stillbirth. To account for this, the FDA requires you to show two negative pregnancy tests, one month apart, to even begin taking the medication. Then, to be approved for your monthly medication refill, you have to send your doctor a negative pregnancy test result. I recommend buying a bulk pack of pregnancy tests from Costco or Amazon to use during your treatment.
In addition to requiring negative pregnancy test results to get your medication, the FDA also requires you to either use two forms of birth control or pledge abstinence. These methods are reported using the mandatory iPledge online program and must be entered once a month to get your medication.
Even if you are someone who is not at risk of getting pregnant (like if you do not have sex with people who can get you pregnant), you are still required to do this.
If you are someone who has sex with people who can get you pregnant, be sure to continuously use your forms of birth control, even if it feels like overkill. If you get pregnant on this drug, you will be forced to immediately stop your treatment and lose all of your progress. Do not be that person.
Alcohol
You might notice that you get drunk much easier on Accutane. Accutane is processed by the liver; although it is unlikely to cause acute liver damage, it does affect the way your body processes substances like alcohol. Try to avoid drinking alcohol when possible to prevent your liver from experiencing unnecessary strain or interfering with the absorption of your medication. That said, we are in college, and drinking alcohol is a facet of student culture everywhere. So, if you do choose to partake in such activities, make an effort to limit your consumption. Your body will thank you.
Tattoos and Piercings
You should not get any tattoos or piercings during or within two months of taking Accutane. As tempting as it can be to accessorize your newly clear skin with a septum or a Britney-style tramp stamp, the fragility of your skin will prevent these from healing fully and properly.
Getting a tattoo or piercing on this medication can increase your risk of infection, increase risk of scarring or even make the process more painful. Permanent body modifications should be treated as such — lasting physical changes that are worth getting right. You have your whole life to deck out your body; it is worth waiting a few months to make sure your tattoos and piercings look their best for years to come.
My number one piece of advice for people interested in taking Accutane or already on the drug is to use Reddit as a resource. The r/Accutane forum contains hundreds of posts from tens of thousands of people who have successfully survived the drug. It contains skincare routine recommendations, advice for every side effect one could experience, progress photos and resources for people at every stage of their endeavor for clearer skin.
Yes, medical literature is an important source for learning about how this drug works and what side effects you might experience. However, personal advice from legions of people who have taken the medication can save you the hassle of firsthand trial-and-error, and validate the emotionally turbulent journey that is Accutane.
Overall, fear-mongering around Accutane can be daunting, especially with the side effects it is known to cause. The fact that some new medications can turn your bones green was a bit of a turn-off. But it is possible to master the art of living while taking this medication. So make sure to stay strapped (with Aquaphor) and keep it sexy (safely).
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