Skin deep: the painful path to a clear complexion

When I was a kid it was easy to hate me. A skinny 12 year old kid, I was either too much or too little of everything. Too thin, too hairy, too big nose, too small chest and way too sensitive not to take all the mean comments to heart. Finally, I grew in my features and out of others. I shaved, had contact lenses, removed my braces, and by the time high school started my appearance was the only part of myself I trusted. At this point, I felt like I deserved to love myself.

And then my skin deteriorated, which led me to join the other two million people taking Accutane, a last-resort drug used to treat severe acne. However, Accutane has some intense side effects, which means choosing to continue is a serious choice to make.

I didn’t even notice my poor skin for a very long time. As always, it started with a few buttons. Once gone, new ones would take their place. I also developed general anxiety and started scratching my pimples and lips. At the age of 15, something was still bleeding. And somehow, I didn’t hate myself. I was frustrated that despite my intense skin care routine, my skin was not healthy. But I would put a foundation and I would live with it. Every now and then I would change my skin care routine. Sometimes they would help. But the problem never completely disappeared. New acne began to blend in with the scars. I bought a more solid foundation.

By the time I graduated from high school, my acne had never been worse. And yet, my skin has not thickened with age. I quickly found it amazing how many people felt the urge to comment on my skin as if they knew or understood the first thing about it. One day at work, I was taking payment from a client. I never liked the waitress uniform I had to wear – the shirt low enough that the red spots on my chest were impossible to hide.

“Does it hurt?” the old lady asked as her partner inserted her card into the debit machine.


“That rash on your chest.”

My heart has collapsed. I looked her in the eye, without smiling. – It’s acne, I say.

It wasn’t the first time that a stranger felt the need to comment on it. Months earlier, I was at Walmart without any makeup. While I was looking for the vanilla yogurt that I love, a little woman with lipstick patted me on the shoulder.

“What are you using for your acne?” ” she asked.

“Uh … a lot of things,” I said, laughing despite the discomfort.

“Well you should be using Proactive,” she commented. “My niece had worse skin than yours and she cleared up straight away.”

There were a hundred things I wanted to say at the time, but I’m gentle. So I thanked her for the insult.

Desperate, I finally went to a dermatologist. She looked at my face for less than a minute before announcing, “Your scars are pretty bad. At this point, the only thing that might help is Accutane.

Accutane, also known as isotretinoin, is a drug that was developed in the early 1980s. It is used to treat cystic acne. A doctor will only prescribe it if nothing else works. Thirty percent of patients who complete an Accutane cycle never treat acne again. However, the side effects are unpleasant. My already chapped lips would become unbearably dry, as 90% of users do. My nose was bleeding every day. “Keep an eye on your mood,” I have been told, “because depression is a possible side effect. “

For over a month, I had nosebleeds every day. Some of them were pretty bad. Photo by: Kendall Bistertzan

According to the 2014 Encyclopedia of Toxicology, “it is not known how this emotional instability arises. These effects appear to be strongly correlated with the use of Accutane since the effects wore off after stopping use of the drug, but reappeared when use was resumed. However, in an interview with the Dermatology Times, Dr Patrick Feehan of Penn Medicine Lancaster General Hospital said that “when suicidal ideation and depression were cited as side effects, I found that people were much more likely to suffer from it. ‘be depressed and commit suicide before taking isotretinoin. . Any teenager who has acne problems can have mood swings; 99% of patients actually become less depressed with this drug. As of 2001, the drug is now accompanied by a depression warning, shortly after Bart Stupak said that Accutane drastically altered his sons’ personalities, resulting in the 17-year-old boy’s suicide.

Depression wasn’t the only possible side effect I had to worry about. My eyes and hands could dry out, my hair would become thinner, I was at risk of joint pain, and I had to take all necessary precautions not to get pregnant. In fact, the capsule containers are printed with a pregnant belly crossed out.

“Two types of contraception at all times,” I was reminded. This is because Accutane causes serious birth defects in fetuses that can affect their nervous system, eyes, heart, glands, and skeletal system. However, this danger was not officially addressed until 2002, when the director of the FDA’s Center for Drug Evaluation and Research, Janet Woodcock, wrote that “a significant proportion of fetal exposures have occurred because the patients were already pregnant. These events are completely preventable. That’s why, regardless of my sexual history, I do blood tests before every prescription refill.

When I was 20, I started the first cycle of a drug that I hoped I would never have to take. Thanks to my age, I was still covered by both parents’ insurance. This would significantly reduce the cost of the pills which are priced at four dollars each.

I was not alone in my fight. My roommate, Emma Turnbull, was starting her second cycle of Accutane. In a way, she had become my mentor. We shared petroleum jelly for our chapped lips. She taught me how to cover up the initial drug flare-ups. Our bathroom garbage was littered with horrible anti-pregnancy packaging. She was an Accutane veteran and, like me, had decided that fair skin was worth the cost of the side effects and the high price tag.

She started her first cycle in August 2018, after a serious breakout several months earlier. She had tried several topical treatments and oral medications, but nothing had worked. Finally, her doctor recommended Accutane, and she was more than happy to oblige.

“I did my research on YouTube and watched it all on WebMD, so I was like, ‘Oh shit, I’m going to die of a heart attack or stuff.’ But for me, the positive things outweigh the possible side effects, ”says Turnbull.

She took Accutane for 280 days (and was 22, meaning at four dollars a pill she paid about $ 1,120) and started seeing results after about three months. Her skin only remained clear for a few months, but during that time she finally felt alive.

“Having acne, I’ve always been so self-aware and self-aware. I hated going out. I hated taking pictures or hosting family events, so when my skin cleared up a bit , I was so happy, for the first time in my life, I could go without makeup, which I loved.

Despite the side effects and having to endure a second round of Accutane, she maintains her decision. However, I am still not sure.

My mood didn’t deteriorate with the drugs, but it could have. I often wonder what kind of difficulties I would have faced if this had been the case. I was ready to trade the side effects – some of which are potentially damaging to my health – for higher self-esteem. Yet, it’s been four months and my hands are cracked, my pillow cases are stained with blood, my wrists and knees are creaking like those of old people, and my skin is still covered in angry redness.

Accutane has not yet been fair trade.

The actual Accutane capsule. Photo by: Kendall Bistertzan

But this medicine did not make me desperate. In fact, for the first time in years trying countless skincare lines, topical treatments, and antibiotics, I know there is a statistically reasonable chance that my skin could clear up. After all, most patients don’t see results until the fifth or sixth month. Maybe for the first time in my adult life, I’ll feel good about myself. And who knows? I could just venture out to Walmart with no makeup on.

This story is part of our March-April print issue. Check out the digital version here or pick up a copy at newsstands across town.

Publisher: Isaiah Lindo | [email protected]

About Sally Dominguez

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