"Many articles about acne start the same—but that’s because the struggle with acne, one of modern society’s most frustrating skin conditions, is far too common. The often-painful-and-often-shameful ailment is frequently lauded as adolescent and pubescent—but a Rutgers Robert Wood Johnson Medical School study finds about half of women in their 20s, one-third of women in their 30s, and one-quarter of women in their 40s will be bothered by breakouts.
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For the last 12+ years, I have struggled with acne on my face, chest, neck, and back—so when my dermatologist suggested isotretinoin for the third time (yes, literally the THIRD TIME), I was all too eager to sign on the dotted line.
I grew up knowing that acne was a likely possibility, as both of my parents struggled with acne as teenagers themselves. My older sister’s skin broke out a few years before mine did, so I knew it was only a matter of time. When I was in seventh grade, my face erupted with painful cystic acne—and I spent an absolutely massive amount of time each day layering makeup on, hoping to disguise my greatest source of shame. While each person and their insecurities are different, I speak for myself (and hopefully other acne sufferers) when I say that I would not wish cystic acne on my worst enemy. I felt betrayed by my body and ashamed of my face—sometimes even turning down sleepover invitations or trips to a friend’s pool, knowing I’d be expected to be makeup-free in front of my friends. In the scheme of problems in this world, I know this is not major—but to a little suburban teenager who was already uncomfortable in her tall and gawky frame, it was an absolute nightmare. (Good God, I wish I could hug that little teenage Abigail and tell her she’d be engaged to a global pop star someday! That’s technically not true yet, but I do think she’d like to know.)
Wait, what exactly is isotretinoin?
Good question. Isotretinoin is a naturally occurring derivative of vitamin A. Doesn’t sound familiar? You probably know it as Accutane.
Note: There are many other brand names for isotretinoin (like Claravis, the one I took), but Accutane is its most common, despite the fact that its manufacturer pulled it back in 2009. In this article, I’ll be referring to the medication by its clinical name.
Isotretinoin has been known as a controversial drug to take for a few reasons. First of all, its success rate comes with some heavy side effects–which can reportedly include anything from annoying dry lips to serious mental health problems. As Emily Goldberg wrote for The Atlantic, “Since it became FDA-approved to treat acne in 1982, it has also been linked to inflammatory bowel disease, depression, and increased rates of suicide. While studies have not proven that isotretinoin causes these conditions, they remain among the risks of taking the medication.”
Additionally, becoming pregnant while taking the drug can cause severe birth defects to a fetus—so there are strict rules regarding your birth control while taking it. Those who menstruate are required to commit to two different forms of birth control (for example, both hormonal birth control pills and latex condoms, among several other options) and to enroll in an online program designed to educate users on the importance of not getting pregnant while taking the drug. All that being said, isotretinoin is still a massively popular option because it’s highly effective at clearing up cystic acne (or, as your dermatologist might call it, “acne vulgaris”—a term that does NOT make a self-conscious teenager feel good).
Wait… you said you’ve done this multiple times?
I went on isotretinoin two different times while I was a teenager. The first time, I was in eighth grade, and the drug worked incredibly well—for a time. Given (probably) that I was still a teenager filled with hormones and not yet through puberty, my acne came back with a vengeance. I tried again during my junior year of high school, but was pulled off of it midway through the cycle (about three months in) by my parents and dermatologist due to my declining mental health. This is another article for another day—but I do want to make it clear that I have no idea if my mental health problems were related to the isotretinoin. I’ve struggled with depression and anxiety for many years, and I’m not sure if it would’ve happened regardless. Like I said—that’s a bigger discussion, but it is worth noting.
So, why did you do it again?
I spent most of college blissfully acne-free, but my early 20s were once again plagued with breakouts, extreme scarring, and a lottttt of concealer. By the end of 2019, I was living with my parents, gainfully employed, and covered in cystic acne—not a great Bumble profile, but the great makings of a candidate for the (very expensive) treatment.
When my dermatologist and I discussed it, I was sold immediately—but knew I needed to be practical. With such extreme possible side effects, the drug was a risk. I was afraid of the same mental health problems I had had nearly 10 years earlier, I was afraid that it wouldn’t work, and I was afraid that it was too expensive. After a lot of discussions with my family, the introduction of a new therapist, and much prayer and deliberation, I decided to begin… which is far easier said than done.
Pre-treatment
Given the potential birth defects, it’s notably more difficult for those who have a uterus to go on isotretinoin than it is for those who do not. Before you can fill your prescription, you need to be on birth control for at least a month, and you need to take a negative pregnancy test and a blood test (in addition to the requirements of the online education program—which includes monthly quizzes determining whether or not you’re well-versed in reproductive knowledge). I was cleared to begin in December 2019, but couldn’t fill my prescription until January 2020.
And that’s where our story TRULY begins (lol, what have you gotten yourself into?). Here, I share a breakdown of the five months I spent taking isotretinoin every day.
pre-treatment, wearing lots of makeup; November 2019
(Yet another note: You would be HARD-PRESSED to find a photo of my face from the side from the last six-ish years. Most of my acne affected the sides of my face, my jawline, and my neck, so I very purposefully avoided profile shots, side angles, or candid looking-off-into-the-distance moments. This photo from November 2019 is the closest thing I have to a “before” picture, thanks to my intense insecurity and desire to hide my skin—you can see that the pimples are clustered, kind of in a line across my face, and cystic (read: under the skin).) Double parentheses!
Month 1: January
After my month of new birth control (I have a blood disorder that prevents me from taking certain types of birth control, so this was a minor debacle. Not horrible, but a hurdle worth mentioning) and two negative pregnancy tests, I began my treatment cycle on January 11, 2020. My dermatologist predicted that my treatment cycle would last anywhere from 3-7 months, depending on how well my skin reacted to the drug.
Something that I have yet to mention is that isotretinoin is allegedly hard on your liver—so my dermatologist told me that I should have literally zero alcohol throughout the course of my treatment. I love my wine, but I figured it would be easy to give it up in the pursuit of flawless skin. Indeed, the first few weeks WERE easy—I reveled in how well I was sleeping, how much energy I had, and how consistent my workouts felt. I was in the sweet spot—no alcohol, the hope of clear skin, and no side effects yet.
Side effect tracker: My lips started getting dry, but smooth sailing otherwise!
Progress tracker: No improvement
Month 2: February
the peeling on my face after getting my eyebrows waxed; February 2020
Ah, the month before coronavirus derailed our lives. I spent February working a lot, fighting the bitter Chicago cold, and missing red wine by the fire. When I went out with my friends, I’d order sparkling water with lime, and I was still relishing the benefits of a sober lifestyle. My skin started getting drier, but I felt like it was improving. Was it really? Hard to tell.
At the end of February, I got my eyebrows waxed (something that is frowned upon during the isotretinoin cycle, as sensitivity in your skin is obviously heightened) and was given my first interesting effect: a chunk of skin ripped out by the wax. If I’m being perfectly honest, I was relieved—it felt good knowing that SOMETHING was happening within my skin.
hand dryness, smothered in Vaseline; late February 2020
Side effect tracker: My hands were dry, scaly, and almost a little swollen (see photo), and I didn’t feel like exercising—but that probably had more to do with the fact that February in Chicago is a little slice of hell and less to do with the fact that I was a few weeks into an invasive drug.
Progress tracker: Little to no improvement
Month 3: March
The month of March 2020 was, as in life around the world as with my acne journey, quite a catalyst. At the beginning of March, I flew to Texas for a close friend’s wedding. While at said wedding, I received a double whammy: the email that our office was closing indefinitely, and the interest of a cute groomsman. This combination of things provided me with the justification I was so desperately seeking to break my streak of sobriety and drink some champagne. I got tipsy VERY quickly.
In other news, I felt that my skin was beginning to clear up. I sent the following picture to our fashion writer/one of my best friends Maddie, and I marveled that, though still red and noticeable, the texture of my acne was decreasing into flatter blemishes. I was pleased with this progress.
skin progress; early March 2020
Side effect tracker: As the weather started to warm up for spring, I was running more—but began noticing increased joint soreness accompanying said workouts. My lips were cracking, and my skin reddened more easily.
Progress tracker: New pimples felt less frequent, but still scarred aggressively. No improvement in prior scarring–resulting in flatter texture but the same (if not increased due to sensitivity) redness.
Month 4: April
At this point, it’s honestly hard to tell what was happening due to an invasive drug eating up my insides vs. what was due to an increasingly horrifying global pandemic. I felt consistently downtrodden with the weight of the world, and my desire to participate in activities I loved weakened. I turned 26 and celebrated with alcohol—something that was (regrettably) growing more consistent in my routine.
the peeling skin abrasions that showed up in place of breakouts; early April 2020
This was the first month that my skin was becoming noticeably devoid of breakouts—but in their place came deep “burns” (I’m not sure if that’s what they were—but they were flat, bleeding abrasions that came from picking at and shedding my dry skin) across my cheeks. I had read that this would happen, and it proved to be completely true: I was literally shedding layers of skin.
During this month’s visit to my dermatologist, we discussed my progress and the likelihood that my treatment would need not be longer than 5 or 6 months. I was most excited for the reemergence of guilt-free alcohol into my life, but I was also ready to feel moisturized again.
Side effect tracker: The shallow abrasions on my face were unable to be hidden with makeup, and I resorted to covering them up with band-aids to avoid picking at them further. My lips and hands continued to flake, scale, and peel—and no amount of stretching or cooling down could ease the joint pain in my ankles after a run. I woke up stiff and sore every single day.
Progress tracker: The raised pimples on my face came to a minimum, but an overall redness was left in its place. The scarring formed a kind of a Pangaea on my face—merging into red splotches on my cheeks as opposed to more defined single scars.
Month 5: May
My treatment ended in mid-June, and the six weeks leading up to that date were some of the most physically painful I’ve ever experienced. As my dermatologist increased my dosage and the medicine “built up” in my system (that is not medical terminology—I am not a doctor), my skin reached a point of dryness that I genuinely felt I would never recover from. I had a steady regimen of moisturizing products (see below)—and it helped—but the dryness came from within. I was constantly thirsty, tired, and sore. I was frustrated with my running times, I limped when I walked (that is not an exaggeration—my ankles hurt constantly), and my skin was still peeling off. For these six weeks, I could think of little other than that the clear-skinned light at the end of the tunnel. I was THRILLED with my results, but the price with which they came was high. The joint pain was unexpected—I knew it was a likely side effect, but I did not anticipate the level to which it would affect me.
This is what my skin looked like without makeup on—skin abrasions, but lessened scarring and redness; mid May 2020
Additionally, this month brought with it more painful, peeling facial abrasions. I used an ill-advised pore strip, and the skin on my nose peeled off in a sheet. I was left with a gaping nose sore for the duration of my treatment.
This is what my skin looked like with makeup on—dry, peeling, and caking; mid May 2020
Side effect tracker: Intense joint pain, facial redness, skin sensitivity, painfully dry lips (like it-hurts-to-even-smile level painful)
This was when my dryness and pain were at their worst—it felt like I had lost all power over my skin (for better and for worse). You can see the nose peeling in addition to the overall sensitivity and shedding; early June 2020
Progress tracker: To quote The Fault In Our Stars, my skin cleared the way you fall asleep: slowly, and then all at once. My progress photos from early May show scarring, a few raised bumps, and angry redness—but as the weeks wore on, the scarring and bumps went down, leaving angry red “scrapes” in their place.
Post-treatment
Within just a few weeks of stopping treatment, my skin once again reached a normal level of moisture. I continued use of my mid-treatment skincare products, and one of them (the toner) is, to this day, still in my twice-a-day regimen. Also within weeks, my joints and body felt a lot more comfortable—I started running at a faster pace, and I stopped waking up stiff and sore.
post-treatment, with light makeup; August 2020
Yes, my skin cleared up. The skin I have now is skin I didn’t know was possible for me—it’s still scarred (but to a much lighter degree), and it’s now been completely bump-free for almost three months.
That being said, the physical pain that came with the treatment is not to be understated, and the emotional and psychological risks are nothing to be taken lightly. I prepared for this by choosing to live with my parents (who are well aware of my mental health struggles and kept a close, watchful eye on my behavior) and by committing to a therapist who was also aware of my medical history and current treatment plan. While my situation is unique in that it took place in the midst of the coronavirus pandemic (and therefore it’s difficult to determine what emotional side effects were caused by the medication as opposed to anxiety-inducing current events), the fact remains that the medication took a visible toll on my body. I’m thrilled with the results—but I cannot in good conscience recommend the drug to anyone who may feel physically or emotionally fragile. I sincerely implore anyone who is considering isotretinoin to take the side effects seriously and to passionately discuss options, potential harm, and subsequent action plans with their medical professionals and loved ones.
post-treatment, with makeup; August 2020
Since June, my self-confidence has skyrocketed. When I look in the mirror, I see a whole person with great features, as opposed to just a face riddled with acne. For years, I assumed that when people looked at me, they saw nothing but a face full of flaws. Now, I try new makeup looks because I want to, not because I’m covering up. I’m embracing my fashion sense in a fresh way, I’m more interested in dating than I have been since college, and I’m not afraid to go makeup-free on all my Zoom calls.
post-treatment, without makeup on; September 2020
While I do know that I am more than my skin and that my acne never defined me, I admit that I allowed myself to forget that all too often. For those who suffer from acne, the simple act of meeting someone new, stepping outside, or standing up in front of a crowd can feel debilitating. Thanks to my treatment plan, a helpful therapist, and my supportive family, I no longer have to live under the weight of my acne. And while that’s exciting—it’s even more exciting to consider all I can do with the time I’ll no longer spend covering up.
Abigail’s isotretinoin skincare routine
My dermatologist urged me to use minimal products during my treatment cycle, but encouraged moisturizing agents. I used these products consistently during various phases of my treatment.
For the most part, I rinsed my face but didn't use a cleanser (unless I had makeup on, in which case I would double cleanse). When I did use a nighttime cleanser, this is the one I used. It's lightly exfoliating, which made me feel squeaky clean but not uncomfortably tight. I would die for this toner. Unlike what you may think of as an "astringent," this toner is deeply light and moisturizing. I used it twice a day, every day during treatment and have continued ever since. As someone who also struggles with eczema (I am a dermatologist's dream/nightmare), I stan colloidal oatmeal. This moisturizer is light enough to not feel heavy or greasy, but was hydrating enough to soothe my poor, troubled skin. A little goes a long way, and I'm still using this product now. I've always known I should be using sunscreen on my face EVERY day, but it took the sensitivity that came with isotretinoin to make me believe it. This SPF is hydrating and brightening yet protective—so I justified the price with the multitasking capabilities (plus, it smells good!). This product is UNREAL (and I do not say that lightly, because I'm pretty skeptical when it comes to skincare claims). I applied this product before bed 3-5 nights a week (depending on my dryness levels) and would wake up every subsequent morning with plump, glowing skin. This was the most noticeably moisturizing product I tried, and I used it consistently throughout treatment. It's a little sticky before bed, so I'd recommend applying it about 20 minutes before you hit the sheets. I have since repurchased—this is going to be my holy grail during the Chicago winter. When my skin was feeling particularly dry, or when I wanted to "seal in" my moisture, I spritzed this bad boy all over my face. It sounds a little extraneous, but I promise that this hydrating spray made a big difference in my comfort level (and dewiness level). This is the absolute worst-tasting thing I have ever put on my lips—but in the deepest depths of my dryness, this was also the only thing that could soothe me. I put this on every night before bed (and during miserable moments throughout the day). This is not for people who are like "oh, my lips are kind of dry"—it's intense enough to calm broken, cracked lips, but the taste and smell are not worth it if you're not desperate (note: I was desperate).
