When I was a teenager, I had 50 pimples scattered across my face at any given time. Yes, literally 5-0. I counted. I tried every over-the-counter and prescription fix available, and while a few of them worked-pretty well, for a couple of years at a time-the clusters of cysts and whiteheads always came back. Finally, my mom asked my dermatologist to prescribe me isotretinoin, what used to be called-and is still commonly known as-Accutane.
I took the pill every day for five months and my acne...disappeared. My skin basically did a complete 180, to the point where I’d do actual double takes in the mirror. My friend Maggie, 26, also credits isotretinoin for resetting her skin. “I would not be the same person today without it. It was essential for me,” she texts when I ask about her experience. Like me, she has no regrets.
But the thing is, some people do-or at least, they have questions. Many 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?” immediately pop up and link to articles about truly scary potential side effects. (If I had already developed my millennial habit of Googling every Rx I’m prescribed, teenage me might have been too terrified to take my first dose.)
Much of the panic started when a former U.S. representative’s 17-year-old son died by suicide in 2000. He’d been on Accutane for six months before his death (a typical course of treatment lasts four to six months), and his dad blamed the drug, igniting years of contentious debate.
Spurred in part by this tragedy and others like it, scientists have looked for clear links between isotretinoin and depression and suicide. Some patients have claimed that taking the medication caused their depression, but so far, there is no conclusive evidence that Accutane directly leads to mental health issues.
“Multiple large, controlled studies don’t support that hypothesis,” explains dermatologist and psychiatrist Amy Wechsler, MD. “Actually, we often see an increase in self-esteem and mood during treatment because clearing the skin can promote confidence.” (In the early 2000s, spokespeople for the maker of Accutane argued that since it’s common for teens to have both acne and depression, the two diseases might overlap but treating one has not been proven to lead to the other.)
The five dermatologists I interviewed for this story still stand by Accutane as an overall safe, effective-the most effective, actually-treatment for acne, especially the stubborn kind that doesn’t respond to anything else. “We’re still learning more about how exactly it works,” admits Rachel Nazarian, MD, “but we know that it shrinks oil glands and makes cell turnover more efficient. And just in the past few months, we’ve learned that it also alters the skin’s microbiome, the collection of good and bad bacteria, to mimic that of someone who doesn’t have inflammatory acne. We know enough for me to feel very comfortable prescribing it to my patients.”
Still, the drug isn’t 100 percent side-effect-free, and one serious warning would give anyone pause: Women should never, ever get pregnant while on Accutane because it can cause serious birth defects. Before taking your first dose, you need to clear two blood or urine pregnancy tests, at least 30 days apart, and literally pledge (via an online FDA program) to use not one but two forms of birth control for one month before, during, and one month after being on the drug. You also need to get monthly follow-up tests to rule out pregnancy, and many doctors will monitor your blood along the way to watch for liver or other complications.
I know that sounds intense. But it’s worth noting that a lot of this stems from strict U.S. regulations. “We’re the only country in the world that monitors isotretinoin to this level,” says dermatologist Dendy Engelman, MD. “You could essentially walk into a pharmacy in South America, ask for it, and get it that day.”
Here’s some more perspective: The derms I talked to have collectively written more than 2,200 isotretinoin prescriptions, and of those, fewer than 15 patients have had serious problems (any of their issues were resolved with a lower dose or a hard stop). “The most common side effects are skin dryness and sun sensitivity,” says Dr. Wechsler. “These are usually managed just fine with lip balm, moisturizer, and SPF.”
Hayden, 26, another friend who’s taken Accutane, says it definitely dehydrated her skin and triggered joint pain. And she’s still dealing with straw-like hair (the drug reduces the size of oil glands and suppresses oil production everywhere, including on your scalp). But despite these problems, she says, “I have no regrets about taking Accutane. Acne can be paralyzing, and it helped free me of the worst breakouts.”
As for me, the only annoying issues I had while on the drug were the frequent blood tests, flaky lips, and having to figure out how to conceal my pimples while waiting for it to kick in. Actually, I’m considering round two, because after years of no acne (results can last from a year to forever, depending on the patient and dose), I do get the occasional breakout. And now that I’m armed with the latest research and all these derms’ okays, I am ready to get my yes-I-1000-percent-woke-up-like-this skin back.
('You Might Also Like',)