How to Take Care of Your Skin and Mind While on Accutane — and After
Here's everything you need to know, according to one woman who's been on the medication twice.
If you have ever struggled with acne, you've probably heard your dermatologist mention Accutane at least once during your visits, or maybe even while researching one of the many solutions for this very common skin condition.
Known as the “miracle drug,” Accutane — medically referred to as Isotretinoin — has gained quite the reputation within the beauty and skincare community over the years. Whether it’s due to some of its notorious side effects, or the unbelievable results that users have experienced, this medication has certainly made a significant impact on those who have dealt with extreme acne.
Dermatologists and medical professionals alike have all praised the medication, citing its success and effectiveness. But before you consider this treatment, it's important to understand what it does to the skin.
"Accutane helps to reduce the number of C. acnes on skin, but they can creep back up over time,” microbiologist and scientific advisor at Ellis Day Skin Science Dr. Laura Marinelli shares with InStyle. That's why along with taking the medication, she also suggests developing an alternate skincare plan for the duration of the treatment.
“Firstly, it is very important to follow the advice of your dermatologist, as they will likely have some helpful tips for maintaining the health of your skin and avoiding future breakouts," the expert explains. "Second, I suggest incorporating products into your skincare routine that address the key underlying cause of breakouts and acne, the skin bacterium Cutibacterium acnes (C. acnes for short). While a lot of factors contribute to acne formation, this microbe is thought to play a critical role by proliferating within your pores and producing a whole array of factors that cause tissue damage and inflammation. In fact, certain types (or strains) of C. acnes have been shown to be more highly pro-inflammatory and are also more common on the skin of those suffering from acne."
In the morning, she suggests washing your face with a gentle cleanser that won't strip the skin, followed by a non-comedogenic moisturizer and sunscreen to nourish the skin and add in a layer of UV protection. You may also incorporate a serum before your moisturizer, but be sure not to use any that contain high concentrations of AHAs/BHAs or vitamin C, as it may cause irritation.
"At night, you can repeat this same routine, without the SPF of course," she adds.
The first time I used the medication, my day and nighttime routine were very simple. I stuck with the basics: Cetaphil Gentle Skin Cleanser and Daily Facial Moisturizer, as recommended by my dermatologist. I was also advised to stay away from any heavy exfoliation or products that were not made for sensitive skin.
Personally, I've had to be prescribed Accutane at two different points in my life. The first was during my senior year of college — a period of time where I had wished that my acne days were long gone — and the rigorous requirements that are involved with taking Accutane definitely made my life quite difficult during this time.
Not only did I have to deal with having monthly blood work done, traveling back and forth between cities for dermatologist appointments, and unexpected medical costs, but the physical and mental toll that Accutane took on me was wreaked just as much havoc.
Imagine this: you have just started your first week at an internship with a well known PR agency on their fashion and beauty team. You want to try to look your best every day and seemingly blend in with all of the stylish women around you, but it literally hurts to put makeup on your face. Not to mention, you also are attending a fashion business school, where your whole look from head-to-toe is silently judged by your peers on a daily basis. There are some days when you don’t even want to go to class or your internship because you are breaking out so badly, and are literally embarrassed to show your face. This was me during the fall 2018, as I had Aquaphor glued to my hand along with a full bottle of water at all times to deal with the dryness caused by the meds.
The mental and emotional component of being on this medication truly tests you in ways you never might have thought of otherwise. And the thing about Accutane is that it typically purges everything out of your skin first before it begins to work, essentially meaning that your acne is going to get worse before it gets better. So preparing yourself for this is a crucial part of mustering up the strength to push through the hardest part of the process, knowing that there is clear skin on the other side.
That's why while I was on it, I tried to indulge in my favorite activities. I made sure I took walks outside when the weather was nice, I got my favorite snacks and food, and tried to relax as much as possible. I found that trying to distract myself by watching movies and even reading up on other people's experiences helped me cope when I was having a particularly bad mental health day.
Plus, having to deal with Accutane and all of the scary side effects that come with it the first time around was no walk in the park, either. My skin was constantly dry and required consistent hydration, the corners of my mouth and inside of my nose would crack and bleed, my joints would ache, and my head would hurt almost all the time.
“Accutane affects your skin and body in a number of different ways, one of which is by decreasing the size of the oil-producing glands in your skin, known as sebaceous glands," Dr. Marinelli explains. "This decrease reduces the amount of oil your skin produces, which effectively starves the acne-causing C. acnes bacteria that live in your pores. However, by doing so, Accutane also makes your skin much dryer and more sensitive, meaning that after a course of Accutane, it may be in need of some serious TLC.”
After nearly 6 months of constant agony and annoyance in relation to my skin, there was finally a breakthrough. All of a sudden, my skin began clearing up, and my pimples all started to fade away. What I was left with was certainly not a blank canvas due to the scarring and discoloration caused by previous breakouts, but I was happy to see progress nonetheless.
For the next eight months or so, my skin was in a place I had never imagined it would be: clear, glowing, improving by the day. I began to have some professional skin treatments done, like chemical peels, and was loving all the improvements I was seeing in my overall complexion and texture.
I developed an entirely new skincare routine and was trying out new products that I could finally withstand now that I was finally off of the medication. At the time, I was using the Tatcha Rice Polish Foaming Enzyme Cleanser, Skinceuticals C E Ferulic Serum, and First Aid Beauty Ultra-Repair Cream. The Tatcha powder cleanser offered light physical exfoliation that my skin could handle. The Skinceuticals serum was given to me by the esthetician I went to for the chemical peels, and it really helped with the dark spots that were left behind from my acne. As for First Aid Beauty 's cream, it helped to keep my skin hydrated and soft.
However, a few months later, my acne slowly began to creep back up on me. After trying out several different remedies, I made the difficult decision to go back on Accutane this past spring, something I had hoped I would never have had to do again in my life. This time, though, I knew what was ahead of me. I was prepared to roll with the punches, ready for round two — and all the subsequent side effects, from incredibly dry skin and hair, to headaches and mild joint pain.
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While on Accutane, your skin becomes extremely sensitive, therefore limiting the types of products you can use within your skincare routine. So or the past six months or so, I’ve been sticking to a gentle cleanser, hydrating moisturizer, and a facial sunscreen with 50 SPF.
But now that my second dosage is almost officially over, I’ve been eager to work in a few new products that my skin can finally tolerate.
Maintaining clear skin after Accutane should be pretty low-maintenance, but you'll need to give your skin some time to adjust.
Now that I've passed the finish line, I'm incorporating products like The Ordinary Azelaic Acid Suspension 10% and The Ordinary Niacinamide 10% Zinc 1% into my routine. I'm also using Kiehl's Ultra Facial Cream SPF 30, The Ordinary "Buffet" Serum, and Ole Henriksen Banana Bright Eye Cream.
And as the Accutane begins to exit my system over the course of the next month, I will begin to incorporate some other products that I wasn't able to use before, like Peter Thomas Roth's 8% Glycolic Solutions Toner and Ole Henriksen's Truth Serum.
Despite the side effects and discomfort, I will say that I think Accutane is an excellent solution for anyone who has been frustrated with their skin and has struggled with acne for years. It definitely helps to achieve desired results. But I'm not going to lie, there are times when you'll want to give up. But you need to just power through.
I know I'm so glad I did each time.