Life After Accutane: 9 Women on What *Really* Happens When the Dosing Stops

Kate Foster
·20 min read
Photo credit: Katie Buckleitner
Photo credit: Katie Buckleitner

From Cosmopolitan

There’s acne (blackheads! Whiteheads! The occasional bb zit!)...and then there’s acne: clusters of deep, red, painful cysts and bumps that take months to heal and almost always leave a scar on your skin/sanity. I’ve lived through acne—like, a constant rotation of 50 pimples on my face at all times—and if your skin is anything like mine was, you’ve probably spent a ton of time thinking about isotretinoin, i.e., the generic drug name for Accutane (which, FYI, isn’t actually on the market anymore, but everyone still refers to isotretinoin as Accutane anyway).

Spend approximately five minutes researching isotretinoin on the internet, though, and you’ll come across horror stories about its alleged side effects, all of which can make the idea of going on it feel extra terrifying. But despite what you’ve heard, it’s important to note that Accutane isn’t actually as scary as it’s made out to be. I should know—I’ve not only taken it myself, but I’ve also spent my career as a beauty writer learning and discussing all things acne and isotretinoin.

In fact, I once polled a handful of dermatologists who, collectively, had written more than 2,200 isotretinoin prescriptions in their careers. They said out of all their patients, fewer than 15 (!) of them had serious problems while taking Accutane—the effects of which were resolved with a lower dose or stopping treatment altogether.

Still, that’s not to say that Accutane isn’t a serious drug with serious potential side effects—it is, and everyone can respond differently to the medication. That’s why I decided to have candid conversations with nine real women about their experiences with the drug, including two women who finished treatment just nine months ago, to another who completed isotretinoin eight years ago. Keep reading to find out everything you’ve wanted to know about Accutane, from the before-and-after results to the possible side effects during treatment—and after.

Isotretinoin works by slowly shrinking the oil glands in your skin over several months. There’s no universal dose or timeline—how many milligrams you take each day and for how long is based on your weight and health, and is determined by your dermatologist. That being said, many patients tend to take 40-60mg a day for six months.

✨ Nine months post-Accutane ✨

A few months before I decided to start isotretinoin, I developed a very rare, very severe type of acne called acne conglobata, which left my face covered in deep, itchy, leaky, and incredibly painful cysts. It affected every aspect of my life, and I honestly felt like a victim to my own skin. I ended up going on isotretinoin for a little over eight months, and for the majority of that time, I was on 30mg: a lower dose than the usual 40-60mg, but the perfect dose for me.

Photo credit: Courtesy Image
Photo credit: Courtesy Image

I had pretty much all the side effects that you hear about with isotretinoin: I was tired all the time, no matter how much sleep I got; my skin dried out to the point of getting little flakes everywhere; I couldn’t exercise without getting a headache; if I stood up too long my back would ache. The worst side effect for me was the dry eyes, and I do think it affected my mental health a bit—I just felt more anxious and didn’t have any motivation. But, that’s also why my dose was lower: to keep my mental health and the side effects in check.

Thankfully, all of my side effects started to subside a month after I finished isotretinoin, and I noticed my energy levels rising after about two weeks. I still have dry eyes nine months later, and I still break out before my period. But by “break out,” I mean a few tiny spots on my face—nothing like before. Still, all of the side effects were so worth it to me, because isotretinoin saved my skin—it genuinely changed my life.

A dermatologist's take:

“Accutane, aka isotretinoin, shrinks the glands in your skin that produce oils,” says dermatologist Mona Gohara, MD, associate clinical professor at Yale School of Medicine. “When you shrink those glands, your organs—including your eyes—will be drier, but this side effect usually goes away after you finish your dose.”

As for Mariah’s lower energy levels? Another common, yet annoying side effect. “Some reports suggest that fatigue is dose-dependent, meaning the higher your dose of isotretinoin, the more likely you are to experience it,” says Marisa Garshick, MD, of Medical Dermatology & Cosmetic Surgery in New York City. “In general, though, most people find this side effect to be temporary.”

Nine months post-Accutane ✨

Before isotretinoin, my skin was so oily that even setting powder couldn’t take away the shine, and my face was covered in inflamed breakouts. My dermatologist ended up starting my Accutane dosage at 20mg the first month, then bumped me up to 40mg for three months, then had me on 60mg for the last two months.

Throughout my course, I dealt with pretty bad eczema on my arms and a dry scalp toward the end, and I also dealt with continuous headaches (though they were persistent enough that I stopped noticing them after a while, so it actually wasn’t the end of the world). The only remaining side effect I have nine months after stopping Accutane is the eczema. It’s still on my arms, and I’ve also noticed it becoming apparent around my scalp, but it isn’t nearly as bad as it was when I was on Accutane.

As for my acne, I do get the occasional cyst or whitehead now, though nowhere near as severely as before. It actually took me a few years to finally go through with isotretinoin because of how scary it’s made out to be, but for me, the whole thing was generally fine. I do feel really proud of myself for going on it despite my fears, though, and if I needed to, I would probably do it all over again.

A dermatologist's take:

“Dryness is far and away the most common side effect of isotretinoin” says Dr. Gohara. “Most patients can expect some degree of dry lips, dry skin, dry eyes, and sun sensitivity while they’re taking it.” Though eczema certainly isn’t the norm, it also isn’t uncommon: “Eczema comes along because the drug is essentially sucking the oils out of your skin, which is good for your acne, but not great in terms of skin moisture,” she says. “I tell my clients to swap harsh soaps and washes for gentle, hydrating cleansers, then moisturize with heavier creams as opposed to lighter lotions.”

✨ 11 months post-Accutane ✨

I got my first breakout when I was 12 years old, and for the next five years, I was in a constant battle with my skin. I tried everything under the sun to treat it: antibiotics, topical creams, chemical peels, veganism, hormonal pills, spironolactone, cortisone shots, lasers—everything. I was eventually diagnosed with polycystic ovary syndrome, or PCOS, a hormonal disorder that can cause—among other things—persistent acne. I knew then that I had to take the leap and try isotretinoin.

I was on it for eight months total: For the first three months, I took 40mg, then 60mg for the last five months. I had dry everything—face, lips, eyes, scalp, body—and my hair started shedding a bit, too. I’m prone to headaches, but isotretinoin really exacerbated the symptoms, and my head would often feel like it was crushing in on itself. It was all an emotional roller coaster for me. I’m not sure if it was the medicine or my personal life or both, but I definitely think I was more emotionally fragile while I was on it.

About two months after I finished Accutane, I saw the severity of my migraines, dry eyes, and dry scalp decrease. After four months, my emotional health evened out and I felt back to my old self. As for my skin, I’m now experiencing breakouts all along the lower half of my face and around my hairline. Thankfully, they’re much more minor than before—just small whiteheads and blackheads—and truthfully, they could also just be a side effect of going off birth control a few months ago.

It sounds weird, but I really think I was meant to get severe acne. My journey taught me so much about myself: to love myself and be confident, no matter the condition of my skin. Yes, it was so hard, but I wouldn’t change a thing. And I would 100 percent consider going back on isotretinoin again if I needed to.

A dermatologist's take:

If the idea of potentially losing your hair on Accutane freaks you out, take deep breaths: “If any hair loss occurs, it’s generally temporary,” says Dr. Garshick. “One study showed that isotretinoin doesn’t affect hair loss if the dose is low enough.”

Dr. Gohara agrees, stating that “less than 10 percent” of her patients see this side effect, and if they do, "it's usually because the hair is drier and more fragile from the medication, and nine times out of ten, it slowly grows back totally normal,” she says. “Once the Accutane's out of your system, hair and nails are always laggy in terms of regenerating themselves.”

✨ One year post-Accutane ✨

I suffered with severe acne for three years before deciding to try isotretinoin. My breakouts were super oily, sore, and red no matter what I put on them, and kids at school would call me Braille face. I didn’t take Accutane just that one time, though—I ended up taking it three times over the next few years.

The first two times, my acne slowly got worse over six months, then came back as bad as before. My dermatologist even switched up the dosing each time: My first course, I slowly reached 60mg a day; my second course, we took the approach of 10mg a day for a longer period of time; and my third course, I slowly reached 60mg again.

But after my third round, my skin was still incredibly oily and broken out. I remember sitting in my dermatologist’s office as he explained that Accutane hadn’t worked how it should have. He apologized and said there was nothing else he could offer me. I cried the whole way home. But then, strangely, my skin began to clear up a few months later, almost like a delayed effect. Now, my skin is totally clear, and I don’t have any active acne.

Even though Accutane eventually worked for me, it wasn’t an easy journey. I honestly had almost every side effect in the book: dryness, eczema, rashes, body soreness, fatigue, blurred vision, headaches, nosebleeds, stomach problems, hair loss, irritability, and brain fog. Even my vision was still a little blurry until this past summer. But recently, I went to an ophthalmologist who reassured me that my vision is officially back to 20/20.

If you do decide to go on isotretinoin, I have two words of advice: 1) Take progress pictures! I promise you will not notice how much your skin has changed without them, and they’ll really help you stay positive; and 2) Listen to your body. It’s so important to rest when you need it, and say no to going out if your body needs it. I tried to push myself over and over again, and I ended up worse off in the end.

A dermatologist's take:

“There are certainly people who take longer to respond to Accutane,” says Rachel Nazarian, MD, a dermatologist with Schweiger Dermatology in New York City. “This may be due to their own natural resistance, or due to their doctor’s dosing regimen, but it’s important to remember that even when you stop taking the pills, the medication continues to stay in your system for weeks. So some people may actually start to show improvement around this ‘tail end’ of treatment.”

✨ 1.5 years post-Accutane ✨

Before Accutane, I used to have severe acne—mostly concentrated on my cheeks and forehead, but also along my neck, chest, and back. I took 50mg for the majority of my isotretinoin treatment, and luckily, my side effects didn’t affect my day-to-day life that much: My eyes, lips, face, and entire body were dry; I had the odd headache here and there; and toward the end of treatment, I got some joint and back pain.

For the first month of treatment, my skin also went through the initial purging period, meaning my acne got significantly worse (like, it doubled in severity) before it started to calm down again. Those first few months were 100 percent the hardest to endure, but I look back at it all with gratitude. Even though my acne did come back six months after finishing Accutane, it’s nowhere near as severe—I’d say my skin is 60-70 percent better than it was before.

Overall, I’m really lucky to have had such a positive experience, with very minor and manageable side effects. When my acne was at its peak severity, my mental health truly suffered in all ways imaginable. So if my skin ever came to affect me the way it did prior to isotretinoin, I would probably go on it again.

A dermatologist's take:

“In terms of purging, I’d say a third of my patients see their acne get worse in those first few months of taking Accutane, while a third see nothing happen at all, and the last third say, ‘This is the best thing that's ever happened,’” says Dr. Gohara. “For most people, after month three, their improvement takes off like wildfire.”

✨ 2.5 years post-Accutane ✨

Before isotretinoin, I had severe cystic acne on my face, chest, arms, and back. Every time my skin bumped against something, it felt like somebody had poked the most sensitive blister. My acne would then form keloid scars, which I still have all over my shoulders and back.

I decided to go on Accutane in the fall of 2017. I started with a low dosage twice a day, then was upped to a stronger dose once a day after a few months. The strongest side effect I had was dry skin: My scalp and nose were always dry and itchy, and my lips were constantly cracked. The second side effect was a lower alcohol tolerance. I remember going out with friends early on in my Accutane journey, drinking just a few drinks, and getting a terrible hangover and headache that lasted way longer than my usual hangovers. Thankfully, these were my only two big side effects, and they went away on their own within two months after treatment.

Because my body tolerated Accutane so well and the results were so excellent, I finished after six months rather than the anticipated nine. I'm so happy I did it, and I wish I hadn't been so scared in the first place. The best part is that my skin isn't constantly inflamed anymore—I can wear makeup, bras, and whatever clothes I want without being in constant pain. And now, whenever I do get the occasional pimple, I'm not worried that I'm about to face clusters of inflammation for months.

A dermatologist's take:

“In general, it’s recommended that people avoid alcohol while on isotretinoin,” says Dr. Garshick. Not only does Accutane already put a bunch of stress on your liver (which is the same organ responsible for processing all those White Claws you drink), but it also dries your body out. Basically, you’re setting yourself up to have a major hangover the next day.

✨ Four years post-Accutane ✨

I used to have patches of painful cysts and nodules underneath my skin that didn’t respond to regular acne treatments. I grew up in a beach town and would wear a full face of makeup to the beach, or beg not to go to school because I was having a particularly bad skin day.

I ended up doing two rounds of isotretinoin about four years apart. The first time, it worked perfectly, and I didn’t have a single pimple for three years. Over time, though, my acne came back even worse and more painful than before, so I ended up doing a second round of treatment. It’s been about four years since I finished, and while I still get an occasional pimple, my acne hasn’t come back at all. I have no residual effects from the medication, and all of my deep acne scars have gone away, too.

For me, the biggest side effects I dealt with were an extremely dry nose and lips, and I had large patches of cracked and scaly skin. But all of it started to go away within a few weeks after I finished the medication. I honestly wouldn’t hesitate to go back on isotretinoin if my acne came back, though. The five or six months of uncomfortable side effects didn’t outweigh the great benefits for me.

A dermatologist's take:

“I would say only five percent of my patients go on isotretinoin a second time—either because their acne came back in full, or because they’re getting some breakouts that they don’t want to deal with again,” says Dr. Gohara. “Another five percent get a little bit of acne again that clears up with retinoids or antibiotics, and the other 90 percent never see a pimple again.”

✨ Five years post-Accutane ✨

Before isotretinoin, I had severe cystic nodular acne, mostly on the lower half of my face, that wouldn’t respond to typical acne treatments. The bumps under my skin were so large and sore that I ended up going on 60mg of Accutane in 2015. Throughout my six-month dose, everything was dry—my eyes, the insides of my nose (to the point of occasional nosebleeds)—and my joints were super stiff and achy, especially in the morning and at night. Even bending down and picking something up was harder on Accutane; I had to move slower because of how stiff I felt.

Thankfully, all of my side effects ended quickly, just a few weeks after I stopped taking the pill, but my acne started to come back six months later. In the end, I decided not to go on another dose of Accutane, though, since my acne is so hormonally driven that I feel like it wouldn't have helped. I still have acne five years later, but I’ve found more natural ways to treat it over the years, and it’s nowhere as severe as it was before.

Even though it didn’t work for me, I’m still really grateful I took isotretinoin. Without it, I wouldn't have started my Instagram account @myfacestory and wouldn’t have connected with all the people I’ve had the opportunity to meet online and in person. The fact that Accutane didn’t work for me ended up being my gateway to skin positivity; it helped me accept and love my skin no matter what it looks like.

A dermatologist's take:

Ask a dozen dermatologists for their thoughts on isotretinoin and hormonal acne, and you’ll probably get a 50/50 split in opinions. Some dermatologists believe isotretinoin isn’t super effective for hormonal acne in women, but Dr. Gohara (and many others) disagrees: “We know that acne is caused by a hormonal surge that triggers your oil glands to produce oil, allowing bacteria to settle in and create inflammation,” she says. “So it simply doesn’t make sense to me that this process wouldn’t respond well to isotretinoin. I think that in the cases where a patient’s skin isn’t responsive to Accutane, it’s because that person’s body just isn’t responsive to Accutane—which can happen in some people.”

✨ Eight years post-Accutane ✨

The best way I could describe my skin prior to isotretinoin is...painful. There was a period of at least five years where I don't remember waking up without my face hurting. I actually got fired from a job at a beauty counter in college because the manager thought I made a bad impression on customers because of how my skin looked.

Accutane ended up working really quickly and really successfully on my acne, but I also had virtually every side effect—the most annoying of which was the dry skin. I needed to apply lotion to my face, hands, and body all the time, and I dealt with horrible joint pain, especially in my hips. Because isotretinoin dries up a lot of your body’s natural moisture and lubrication, even my anus (yup) was dry, which meant taking a sh*t was one of the most painful experiences of my life.

I also experienced suicidal thoughts and ideations toward the end of my treatment, but I didn't want my derm to pull me off the meds—at that point in my life, I thought my skin was more important than my mental health, but I should have been upfront with my dermatologist (I absolutely don’t recommend this dangerous behavior, FYI).

Within six months, my acne cleared up, and my dermatologist decided I no longer needed to take isotretinoin. All of my side effects disappeared within a month, except for the depression. To be fair, I’ve always had depression in some form, but I had never had suicidal ideations until I was on isotretinoin. Still, as awful as some of my side effects were, I don’t regret a second of it. I was so self conscious about my skin that I used to hide in the bathroom and cry. I truly believe that Accutane was the only viable treatment for my cystic acne.

A dermatologist's take:

According to Dr. Nazarian, less than one percent of her patients experience mental health symptoms while on isotretinoin. As for Dr. Gohara, “scientifically, there's no correlation between isotretinoin and depression or anxiety, but anecdotally, I see it in 10 percent or less of patients,” she says. “If somebody has a pre-existing mental health condition or is seeing a mental healthcare provider, I make sure that provider is on board with Accutane before I even start it, and that we are in really close contact so we can quickly lower the patient’s dose or come off of the medication ASAP if need be.”

If you or someone you know is considering suicide, call the National Suicide Prevention Lifeline at 800-273-8255 or contact the Crisis Text Line by texting HOME to 741-741.

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