A dermatologist once described Accutane to me as a drug that “damages the sebaceous glands so that they no longer produce oil.” No oil, no acne, right? Well, a little, but it’s a bit like amputating your arm to mend a broken bone. It’s like setting the planet on fire to stop climate change. What Accutane really does to your skin it’s like, well, destroying it in the name of saving it.
To save it a bit: Accutane is officially known as isotretinoin, an isolated derivative of vitamin A prescribed for 1.1 million acne patients per year in the United States (It is also marketed under the names Roaccutane, Claravis, Myorisan, Absorica, Zenatane and Amnestimate.) âDespite the fact that it is derived from a vitamin, this drug and this dose is not found naturally â Dr Rajani Katta, the author of Glow: The Dermatologist’s Guide to a Whole Diet for Younger Skin, said NYLON.
The substance has been carefully scrutinized for its alarming, albeit infrequent, side effects: depression, rectal bleeding, seizures, anemia, and increased blood cholesterol, to name just a few of the few hundred of possibilities that appear on the official list of isotretinoin. Receipt warning. It makes users twice as likely develop inflammatory bowel disease. Its impact on the reproductive system – birth defects, spontaneous abortion – is so severe that patients must literally pledge to use two forms of birth control while taking isotretinoin and to have monthly blood and pregnancy tests, just to be sure.
Yet despite all the criticism leveled against it, isotretinoin is garnering even more praise. Beauty editors and influencers are quick to minimize your risks and revel in the rewards of a face without a button. It is the most reliable acne medication available to dermatologists, with a “success” rate of around 70%. $ 1.32 billion per year in profits. In other words, the trick works.
But how does it work?
âIsotretinoin helps reduce the production of sebum on the skin and actually helps reduce the size of the sebaceous glands, which are the glands in the skin that produce sebum,â says Dr. Katta. The sebaceous glands are part of the body’s exocrine system, for the record, and sebum is a fancy word for the skin’s natural oil.
Dr Aanand Geria, a dermatologist certified by the board of directors of Geria Dermatology in New Jersey, puts it a little less delicately: it appears that isotretinoin causes “sebaceous gland cells” to self-destruct.
The lack of enough sebum is responsible for the less serious but extremely common side effects of isotretinoin, including “dry eyes, dry lips and very dry skin,” says Dr. Katta, which affects nearly 100% of patients. “I have even seen patients develop eczema with dry, cracked skin.” Most agree to swap acne for extreme dryness, assuming the dryness will end when treatment does. But for some – like me, a decade after Accutane and still struggling with a lack of moisture and acne-prone skin – these symptoms persist.
Although dermatologists claim that the sebaceous glands eventually rebound, research shows that sebum production is still inhibited in patients with two months, one year, and 12 years after treatment with isotretinoin; with a study calling dry skin, dry eyes and eczema “likely long-term side effects”. Which is sad, really.
Our poor, sweet sebaceous glands did nothing to deserve this. Sebum – and I can’t stress this enough – does not cause acne.
âSebum is an essential building block for normal, healthy skin,â agrees Dr Geria. It is the body’s built-in moisturizer responsible for locking in hydration. It is an integral part of the acid mantle, a thin layer of the skin barrier that helps neutralize invading pathogens and stabilize the skin’s pH. The sebum has “innate antibacterial activity“and may even have an anti-inflammatory effect on the skin. It is essential for the skin’s healing response and also acts as a natural sun protector. Sebum is one of the most magical skin care products and the most valuable that exist, and it comes out of your own pores.
So how did it get such a bad rap? It is complicated. Sebum is involved in acne overgrowth, but to borrow one of science’s favorite sayings, “correlation does not equate to causation.” Sebum only contributes to acne if other factors are at play. (Think of it this way: “Oily” and “acne-prone” are two different skin types, right?) So, yes, eliminating the production of sebum with isotretinoin can therefore curb the skin. ‘acneâ¦ but that doesn’t solve the reason why acne is present in the first place. This explains why around 23 percent patients with isotretinoin – those whose sebaceous glands do rebound – need two or more courses of treatment to see “results”. The root of the problem is still taking its toll.
“A lot of what I see with Accutane is people who come in four, five, six years after the incident and still have acne,” Jessica coogan, a holistic health care practitioner in Los Angeles who focuses on skin care and autoimmunity, tells NYLON. “Some have taken Accutane three or four times. If this is not an example of [isotretinoin] being a band-aid for what’s wrong, I don’t know what it is. “
The root cause (s) differ from person to person, but the most important is hormonal imbalance. The production of sebum is stimulated by testosterone and the âstress hormoneâ cortisol. Too much of either can lead to excess sebum, which can lead to clogged pores, which can lead to acne. In that sense, hormonal surges act like communications from the body (âWe’re out of balance here!â), And when you silence the sebaceous glands, you cut off that communication – at least temporarily. In patients whose acne was determined to be hormonal, “complete remission could not be achieved” with isotretinoin, a study find.
There are many other acne factors: low levels of linoleic acid (which can thicken sebum and clog pores), diet (sugar and dairy can cause acne, but foods ” healthy ‘too, if your only body is sensitive to it), an altered microbiome (in your or on your skin), not enough Vitamin D, abuse of skin care products, abuse of hard skin care products, immune response, intolerances, etc. But you know what’s not on this list, and never will be to be on this list? Sebum.
This is where you might be wondering, “If sebum doesn’t cause acne, how come isotretinoin, which removes sebum, is considered the gold standard in the treatment of acne.” acne? Well, first off, take a look at this $ 1.32 billion profit story. But on a less capitalist level of conspiracy theory, that’s because sebum is the one common denominator in all of the above acne triggers.
The problem is that sebum is also the common denominator between acne-prone skin and healthy, happy, clear, hydrated skin.
âI have a ton of post-Accutane clients whose skin is so damaged and so dry and so prematurely aged because their faces don’t naturally hydrate, and they have to work a lot harder to balance their skin, because their skin has lost its natural function, “Cogan says.” I have post-Accutane clients who break out again and have the same damage to the sebaceous glands, so we have to deal with acne and damage. Then I have the post-Accutane clients who are just chronically dry. “
Many of these patients, Cogan says, feel duped. Isotretinoin has simply replaced one chronic skin condition with another; one that is arguably more difficult to deal with. After all, there is no non-destruction of a completely self-destroyed sebaceous gland – but with time, trial and error, there is is possible to cure acne holistically. (As for how, I would need a whole book, but The answer to acne is a good place to start.)
Of course, it’s important to note that it can take months or even years to properly tackle the root causes of your acne. âI went to the dermatologist the other day for a mole check and he said, ‘Oh my god, did you take Accutane, your skin is beautiful,'” Cogan recalls. âI was like, ‘Thank you very much, no, I’ve been on an acne healing journey for six years.’â The practitioner says that while she is grateful for her own long, winding path to a clear complexion , taking isotretinoin “would be” It was so much easier and would have saved me deep psychological scars, so I understand why people go that way. “
I also understand; this is precisely why I accepted Accutane 10 years ago. Acne anxiety – the intense shame, the feeling of unworthiness, avoiding mirrors at all costs – had invaded my life, and dermatologists told me it was my only option.
I wouldn’t do it again, and Dr Geria sums it up perfectly why: “We need to change our attitude towards sebum, because the vilipender almost always makes the skin worse in the long run.”