When I was a teenager I had 50 pimples strewn all over my face at one point. Yes, literally 5-0. I counted. I tried all of the over-the-counter and prescription solutions available, and although a few of them worked quite well, for a few years at a time the clusters of cysts and whiteheads kept coming back. Ultimately, my mom asked my dermatologist to prescribe isotretinoin, which was once called – and still is commonly called – Accutane.
I took the pill everyday for five months and my acne … was gone. My skin basically did a full 180, to the point where I was doing real double takes in the mirror. My friend Maggie, 26, also credits isotretinoin for resetting her skin. “I wouldn’t be the same person today without it. It was essential for me. she texts when i ask her about her experience. Like me, she doesn’t regret anything.
But the point is, some people do – or at least they have questions. A lot of questions. Google “Accutane” and you’ll see what I mean. “Why is Accutane dangerous? “” Is it safe to use Accutane for acne? “And” What are the risks of taking Accutane? “ pops up immediately and links to articles about the really scary potential side effects. (If I had already developed my millennial habit of Google searching for every Rx I’m prescribed, my teenage girl might have been too terrified to take my first dose.)
Much of the panic began when the 17-year-old son of a former US representative committed suicide in 2000. He had been on Accutane for six months before his death (typical treatment lasts four to six months), and her father blamed the drugs, sparking years of controversial debate.
Spurred in part by this tragedy and others like it, scientists looked for clear links between isotretinoin and depression and suicide. Some patients have claimed that taking the drug caused their depression, but so far there is no conclusive evidence that Accutane directly causes mental health problems.
“Several large controlled studies do not support this hypothesis,” says dermatologist and psychiatrist Amy Wechsler, MD. “In fact, we often see an increase in self-esteem and mood during treatment, as cleansing the skin can build confidence.” (In the early 2000s, spokespersons for the maker of Accutane argued that since it’s common for teens to suffer from both acne and depression, the two conditions might overlap, but it doesn’t treatment has not been proven to lead to the other.)
The five dermatologists I interviewed for this story still support Accutane as an overall safe, effective – the most effective, in fact – treatment for acne, especially the stubborn type that doesn’t respond to anything else. “We’re still learning more about how exactly it works,” admits Rachel Nazarian, MD, “but we do know that it shrinks the sebaceous glands and makes cell renewal more efficient. And just in the last few months we’ve learned that it also changes the skin’s microbiome, the collection of good and bad bacteria, to mimic that of a person who doesn’t have inflammatory acne. We know enough that I feel very comfortable prescribing it to my patients.
Still, the drug is not 100 percent side effect free, and a serious warning would give anyone a break: Women should never, ever get pregnant while taking Accutane, as it can cause serious birth defects. Before taking your first dose, you should take two blood or urine pregnancy tests, at least 30 days apart, and literally commit (via an online FDA program) to using not one but two forms of contraception for one month before, during, and one month after taking the drug. You also need to have monthly follow-up tests to rule out pregnancy, and many doctors will monitor your blood along the way for liver or other complications.
I know it sounds intense. But it’s worth noting that much of this stems from strict US regulations. “We are the only country in the world that monitors isotretinoin at this level,” says dermatologist Dendy Engelman, MD. “You could basically walk into a pharmacy in South America, ask for it, and get it that day.”
Here’s a bit more perspective: The dermatologists I spoke with collectively wrote over 2,200 prescriptions for isotretinoin, and of those, less than 15 patients had serious issues (none of their issues had resolved with a lower dose or abrupt discontinuation). “The most common side effects are dry skin and sensitivity to the sun,” says Dr. Wechsler. “These are usually very well managed with lip balm, moisturizer and SPF. “
Hayden, 26, another friend who took Accutane, says it permanently dehydrated her skin and triggered joint pain. And she still has straw-like hair (the drug reduces the size of the sebaceous glands and suppresses the production of sebum everywhere, including on your scalp). But despite these problems, she said, “I don’t regret taking Accutane. Acne can be crippling, and it helped me break free from the worst rashes.
As for me, the only annoying issues I had while taking the drugs were frequent blood tests, scaly lips, and having to figure out how to hide my pimples while I waited for it to happen. I’m actually considering the second round, because after years without acne (results can last from a year to an eternity, depending on the patient and the dose), I have occasional breakouts. And now that I’m armed with the latest research and all that dermatitis deal, I’m ready to get my yes-I-woke-up-like-that-skin skin back.
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