The Accutane Diaries
I've mentioned in passing that I just finished a six month course of Accutane. I did a TON of research online before and during my treatment, and while there's a lot of info out there, I feel like I have a few things to add to the discussion. As a disclaimer, I'd like to say that this is about MY PERSONAL experience while on Accutane. This is a major drug that affects everyone differently, and your experience may be the complete opposite of mine. What I found helpful before and during my course of Accutane was reading as many different testimonials as I could, and then picking out which tips and tricks applied to me. Your personal Accutane experience will also depend on your dermatologist. Maybe yours is super aggressive, or super conservative, or like mine, who made me sign a contract promising to get an abortion if I became pregnant while on Accutane. Anyway, disclaimer over. Now to begin my Accutane story.
First, let's talk a little about what exactly Accutane is. Accutane is the most commonly used designer name for isotretinoin. I'm going to refer to the drug as Accutane throughout this post (as patients and dermatologists will when discussing the drug with each other), but I don't think many patients actually take Accutane itself. I, for example, took a generic called Claravis. Accutane is a very powerful, very controversial drug used for the treatment of acne. In the most basic terms, it's a mega dose of vitamin A that shuts down oil production in the body. It's also known to have some grisly side effects, most famously birth defects and suicides.
By law, any female patient physically capable of becoming pregnant must take a monthly pregnancy test and use two kinds of birth control while taking Accutane. For awhile there was a string of deformed babies being born to Accutane patients, hence the crackdown. There's a picture of a heavily (I'd say about 19 months along) pregnant woman with a big no-no sign on each little pill space in your Accutane blister-pack, and each pack includes lovely pictures of a baby's deformed skull. As a potentially pregnant woman on Accutane, you'll need to get a monthly blood test proving you're not with child, take a quiz online proving you know how sex/birth control/Accutane works, and only THEN can you go fill your prescription. It's a pain in the ass but in my opinion acne is a bigger pain in the ass, so I was happy to jump through hoops for my pills. I could also go into how insulting this program is, and how it assumes women can't take care of their own bodies without official interference, but hey, I was totally willing to be treated like a damn fool to get rid of my acne, so I probably shouldn't get too preachy.
To get Accutane you'll first have to have acne. Duh, right? What I mean is that you're going to have to have acne for awhile. My acne wasn't severe at all (To me, one zit was severe acne, but if you compared me to many other Accutane patients my acne was a walk in the park), however it was becoming resistant to treatment. I had been seeing dermatologists and using prescription acne treatments for 13 years before I finally took the Accutane plunge. You're going to need a lot of documentation proving that you've tried it all, at least if you don't have very severe acne and want to try Accutane. If you come into a dermatologists office with truly godawful acne all over your mug, they might get you on the Accutane track right off the bat.
Accutane was first suggested to be by a dermatologist a few years ago, but I was afraid to take a drug with such a horrible reputation. I have a history of mild depression, and the stories of Accutane patients with extreme mood swings and even suicides totally freaked me out. This was the first thing I brought up with my current dermatologist when we discussed Accutane. He told me that he had been prescribing Accutane on the reg for 30 years, and he'd never had a patient off themselves, or even stop their treatment because of mood effects. He told me that 99.9% of patients that become suicidal on Accutane are teenagers, and I was well past the danger zone at age 25. My derm ALSO told me that every single one of his patients that complained of mood changes while on Accutane decided that they'd be in a worse mood if they had bad skin, so they chose to tough it out on the 'tane. He made me feel very safe and taken care of, and I decided I could take Accutane with minimal worries. Full disclosure: I was taking a low dose of Prozac before and while on Accutane. My dermatologist said this was fine, and that the antidepressants might actually help with any ill effects on my mood while on Accutane.
So, you and your dermatologist have decided that Accutane is the treatment you need. What happens next? Well, you get a lecture about the dangers of Accutane, and a big-ass book to read, and they send you home. You read the book (you should actually read this book, BTW. It's your body, not your education. Take it seriously.), come back to the doc, and tell them you're in. Then you go get a blood test to make sure you're not packing a fetus (this is if you're a female patient capable of getting pregnant, which I was, and the point of view I'm going to be presenting. I have no idea what happens next if you're a man or a uterus-free woman or something). You also sign a contract saying that you understand the potential risks associated with Accutane, promise to use two forms of birth control, and tell the friendly folks at iPledge (the program that controls if/when you can get your pils) just what those forms are. Your blood test results get sent to your doctor, and you wait a month. After a month goes by (during this time you take no pills. You just wait.) you take ANOTHER blood test, because you're a crafty and/or stupid woman that can't be trusted to not get pregnant even after a book, website, nurse, doctor, phlebotomist, and whoever else told you not to. After this blood test comes back proving you're baby-free, THEN you get a prescription. You have your paper prescription, but you can't just waltz into your local Walgreen's and get that sucker filled. Nope. First your doctor (in my case my doctor's official "Accutane Nurse") has to log on to iPledge and confirm that you're not with child, and after that YOU log into iPledge, verify your two forms of birth control, and take a little quiz about sex and drugs. The quizzes are incredibly simple multiple choice tests. Tip: If you're ever confused about an answer, just chose the most conservative, paranoid response. For example, if asked "You think you're pregnant while taking Accutane. What should you do?" Answer, "Kill it! KILL IT WITH FIRE!" You repeat these steps each and every month while on Accutane. You will get to know your phlebotomist and the staff of your derm's office and pharmacy very, VERY well.
Course of Treatment
You'll start Accutane on a small dosage, and your dermatologist will up your prescription slowly as your treatment progresses. Your dosage depends on your size and how well you tolerate the medication. From what I've read, most people start at 40mg, then up to 60mg, and finally get to 80mg. I have a tolerance to drugs that baffles even medical professionals (someday I'll tell you the story of how I had to get twice the amount of expected drugs from an anesthesiologist before a surgery), so for my last few months I was at 100mg a day. The maximum dosage is 120mg, so I wasn't at the tippy top of the dosage scale, but I think if I had a longer course of treatment or upped my dosages faster I would have gotten there. As it was I took 40mg for one month, 60mg for one month, 80mg for two months, and 100mg for the last two months. There are only certain milligram amounts available, so usually I ended up with two different blister packs of pills at a time. To elaborate: At 40mg I took one 40mg pill each day. At 60mg I took one 40mg and one 20mg each day, at 80mg it was two 40mg pills, and at 100 it was two 40mg and one 20mg. Also, and I didn't know this until my last two months of treatment, you're not supposed to take all the pills at one time. So if you're on 80mg take one 40mg in the morning and the other at night. I guess by taking them all at once I was doing a real number on my liver, but again, I have a freakish tolerance to drugs, so I never noticed any ill effects (nor did they show up on my lab results).
Here's a sad fact: I didn't see results from Accutane until I finished my course of treatment. Accutane makes your skin do a little purging, so it's common to have a bad breakout period before things get better. Occasionally, as it was for me, your breakout from Accutane will actually be WORSE than the acne that led to you going on Accutane in the first place. This is hugely depressing, and there's no way around it but to stick with it. This is when the internet came in handy for me. I read countless testimonials about Accutane experiences, and it helped to know that I wasn't alone in my suffering. I'd say invest in some good concealer and buckle down for a few hard months. Even on 100mg a day I was still getting breakouts, although they weren't as bad as the truly dark days around months two, three, and four.
Accutane is expensive. I wouldn't recommend starting Accutane unless you have insurance, and good insurance at that. My dermatologist appointments weren't that pricy, but the monthly blood tests were just under $1,500 before insurance. FIFTEEN HUNDRED DOLLARS. That's more than my rent. Each month. For two vials of blood. I had amazing insurance and parents that struggled with acne (so they were more than wiling to front the bill), so I paid just under $150 for my monthly blood work. The pills themselves run from $300 to $600 each month before insurance. I paid about $40 on average. The takeaway here is, if you live in the US, BE INSURED.
Making Treatment Easier
To help deal with my breakouts, my dermatologist started doing extractions/injections for me every two weeks. This helped immensely. BUT! You should NOT go looking for extractions outside your derm's office. I have super tough skin and didn't react to Accutane as badly as most patients, so I could handle some injections and extractions, plus I was getting treated by the same person who was providing my Accutane and had my medical chart at his fingertips. Don't go walking into some spa and tell them you want extractions while on Accutane. A responsible aesthetician won't touch your face while you're on Accutane, but you might find someone willing to poke at you, and it's your responsibility to JUST SAY NO. It will DESTROY your skin. My derm only went through with extractions after seeing how my skin reacted to Accutane after a few months of treatment, and even then he tread lightly. Try your hardest not to poke and prod at your skin yourself. While on Accutane you're much more likely to scar. I'd say if you're interested in getting your Accutane breakouts treated, ask your dermatologist, and if they say no, then drop it. They know what they're doing. They certainly know more than you.
While your dermatologist might not provide you with blemish extractions or cortisone injections, they will certainly provide you with samples of various face washes and moisturizers to help your treatment go more smoothly. My dermatologist told me to use only Cetaphil to wash my face, which I already did, and to retire my Clarisonic for at least 8 months (the 6 months I was on Accutane plus at least two months after treatment stopped). He also told me to use Cetaphil lotion on my face and body, and after I complained about Cetaphil not providing enough moisture, my nurse recommended this great lotion from Aveeno. Around month 4 or 5 my derm also gave me a 1% hydrocortisone lotion from his own skincare line to use under my normal moisturizer. This was to help with itchiness and redness. (If you're in the LA area and need a dermatologist, mine is AWESOME. I'm not going to post his info for the entire internet to see, but you can comment here/tweet me/email me if you're looking for a great dermatologist. He has celebrity clients! And his own skincare line! And is affordable! Ooooh!) This post is already longer than a hobo's beard, so I won't list everything I've used while on Accutane. Instead, I'll save that for it's own post. Look forward to it on Thursday!
Ok. Now let's talk side effects. I actually had almost no negative side effects for five months. My skin was dry, but never super dry. My theory is that because my skin was so incredibly oily before, once all the oil production in my skin was halted, my skin was just normal. I LOVED IT. Seriously, I got totally giddy at the thought of putting on makeup in the morning and not having to use a blotting sheet even ONCE throughout the day. And my makeup stayed put! It was incredible. Now that I'm almost two months free of Accutane, I'm feeling a tiny bit of oiliness return, but I'm still off the blotting papers. I hope if the non-oiliness doesn't last, at least I'll stay LESS oily than I was before. My previous oiliness also affected my hair, which I had to wash every day to combat greasiness. On Accutane I'd go three to four days without needing to wash my hair. It was amazing. Now I'm still able to skip daily showers, but it's more like two days max. I'm hoping this lasts too, but we'll see. I feel like I'm slowly working my way back to Grease City, but hopefully just the suburbs and not the city center.
HOWEVER, month six of Accutane was absolute hell. I think my body just couldn't handle it anymore. If the side effects were as bad as they were in the sixth month in say, month three, I probably would have stopped treatment. But it was the last month, and by the time I was ready to throw in the towel I had two weeks of pills left, so I stuck it out. What happened? Basically I got slightly depressed, which wasn't too bad, but I had a major fibro flare up. It was BAD, and it lasted a long, LONG time. It was definitely a fibromyalgia flare up (as opposed to just, like, Accutane-induced muscle aches), so I'm fairly certain a non-fibro patient wouldn't have the same effects, but I'm also 99% sure this flare was brought on by Accutane. For the uninitiated, a fibro flare basically consists of muscle pains, extreme fatigue, foggy brain... generally being in pain and exhausted all the time. I was basically stuck in bed, or at least at home, feeling terrible. But again, I only had a few weeks left and even if I stopped taking Accutane then, it would still be in my system, affecting me. They say it takes six months after your last dose for a six month treatment of Accutane to leave your system entirely. So to me, it was worth suffering, since I'd probably suffer anyway, and I'm used to having fibro flares affect my life. Now that I've seen how my skin has vastly improved after Accutane, and knowing what I was like going through that mega-flare, I still think Accutane was worth it.
I went in a few weeks ago for my first post-Accutane checkup, two months after my last dose. At this point I still have redness and some hyper-pigmentation from acne, but I have ZERO active breakouts. My derm said that the redness and scarring will slowly fade, but at this point my skin is still too fragile to start a different course of treatment. He also told me that my skin could still continue to improve, and that he wants to wait another six months before making any changes, just to see how my skin keeps being affected by my course of Accutane. While I still wear makeup on a regular basis, I now feel confident enough to take Hero on a walk or run to the store without a lick of makeup on. I can't even remember the last time I would have felt confident enough in my skin to even leave the house without concealer. Accutane was truly a miracle for my skin, and I'm so glad I took the plunge.