After battling acne for 10 years, going on medication changed everything for writer Adele Miner — but here she speaks to one woman who regrets taking Accutane.
I suffered with acne on and off for more than 10 years. But now, at 29, I’m finally acne-free.
I write that sentence with my breath held and my fingers crossed, just in case I jinx my clear skin. That’s what acne does to a person. It makes you throw all rational thinking out of the window as you try to find the cause and, ultimately, the cure.
I was constantly suspicious, from ‘maybe the milk I have with my Weetabix is causing my acne’ to ‘the breakout on my chin must be from the full moon’. Even the most logical person can become almost paranoid, turning everything and anything into a potential threat.
After a decade of 20-step skincare routines, diet overhauls and thousands of pounds spent on expensive skin treatments, I decided that neither my skin nor my sanity could take any more. In April 2024, I began a nine-month course of Accutane (also called Roaccutane) — an extremely powerful acne medication renowned for causing a whole host of side effects. A last resort, and not a decision I took lightly.
What is Accutane?
It’s a manufacturer’s brand name for the acne drug isotretinoin, with other brands including Rizuderm and Reticutan. The benefits of Accutane for acne include reducing sebum (oil) in the skin, which in turn can prevent pores from clogging, reducing acne-causing bacteria and reducing inflammation and swelling within the skin.
Beginning my own course, I was aware of the gruelling six to nine months ahead — the drug is no walk in the park for your body to process. I had to have monthly blood and pregnancy tests in my dermatologist’s clinic to ensure that my body was handling it.
What happens if you get pregnant while on isotretinoin?
You might wonder why a monthly pregnancy test is required (for patients who can get pregnant, of course). Consultant dermatologist Dr Daniel Glass explains: “Isotretinoin is a potent human teratogen [a substance that can cause birth defects], and its use during pregnancy is associated with a high risk of major congenital malformations. These include developmental abnormalities in the face, heart and central nervous system.”
Can you drink alcohol while taking it?
Taking Accutane requires some lifestyle adjustments, which weren’t easy considering I was on the drug for the duration of the summer, during which most of my socialising revolves around alcohol. After talking to my dermatologist, I chose not to cut alcohol out of my life completely, but instead impose a strict limit on how much and how often I consumed it.
However, it’s generally recommended to avoid alcohol if possible. “While direct studies on smoking interactions are less common, the impact of isotretinoin on liver function necessitates caution with alcohol,” Dr Glass informs me, adding: “Quite simply, drinking alcohol with isotretinoin increases the risk of liver damage.”
I enjoyed the odd drink, but I did make sure to look after my body in other ways, through eating well, resting and doing regular but not too strenuous exercise — the latter, in particular, should be something you discuss with your dermatologist.
How to get Accutane in the UK and Ireland
In Dublin, each dermatologist appointment cost me €180 (£155), plus the charge of the actual drug itself, which came in at about €30-50 (£25-55) depending on dosage. In the UK, a typical six-month course on Roaccutane can cost anywhere between £1,100-£2,250. There’s an option to access Roaccutane via the NHS in severe and persistent cases.
What are the side effects of taking Accutane?
Side effects such as permanent liver damage and joint pain were the ones that most concerned me. “Side effects are common when taking isotretinoin, but most are dose-dependent and reversible,” explains Dr Glass. “Dry skin and lips are the most frequent. Myalgia (muscle pain) and stiffness are sometimes seen in people undertaking strenuous exercise during a course of isotretinoin. Increases in liver enzymes aren’t uncommon [signalling damage or inflammation in the liver]. Increases in blood lipids [which can lead to a buildup of plaque in arteries, increasing the risk of cardiovascular problems] are seen in up to a third of people taking isotretinoin.”
However, he notes: “All effects are generally dose dependent and resolve after stopping the therapy. Isotretinoin has also been linked to a range of psychiatric issues, including depression, anxiety, mood swings, aggressive tendencies, and, in rare cases, suicidal ideation, suicide attempts and psychosis.”
For this reason, close monitoring by your dermatologist is essential during the full course of your treatment.
A somewhat less serious, but still important side effect is that it also makes your skin highly sensitive to sunlight. So, if you’re starting the drug during sunnier months, like I did, always carry a high-factor SPF with you and avoid sitting in direct sunlight as much as possible.
My experience of taking Accutane for acne
Your dose is calculated in accordance with your body weight, meaning the lighter you are, the lower your dose. My nine-month treatment began with me taking 20mg for the first four months, before moving to 30mg for three months and then going back down to 20mg for the final two months.
I waited for changes to happen during my first month. I was warned that my skin would get a lot worse before it got better, and so I naively imagined myself morphing into one giant pimple after popping just a few tablets. Instead, the effects were much more gradual.
Between months three to five, I purged — meaning that all the acne came to the surface in a worse-than-usual breakout as my skin worked to clear itself. In terms of side-effects, I had very dry skin for the duration of the treatment (the whole nine months) and never went anywhere without a bottle of Eucerin’s Aquaphor Soothing Skin Balm to lather on at any given moment. I even had the odd nosebleed as a result of my nose becoming so dry. Apart from that, I also had some slight joint pain.
But every minor ache and inconvenience was worth it for me, as by month six, the magic had happened. I could look in the mirror and not hate what I saw. I had the clearest skin I’d ever had, and my confidence had been restored. I no longer felt the need to cover parts of my face with my hand if I was standing too close to someone or hide behind three layers of foundation.
It’s not always worth it
Sadly, one person still living with the negative side effects is 27-year-old Julianna Shiel. After years of persistent acne, she took a seven-month course of Accutane, with her dosage going as high as 70mg for some months. Now, two years after the treatment ended, she’s lost 30% of the oil glands in her eyes permanently.
“I felt fine on Accutane, apart from having extremely dry eyes. My three sisters had been on it before and had great results with little to no side effects, so I wasn’t nervous. While I was on Accutane, I’d have to manually open my eyes in the morning. I asked my dermatologist if this was normal, and she assured me that everything would be fine in the end and didn’t lower my dose.”
After experiencing issues with dry eyes after she had finished her taking the drug, Julianna visited an eye specialist to get some answers. “I had to continue to use eye drops multiple times a day just to keep them lubricated. An eye specialist did scans and tests on my eyes and confirmed that I’d lost 30% of the oil glands in them, which will likely never return. I was a little upset that I’d have to deal with having chronic dry eyes for the rest of my life and wish that my dosage had been monitored more closely. Maybe this could have been avoided?”
What happens when you stop taking it?
Now, four months on from finishing my nine-month course of Accutane, all the side effects I experienced have gone, and my skin is slowly gaining back its natural oils, but still remains clear. My only regret is that I didn’t try it sooner. However, Julianna doesn’t share the same sentiment: “Overall, I do regret going on Accutane. My side effects are manageable, but I’d warn anyone to consider the long-term effects before taking it.”
Dr Glass shares some advice for those who are unsure as to whether the drug could be the answer to their skin problems: “Patient education and careful monitoring are crucial. The medication is often better tolerated at lower doses; there’s evidence that longer courses of isotretinoin taken at lower doses are as effective as higher doses. Be sure to explore all of these options with your dermatologist before starting treatment.”
Feature image credit: Freepik
