I am passionate about neuroscience and the human brain, but I also enjoy writing articles about the struggles of female acne.
My Advice: Go on Accutane and Get your Life Back
I went on an eight-month course of Accutane one year ago, and I want to urge every woman with moderate-to-severe persistent acne to take the plunge and go on the drug. I spent around three years of my life trying to treat my acne with homemade face masks, topicals that my GP prescribed, and even antibiotics—and all in vain, for absolutely nothing worked. Sure, antibiotics cleared my skin for three months, but the acne sprang back at full intensity shortly after stopping them, leaving me with a very compromised immune system (I will discuss this further).
I am going to be honest and tell you that if you truly have a case of bad acne that is not responding to common treatments, you need to stop wasting your time and money and go on Accutane. This medication will absolutely work for you if you take it with sufficient fats (it is a fat-soluble medication and this is necessary). A lot of first-time users worry that they will not respond to this drug despite it being their last resort, and I understand this anxiety. Nearly every other treatment leaves the acne-sufferer disillusioned and unhappy, as virtually none of them work to treat bad cases. Accutane, however, is a truly potent drug that transforms skin.
I have experienced some side effects from Accutane, some worse than others, but I can confidently say that my biggest regret is not going on it sooner. I spent a ridiculous amount of money trying other treatments during the years before I took the plunge—it probably ran up into the thousands of dollars—especially considering that I also seemed to be constantly buying expensive foundations to pile on top of my ever-worsening acne.
Dosage - Low or High?
Accutane is a cumulative drug, meaning that it does not matter what dose you are on as long as you take it for a sufficient amount of time.
- 20mg is a low dose
- 40mg is a moderate dose
- Anything above 60mg is considered a high dose
Many dermatologists are aware that people with severe acne want results as fast as possible, so they will normally try prescribe a dose of about 60-80mg for five months. However, I strongly advise against a high dose. This medication does come along with a plethora of side effects. Most are due to the drying effect of the medication and are totally bearable, but the higher the dose you are on, the worse any issues will be.
I went on 40mg for eight months. It was long, but the length of the course didn't matter much to me because once I hit month four I had flawless skin—and the lower dose meant that I did not experience severe side effects.
I would recommend a lower dose for a longer period of time, as opposed to a short five-month course at 80mg. You might be fine on a high dose, but the drug did cause me some pretty bad headaches, and I'm sure that I would've been rendered unable to function on 80mg.
How Bad Are the Side Effects?
Everyone is aware that Accutane comes along with some notoriously bad side effects. However, it is very important to keep these within the realm of reality. Research so that you understand the drug and common possible side effects, but DO NOT google further, as you will come across horror stories that are, in all honesty, extremely rare cases.
Truth about side effects: dryness is inevitable as the drug works to temporarily stop oil production. Other side effects including headaches and occasional nausea etc. are possible, but you may not experience them. It has to be said that pretty much all the common side effects stem from this dryness - i.e. itchy skin, sore nose, blurred vision.
- Dry skin - many people worry that Accutane will turn their skin embarrassingly dry, especially if they've experienced this on topicals. I can tell you with certainty that you will not experience bad dry skin on a dose of roughly 40mg daily. I did not experience dry skin. That's right - I had sore, dry lips and dry eyes, but my skin was just normalized. It went from very oily to normal. I absolutely adored this. As well as looking clear, my skin was beautifully balanced and didn't get oily or dry. I often went without moisturizer.
- Dry, sore eyes and impaired vision - this is less scary than it seems. Accutane did severely dry out my eyes, meaning that my vision was subpar at times, but this was sorted out completely by using eyedrops three times a day (product mentioned in the next section). This is essential while on Accutane, even if your eyes don't seem dry. They are not lubricated as they should be while on the drug, so you need to supplement the moisture levels with quality eyedrops.
- Dry lips - Accutane dries out your lips but this is not severe on low-moderate doses. You DO always need to have some form of lip balm on your lips at all times, though, otherwise they will start to itch and appear dry and flakey. However, you'll soon get used to applying balms every 20 minutes or so, and this is less annoying than it sounds.
- Headaches - I am very prone to migraines. I get them bad, with auras and disturbed vision. Accutane definitely triggered migraines for me, to the extent that I had to take ibuprofen every 3 days, as I would wake up with pounding pain. It was well worth it for me and the ibuprofen DID take away the pain, so in that sense they weren't full-blown migraines (which i can't treat with pain-killers), but this is something to think about if you're headache-prone. Taking the medication at lunch prevented these headaches, which meant I had to eat an avocado with lunch some days. Whenever I took it after dinner, I would wake up in pain.
- Anal bleeding and pain - I don't want to put you off Accutane, instead inform you and prevent you getting a scare. Accutane dries out the entire body, which can mean that towards the end of the course, pooping may become rather painful and cause you to bleed a tiny bit. I am talking a few drops, never heavy bleeding. Don't be worried about this if it happens - consider it like your dry lips. It is just your body's tissue drying out, and when friction is introduced, it's natural that there is a little bit of blood. Drink lots of water, eat lots of fruit and use Sudocreme if you are sore down there.
- Aches and pains - I definitely experienced this, despite taking cod liver oil (without vitamin A, essential as you can't take Vit. A while on Accutane). Your joints dry out along with the rest of you, and you may find that you are very achy. This will be worse on some days than others, and lack of sleep made it worse in my experience. You can use paracetamol, but try to ignore it. It may be very minor, but is likely as it is caused by the guaranteed drying effects of the drug. Low dose = less drying = less achiness.
The Truth About Hair Loss on Accutane
Sadly, Accutane can cause hair loss, but it is nearly always reversible. This is due to the nature of the hair loss that the drug can induce. This is called Telogen Effluvium and very rarely lasts for more than 4-6 months. It occurs several months after the trigger, which is the drug, so you will experience any hair loss after you come off the drug. If you're experiencing minor hair loss upon starting the medication, it will be through dryness of the scalp, so you should deep-condition your hair.
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Accutane Can Cause Telogen Effluvium
The natural hair cycle is composed of two phases: anagen and telogen. Normally, your hair is in the anagen phase for 2-4 years. During this time, it grows and grows, until it passes into the telogen phase; it sits in this second phase for around 2 months and is then shedded.
Normally, around 10% of your hairs are in the telogen phase, ready to fall out. It is very typical to lose 100 hairs a day. However, Accutane can induce a phase of hair loss a few months after starting it because it "shocks" the system into pushing more hairs into the telogen phase prematurely.
What this means is that instead of shedding 100 hairs a day, you may shed 300 hairs a day for 4 months after stopping Accutane, until this resolves itself by getting rid of all the hairs that have been pushed into the telogen phase by the drug. It is rare that more than 30% of your hair is pushed into this phase on Accutane. You will most likely shed more than usual for a few months and notice slight thinning of your hair, but whenever a hair is lost, a new hair will be growing in its place. Due to this, you can expect normal scalp-density of hair within a year of stopping Accutane. Do not consider this hair damage, but rather that your hair is falling out as a consequence of a shock to the system (the same shock to the system that has resulted in you having gorgeous skin).
Important reiteration- Telogen Effluvium is NOT harmful to long-term hair health or regrowth at all; it's unrelated to other forms of hair loss, such as pattern baldness and chronic hair loss caused by hormonal issues. The outlook is very optimistic. It is a total myth that Accutane permanently affects the quality of your hair. Instead of Accutane directly inducing hair loss, it is simply a shock to the system that can cause you to shed more than usual for a few months. Low iron levels, anxiety and childbirth can also cause Telogen Effluvium.
Essential Accutane Products
Here are some products that helped me massively during my eight-month-long, 40mg Accutane course.
- This PAW PAW Moisturizing Balm is one of the best affordable moisturizing lip product that I have ever tried; it is recommended by the majority of Accutane users for a reason. It is insanely moisturizing and a little goes a long while, making it great value for money.
- Kiehl's Lip Balm - now, this formula is truly exceptional. These saved my lips during winter while on 'tane! They feel luxurious, smooth, fully hydrating and are exactly what you need while on the drug.
2. Nourishing eye-drops: you need to start using eye-drops 3 x a day once you're on Accutane, in order to avoid eye damage from over-drying of optical cells. These were recommended to me by my ophthalmologist when I went in an appointment for blurred vision, and have worked very well for me. It turned out that the medication was damaging my eye cells to the extent that they were dying (pretty terrifying), but heavy use of these drops reversed the damage.
3. Moisturizer: Since my skin did not get particularly dry, I used the Nivea moisturizer for sensitive skin. It is one of the only moisturizers that doesn't break out my skin.
4. Hair products:
- Shampoo and conditioner: the Aussie Mega Moist shampoo and conditioner are great for dry hair, and smell gorgeous.
- Leave-In Conditioners (essential on Accutane): The Aussie 3 Minute Miracle Reconstructor works great after conditioner, but leave it in for 10 minutes instead of 3. It also smells even better than the other Aussie products.
5. SPF protection (you need to wear SPF with Accutane!):
- I used the La Roche-Posay Anthelios Clear Skin Sunscreen SPF 60 while in California during my Accutane course and didn't burn once. It is oil-free, light, non-comedogenic and perfect for acne-prone skin. In fact, it is still my sunscreen of choice. 95% of regular sunscreens leave me with cystic acne, but this one is completely non-allergic and non-acneic.
Now for the fun part! Ignore anyone who says that you won't be able to wear makeup on Accutane -it is all about opting for a low dose to avoid extreme dryness in the first place, and choosing the right products.
- Foundation/concealer - I encourage that you stop wearing these when your skin is clear, as it is the most liberating thing in the world after years of having to cover acne. I now never wear facial makeup. However, your skin may still be acne-ridden at the beginning of your course and you may wish to wear your usual foundation and concealer. Go ahead, but if your skin is too dry, opt for a more moisturizing formula.
- Lipstick - you will find that the texture of your lips changes as they become dry on the medication. The trick is to wear only moisturizing lipsticks if you choose to wear lipstick; your matte shades will look dire. A tinted balm would work well if you prefer a subtle look, as would lipgloss.
The lipsticks I recommend for those on Accutane:
- Revlon Super Lustrous Lipstick - this lipstick is truly the only one that I have found to be truly pigmented and glamorous while also being moisturizing enough to work on Accutane. I love the shade Mink; it is the perfect wearable chocolate.
- Revlon Matte Balm - despite being of a matte finish, these lip products are actually very moisturizing and glide forgivingly onto dry lips. The only drawback is that they need to be reapplied every 1-2 hours, unlike the Super Lustrous Lipstick which has amazing longevity. However, if you want something really pigmented and matte with "wow" factor to wear to a Christmas party, a summer barbecue or just a day out with friends, this option is ideal.
- Definitely avoid liquid lipsticks, and anything with a truly matte formula. I tried to wear my favorite Cashmere by Limecrime during my course, and it looked awful. Shame, as I adore that liquid lipstick, but I had to ditch it for a few months.
- Eye makeup, highlighter, etc. - use whatever products you used before going on Accutane!
This content is accurate and true to the best of the author’s knowledge and does not substitute for diagnosis, prognosis, treatment, prescription, and/or dietary advice from a licensed health professional. Drugs, supplements, and natural remedies may have dangerous side effects. If pregnant or nursing, consult with a qualified provider on an individual basis. Seek immediate help if you are experiencing a medical emergency.
© 2016 Lucy