A highly controlled drug, Roaccutane (Accutane) effectively banishes acne for the majority of those who haven’t responded to other treatments such as topicals or antibiotics. The majority of patients have one four to six month course, and around a third will need a second, but after that, almost all will never have more than a few spots over the course of their life.
I realise at 22, you’d think I’d have grown out of the ‘acne phase’, and I did – the hormonal acne phase in my mid teens, but when I hit my twenties, I got to the point where I would literally try anything with the promise of spot-free skin; liquid acid exfoliators, rich serums etc. As I started treatment at the age of seventeen, it progressively got worse. Topical creams were tried and three courses of antibiotics later over almost four years, my skin in December 2015 was at its worst. I would go on tablets, it would clear, and the spots would come back worse than they were before. I needed something which actually fought it permanently, not just while I was popping the pills.
Roaccutane can only be prescribed by a dermatologist, hence the usual long waiting list to see a dermatologist at a local hospital. On my first appointment with him, he made me cry, more out of relief that, finally, here was someone who could help me. I also underwent testing for Polycystic Ovarian Syndrome and blood tests to rule out a hormonal cause of the acne – it was all clear.
On my second appointment a month later, I left with a prescription in hand, under strict instructions to not get pregnant, and how much to take each day. I took the very first tablet that evening, and day one of two hundred-ish commenced. “I’ll be fine,” I said to myself.
A month later (yes, you have to see the dermatologist every single month), I think even the dermatologist was surprised at just how much my skin had improved already, minus the breakout of cysts on my chin. I was smiling, my skin wasn’t oily (it was bone dry – you know that moisturiser you have now, buy a new one, a really intensive one), and my hair was in the best condition it had been in for years thanks to only needing to wash it once a week (gross?) instead of every day, and as I explained all this to him, I thought to myself, I must be the most laidback person to walk in this office all day.
However, underneath the exterior, it was all going a little bit…you know? Shall we run through the list of side effects I had? Extremely dry lips, dry skin, dry eyes, eczema on my arms, dehydration, exhaustion, constipation, joint pain (I had terribly bad shoulders), cracks at the corners of my mouth WHICH WOULD NOT HEAL, blood bogies, dry gums which made it feel like my teeth were about to fall out, and really red skin, but as these are all expected, they just sort of look at you like “well...you asked for it.”
Back in my day to day life away from doctors, people spoke to me with such reassurance. From my flatmate to my pilates instructor, everybody offered a voice of encouragement much like “we’re going to get through this together,” which I would usually roll my eyes at. Turns out as I hit the second month on 60mg of Isotretinoin a day, I needed it.
I had wrongly assumed that once the initial first month breakout was over, it would get easier and life would crack on. Month two saw to kill that assumption. You see, when you’re on Roaccutane, everything takes a little bit longer to heal, so it doesn’t help to keep prolonging that breakout by picking the skin which is trying to heal the spot. Don’t do that. I mean, I’d had worse dry skin when I was nineteen, on Epiduo, which is a topical prescription cream but at least that ended after two weeks or so. With Roaccutane, it just went on…and on…and on. It really seemed like there was no let-up. I would sit on the sofa in the living room sighing “give me a break.”
Another odd side effect was the sweat. “But I’m supposed to be drying out, HOW CAN I BE SWEATING SO MUCH ON MY FACE?!”
Alas, around ten days in to the second month, my prayers were answered and I could wear make up again without it looking terribly flaky (the day I tested this was also the day I walked past Harry Styles coming out of the gym while I was walking in – glad I had my face on because I had such a chance, you know); my skin stopped feeling so dry even when I’d JUST moisturised; my lips didn’t crack so much when I tried to open my mouth to brush my teeth in the morning; and the British pale skin of mine returned to its glory instead of having that Brit-Abroad look (y’know the one I mean – red raw British person on a beach in the Med); and I was no longer having awful face sweats on the tube at seven in the morning.
Water became my best friend; I’ve gone through the perils of being dehydrated for extended periods of time when I got landed with a kidney stone in August 2015 (pain = worse than childbirth, apparently…so I hear) but water will be your saviour on Roaccutane. The drug dries you out completely so double the recommended two litres and your experience will improve vastly in all areas…and I mean, all.
My third month saw my lips become the Sahara; no amount of intensive balm from Egypt, courtesy of my flatmate, would help for more than five minutes. They peeled and peeled and peeled until blood was sometimes pouring out of them – attractive. By the beginning of the fourth month, I was spotless. Of course, I had left over hyperpigmentation - red marks and scars, but there was not a single active, raised spot on my face – the first time in over eighteen months. It was glorious to wake up in the morning and not have to dread looking in the mirror. At the appointment with the dermatologist, he also allowed me to increase my 60mg dose up to 80mg if I wanted to; not all the time, because it’s a hefty dose, but at the weekends if I felt like it, if only to speed up the process so I can fulfil my cumalative dose quicker. People would tell me I was ‘glowing’ (did they mean sweating?) and that I looked so healthy; this drug was giving me a life I’d never had. I radiated confidence; all I wanted to do was be outside all the time (wearing suncream, obvs).
Heading in to the fifth month, yes my face was clear but my arms looked awful. Accutane doesn’t just decrease oil production on the face but across the whole body which meant when I scratched anywhere (mainly my arms), the skin would break and I’d be left with cuts along the outside of my them which took weeks upon weeks to heal. Aside from moisturising my body like my life depended on it, I began taking Vitamin E supplements to help it heal, and also added Zinc supplements in to my day. I don’t know whether it was a sort of-placebo effect that I had going on but I could really tell the next day if I’d FORGOTTEN to take my Vitamin E the night before; my lips would be cracking so much worse than if I had and it was harder to get products to sit correctly on my skin. However, by the end of August, my arms were healing and I was left with tiny red and brown patches dotted across my arms which would disappear in time. The skin on my face was still very fragile; I dropped my phone on my face while lying in my bed one night (don’t) and when I went to pick it up, scratched my nose with my nail. I woke up the next morning with a bleeding cut at the end of my nose. Joyous.
My Roaccutane journey finally came to an end as I went in to the sixth month of treatment. My doctor took one look at my skin and told me to finish what I had left (enough for 60mg every day for a week) and then stop. The difference between my skin at the beginning and my skin at the end of my treatment was nothing short of a miracle for me. No longer is my first thought before I even got out of bed ‘how am I going to cover up this face today?’ I can open my mouth and eat properly without fear of my make up smudging. I’m no longer suffering pain at the end of the day whilst simply washing my face. I’m a complete new women with bursting confidence.
Of course, there is always the lingering fear that my acne might return; there is, unfortunately, no cure and you are always in remission to an extent. Even though I remain on contraception to combat hormones which might contribute, that fear even extends to worrying about one day coming off those one day and watching my face explode. I continue to use the methods I used while I was on the tablets – I drink gallons of water every single day, I continue with exercising every day to strengthen my body after the toll Accutane has taken on me and pigs will fly before I become lazy enough to not take my make up off at night. I don’t drink cow’s milk and TRY to limit my intake of milk chocolate (hmmmm…); alcohol, although no longer banned, is definitely limited so as not to cause my liver any more harm after all the Vitamin A its had to process.
PRODUCTS.
Cetaphil Cleanser – I didn’t touch another cleanser other than this and STILL use this morning and night. It doesn’t dry out the skin or leave you with that squeaky clean feeling (your skin shouldn’t feel like this!) and my skin always looks so incredibly healthy after it.
L’Oreal Extraordinary Facial Oil – I know. Oil on a face where I’m trying to decrease oil? What? Believe me, it works. I’ve used oils on and off for years because even though I had acne and typically oily skin, it was also dehydrated. Putting an oil formulated for the face (ie. not coconut oil, no matter what they say) will keep it at the optimal level and add extra levels of moisture for HEALTHY skin. Putting skin oils on will not give you spots unless you are allergic.
Cetaphil Moisturiser – I have since changed my moisturiser but this was my go-to morning and evening moisturiser. Like the cleanser, it’s made by the same company who make a lot of the prescription acne products so is designed to work for this type of skin; fragile and delicate.
Clinique Moisture Surge – When I was experiencing quite tight, flaky skin, I would go to this to give me a boost. It left the skin feeling like velvet and the next day I would barely notice the dryness.
Oilatum Bath Formula – During my dry arm phase, I would soak in this capfuls of this stuff for hours. I used so much I could get through the whole bottle in three baths.
Water – Just drink it. Gallons of it. Keep a litre bottle around and try to get through it in the morning, another in the afternoon, and one in the evening.
