Looking Internal To Fix the External: My Personal Plight with Acne & Accutane

By: Olivia Morrison

As someone who has struggled with the pangs of acne as soon as the perilous days of pre-teen puberty dawned, I have an intrinsic understanding of how these tiny little blemishes, largely unnoticeable to the wandering eye, can lead to debilitating feelings of insecurity. I remember counting each festering whitehead. They weren’t just pimples to pop, but poignant plots of my internal self doubt externalizing as visible indicators of imperfection, diabolically diminishing my self-confidence. Think 2012, you know, the days of Gangnam Style, Katie Perry, or, maybe, reminding you of Instagram posts’ heinously wide white border engulfs you in a wave of nostalgia for those much simpler days. When I think of 2012 I am reminded of the unattainable beauty standards flooding my Tumblr and the soul-crushing anonymous “ratings” of girls’ looks on ask.fm. All of that, coupled with my seemingly incurable acne led my twelve-year-old self to conclude: “yes, I’ve found my Armageddon.” Well, I didn’t know what that word meant just yet, but if I did I totally would have thought it! 

It was a numbers game, and if I could count more than three pimples, the end of the world was surely near. Each new pimple became a quantifiable flaw equating to the cumulative erosion of my appearance. Sometimes, I would be too self-conscious to step outside the house if my attempt to conceal my pimples with layers of CoverGirl foundation and green-tinted primer failed. I tried everything: doxycycline, Epiduo, retinol, three courses of treatment with Accutane over a ten-year period and even cutting out dairy and gluten - yes, I said goodbye to brie and sourdough for a tortuous three weeks. Oh, and how can I forget the numerous CVS splurges in between hoping that St Ives’ grapefruit acne scrub would work its salicylic acid magic and wash away my pimples. Nothing helped, especially not St Ives; frankly, I think the exfoliant made it worse. I was cursed. My mental health and physical outlook were plagued by “acne vulgaris” (Kraft, 2011). While “vulgaris” is a Latin word that means ‘common,’ even the scientific term for acne seemed to echo the sound of my glass facade of self-confidence shattering, deafening my eardrums with piercing, intrusive whispers of “you’re vulgar.” 

Acne is ubiquitously known to impact one’s quality of life, as it largely influences “self-esteem and psychosocial development” (Kraft, 2011). I can attest to this scientific finding; acne puts an unbearable strain on self-confidence. Dermatologist-recommended courses of action to treat acne include antibiotics, topical retinoids, over-the-counter therapies - such as benzoyl peroxide and salicylic acid - and Accutane (Kraft 2011). While Accutane seemed to yield the best results for me personally, its cure was always short-term as I would break out weeks later following the conclusion of my treatment. It is important to note that this was my personal experience; to date, Accutane is the “most clinically effective anti-acne therapy, producing long-term remission” as well as “significant improvement in many patients” (Layton, 2009). However, Accutane certainly isn’t an easy or convenient fix. While it definitely worked temporary wonders for me and has been found to be a long-term fix for many, Accutane is conditional on withstanding its plethora of negative side effects. Thus, in using Accutane as a treatment for acne, one must consider whether or not its unequivocal fix of the external is worth the internal strain on one’s body and mind. 

If you aren’t familiar with Accutane - otherwise known as Isotretinoin - the drug is a “physiologically active metabolite of vitamin A” taken as an oral pill daily (Bettoli, 2019).  Accutane is able to achieve “remarkable efficacy” by “influencing cell-cycle progression,” resulting in a “reduction of sebum production” (Layton, 2009). However, Accutane should not be prescribed “as a first-line therapy,” and is only used to “treat severe acne as a second-line agent” when acne is “unresponsive to other combination therapies” like antibiotics (Layton, 2009). When I first started taking Accutane, I was living in Singapore. It was there that I first learned of Accutane’s most serious side effect: the drug is “teratogenic,” meaning exposure to the medication for a growing fetus can “induce abnormalities of physiological development,” leading to mental and physical birth defects (Costa, 2018). As a result, most physicians require proof of birth control to avoid getting pregnant while taking the drug. In Singapore, regulations allowed abstinence to suffice - I was also twelve years old at the time. Yet, in America, using Accutane to treat acne is much more strictly regulated. That meant that when my acne returned during high school and then, again, during my second year at UVA, I experienced the FDA’s torment personally. In the United States, treatment with Accutane is closely monitored by the FDA. The FDA requires individuals prescribed Accutane to agree to use two forms of birth control, as well as schedule monthly visits to the dermatologist for a negative pregnancy test. Additionally, the FDA administers a tedious monthly survey on iPledge to ensure one fully understands why getting pregnant on Accutane is so serious. That’s not all, I also had to go to the lab each month for blood work as Accutane “elevates liver enzymes” and increases “triglyceride and cholesterol levels” (Costa, 2018). 

Other negative side effects associated with Accutane include “depression, suicidal ideation or attempted suicide.” This side effect is less common, however, as only an estimated 3% of the general population experience feelings of depression or suicidal ideation (Costa, 2018). Fortunately, I did not experience depression as a side effect. I did, however, experience one of the most notorious side effects; Accutane dries out your skin to a painful degree and, as a result, my lips were constantly chapped. I also had to incessantly apply face moisturizer. Seriously, I used to carry CeraVe moisturizer and Blistex around in my school backpack. While Accutane always temporarily cleared up my seemingly incurable acne, following my most recent conclusion of treatment with the drug in the fall of 2020, my acne returned this past spring. I was so frustrated; at that point, I had been dealing with acne for almost 10 years. Despite feeling helpless in curing my chronic acne, it was in my despair that I finally found hope. I discovered that focusing on what was going on internally was the key to fixing the external. 

During an annual visit this past summer with my doctor, in which I vocalized my hopelessness, he deduced that my persistent acne might be due to imbalanced hormones. After getting the correct lab work done to affirm my doctor’s hypothesis as well as discussing what this course of action would entail, he changed my birth control to a higher dose and prescribed Spironolactone. Oral contraceptives, especially combination birth control pills, have been found to reduce acne by “decreasing androgens and therefore sebum production” (Ebede, 2009). Similarly, Spironolactone, a “synthetic steroidal androgen receptor blocker,” helps to balance hormones by “decreasing androgen-stimulated sebum production” (Ebede, 2009). In a study published by the International Journal of Women’s Dermatology, it was found that 85% of participants taking spironolactone, coupled with oral contraceptives, saw major improvements (Charny, 2017). In fact, 55% of participants found that their acne had completely cleared (Charny, 2017). Both Spironolactone and combination oral contraceptives work in a similar capacity to Accutane by reducing sebum production, the apparent culprit of my chronic acne. Taking these two medications, as well as sticking with an attentive, regular skincare routine, has been the only long-term treatment option for me that has yielded long-term success without any strenuous side effects. 

Yet, every individual body is made up of different genetic, hormonal, and environmental factors. For example, many individuals experience immediate relief by using antibiotics or over-the-counter creams (Layton, 2009). I offer my personal experience to illuminate how you must find out what works best for you; for me, seeking the correct medical advice was the answer. My course of treatment is just the solution that aligns with me and my body’s needs best. While my skin is still not perfect on a daily basis, as I continue to have the occasional flare-up, I couldn’t be more relieved to have found a long-term way to manage something that has always felt like a lingering shadow, following my every step in all stages of life. More importantly, this discovery has culminated in a cathartic release; I no longer resort to feelings of guilt in which I convince myself that my own actions, or lack thereof, were the catalyst for my suffering. I have realized my previous self-doubt and blame were wholly unproductive. Managing my acne was never something I could have controlled or unilaterally managed without the input of my physician. No matter how many times I would type “how to get rid of acne” into my iPhone’s Safari browser, professional medical insight from my doctor, as well as getting the right bloodwork done, was essential. Ultimately, listening to my body and gauging what was going on internally unequivocally helped me fix my acne. Subsequently, my quality of life and mental outlook has drastically shifted. Most importantly, I feel confident; and not because my face is free from blemishes - it certainly isn’t - but because I no longer feel defenseless or helpless to a previously incurable strain on my physical and mental health. 

Reference List:

Bettoli, V., Guerra-Tapia, A., Herane, M. I., & Piquero-Martín, J. (2019). Challenges and Solutions in Oral Isotretinoin in Acne: Reflections on 35 Years of Experience. Clinical, cosmetic and investigational dermatology, 12, 943–951. https://doi.org/10.2147/CCID.S234231

Charny, J. W., Choi, J. K., & James, W. D. (2017). Spironolactone for the treatment of acne in women, a retrospective study of 110 patients. International journal of women's dermatology, 3(2), 111–115. https://doi.org/10.1016/j.ijwd.2016.12.002

Costa, C. S., Bagatin, E., Martimbianco, A., da Silva, E. M., Lúcio, M. M., Magin, P., & Riera, R. (2018). Oral isotretinoin for acne. The Cochrane database of systematic reviews, 11(11), CD009435. https://doi.org/10.1002/14651858.CD009435.pub2

Ebede, T. L., Arch, E. L., & Berson, D. (2009). Hormonal treatment of acne in women. The Journal of clinical and aesthetic dermatology, 2(12), 16–22.

Kraft, J., & Freiman, A. (2011). Management of acne. CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne, 183(7), E430–E435. https://doi.org/10.1503/cmaj.090374

Layton A. (2009). The use of isotretinoin in acne. Dermato-endocrinology, 1(3), 162–169. https://doi.org/10.4161/derm.1.3.9364