No one expects to still be resisting the urge to squeeze a jaw-line flecked with white heads or deal with a back covered in boil-like pimples so bad you can’t sit on a hard-backed chair without flinching, but there I was. I had found myself at 25 with the worst acne of my life, just like so many others do unexpectedly.
The funny thing is, no one really knows why women get acne later in life and, in turn, no one really knows the causes of cystic acne.
This is why I didn’t expect it, nor did I expect what an impact it would have on my life. From my confidence to my relationships. Subconsciously it was always lingering. It’s so sad that still in today’s society the stigma around our skin can rule our lives, but that’s the way the Clearasil wipes I guess.
If you suffer or have ever suffered from acne, you may know the myriad of treatments, topical and otherwise, that promise to put a stop to Senõr Sebum. Obviously, I tried them all. The contraceptive pill, the creams, the scrubbing my face to within an inch of its life, the steaming, the Chinese remedies, holistic medicine, diet, the list is frustratingly long.
But it was after much deliberation that I decided to take the plunge and start a course of Roaccutane.
What is Roaccutane?
When I went to see a dermatologist he described Roaccutane as ‘one helluva drug’. And that’s exactly what it is.
Simply put, Roaccutane, Accutane or Isotretinoin as it’s also called, is a drug used to treat severe cystic acne. It belongs to the Retinoid group and if you know your skincare, you’ll know that retinoids are having a serious moment in the limelight for their cell regrowth abilities. However, ageing skin ailment this type of Retinoid is not.
Essentially, Accutane decreases how much oil the face produces. This is done by sucking all the moisture from your skin, taking sebum along for the ride. (I like to picture it like tiny hoovers in my pores, but that’s definitely not how it works).
It’s so powerful that whilst you’re on it, you’re not supposed to drink and if you were to become pregnant, there is a high risk that the baby would be harmed, resulting in an abnormal appearance or mental handicap. If you are at risk of becoming pregnant, you are warned to be overly careful with protection and will only be given treatment after a negative pregnancy test is taken. I had to do this every time I went back for a new prescription, along with a blood test to check my liver was responding OK.
Why does is there scepticism around it?
Besides the potential birth defects and severe dryness symptoms? There have been links to Roaccutane and suicide in the US.
It has been known to trigger depression and heighten anger. Luckily, the doctors and dermatologists who prescribe it know this and will promise to carefully monitor your mood and encourage you to let them know of any changes. Well, the wonderful staff at Guy’s Hospital did this for me, and yours should too.
How long is a course?
The course length and the number of tablets you’ll be put on depends on your body weight. As far as I know, you need to reach a minimum level of the drug in the bloodstream for it to have a lasting effect. It’s a bit like antibiotics in this sense. If you feel better during antibiotics, do you stop taking them? No. You finish the course. This is how Roaccutane does its job. It needs to work and then work some more.
You’re put on anything from 20-80mg a day, which means you’ll take it anything between 1-4 tablets a day as each individual pill is 20mg. If you’re put on a low dosage, which I was due to my high metabolism, you’re probably going to be on the course for a bit longer. If your acne is also persistent or more severe, you’re also going to find yourself on a longer course. I also understand there’s a maximum amount one person can take before it has harmful effects, so this will never be exceeded.
How can I be put on a course of Roaccutane?
There are a few ways you can begin a course of Roaccutane. I guess the main two would be to get referred to a dermatologist by your doctor (which is what I did) or you can go private. I was referred and while there was a bit of a wait (about 6 months), the treatment, care and reassurance I was given was absolutely first class.
I’ll dive into the ins and outs of taking the drug and what happened over time, but first…
A bit of my skin history
I went through the typical spotty teenager thing from the age of 13. My forehead lit up with red spots and shiny beacons of puss just waiting for me to get my picking mitts all over them.
And yes, I was a picker. Over the years, my picking became so bad that I began not to notice I was doing it, so much so that my friends and family had to tell me to stop and actually started slapping my hand away. But I carried on and now I have scars all over my forehead, so let this be a lesson.
At 16, I went to a dermatologist and was offered Roaccutane for the first time. I had my dad with me and one mention of a pregnancy test saw him grab me by the arm and we were out of there. Then the unending list of alternative treatments started.
The most effective was the contraceptive pill. Dianette was the one that zapped them the most, but it also made me black out, forget where I was and sent my hormones raging, so that was stopped. Fast forward a few years and I was on the Mirena coil, where I would experience the most painful blister-like spots that led one colleague to ask me, ‘what happened to your face?’
The spots had made their way from my forehead to my jaw-line, cheeks and neck as they do in your mid-twenties due to a shift in testosterone.
One ultrasound would reveal that I also have polycystic ovaries, which also cause heightened levels of testosterone.
I could no longer put anything in my body with an ounce of Oestrogen thanks to Dianette, and the coil/PCOS was making my already angered face way worse.
I should mention that in the midst of this I developed a rather large and hard lump on my jawline, made up of a cluster of hair follicles (because I’m also very furry, which hasn’t helped my pores either) and I wanted it gone. This was the real reason I went to the dermatologist. Spots I could deal with, but a protruding lump? Nope.
After running through all the other options (one being steroids injected into my face to leave a concaved hole where the lump was) it seemed the only last resort was Roaccutane. With much persuasion, constantly being told it’s helped thousands of people and speaking to friends, one of whom swore it was like ‘crack for your skin’ I agreed.
My Roaccutane Experience
This will be a bit of a skin diary of sorts. A short one, because I don’t want to bore you to tears. However, please do not assume that my journey with this acne treatment will be the same as yours. Every single adult has different skin. We also all have varied mental health. If you read this and think it might be for you, seek a professional medical opinion before you decide.
I didn’t really notice much of a difference in the first month. I started off on one pill a day and would eagerly wake up to see a face that looked basically the same as yesterday. They do say it gets worse in the first few months, but I didn’t notice this. My skin was, for the most part, unchanged until I graduated to two pills a day.
The change was very slow and very gradual, a bit like how you don’t notice your nails are growing. I began to notice increased dryness in my lips, but only my lips. I started the course at the end of October and noticed this around December time, along with needing a more hydrating moisturiser. Keep in mind it was winter, too.
By January, my skin had started to clear up. I couldn’t go in the sun as you’re not supposed to get any UV light exposure when taking the tablets, so I was deathly pale (January isn’t exactly a time for top-up tans either). My dry lips had also become worse, to the point where I would need 3 Nivea lip balms in my pockets and bag at all times to constantly reapply. This then changed to Carmex as I found it to be more effective.
They would flake off and regenerate so much that I felt like I got new lips daily. In a non-Kylie Jenner sense. This re-introduced my wonderful picking habit. I would pick my lips constantly, to the disgusted dismay of onlookers, but I couldn’t physically stop. It was addictive. This also meant that I consumed a lot of lip salve. I learnt to get used to the taste pretty quickly, while simultaneously looking like I’d been up all night on a drug-fuelled bender and was now just chewing my face off.
Apart from the lips and the slightly improved skin, I didn’t notice any other symptoms. My mood seemed to stay my usual angsty self. I didn’t feel particularly angry or depressed, although I was more susceptible to anxiety. However, I’m not sure if this was because of the drugs or my personal life.
It’s April by this point, the 6-month mark. This was the time I thought I was going to be able to stop taking them. This was the point when they told me I needed to be on them a bit longer. I cried.
By this point, the dry lips had turned into burning lips. They physically burned all day. It felt like I was constantly having an acid peel. With actual acid. It had also spread to my nose. I would blow it and blood would come out. The skin on in my nostrils was also flaking off in strips. So it was either let it hang out or get it out and leave scabs up there. I chose the latter. The thinner skin across the top of my nose was also coming off, leaving exposed red marks.
I couldn’t smile or laugh properly without my lips cracking or contorting my face to either not smile or look like an old turtle with no teeth to avoid the pain. My skin required heavy duty moisturiser (I used Epiderm) two times a day.
It was also at this point I was due to go on holiday. Did I cancel it knowing I couldn’t go in the 40degree Caribbean heat? Did I heck. I creamed up with Factor 50 and soldiered on. Wrong move. My skin came out in blisters, everywhere. Do NOT go in the sun when you’re taking it.
When I got home I began to become frustrated. I was sick of drinking 3 litres of water a day just to feel hydrated. Luckily, the acidic lips and light nostril peelage was all I had to deal with.
It was at this point that my friend’s back would crack and bleed every time she bent down because it was so dry. Another admitted to constant nose bleeds.
Through it all, my skin became clearer. My blackheads even disappeared. The lump on my jawline shrunk. My back was smooth. I couldn’t believe it. My skin hadn’t looked like this for 8 years.
The Final Appointment
I had taken a blood test for my liver and the final wee test and sat down with my consultant. “How do you feel?” He said. “Great,” I replied. He was very impressed with the results. A happy story.
After that appointment, the dryness continued and I was told to continue practising safe sex and not drinking for a month. That was in July.
It’s November now and I haven’t had to pop a spot in over 6 months. My blackheads on my nose have returned a bit, but my skin is lovely and smooth. It’s so freeing and has instilled me with more confidence than I never thought I’d get back.
Now I’m working on reducing the scarring, which will also take time, but is well worth the wait.
Am I glad I went on Roaccutane? Absolutely. I feel liberated and there’s no more shame attached to my skin anymore.
Do I wish I had done it years ago? God yes.