Accutane Changed My Life

I never made it through a day without it happening: someone walking up to me and offering a comment ranging from the vaguely judgmental “I know what you’re doing wrong” to the bluntly cruel “What is wrong with your skin?”

The summer of my 13th birthday, I developed a case of cystic acne that was as severe as it was sudden. My face was covered in welts that ranged in shade from angry red to deep purple, leaving my face looking like a martian landscape. The acne was painful to deal with—and impossible not to notice.

In one of the worst moments, my entire science class heard a student accuse me of not knowing how to wash my face. My response: “Oh, that’s what I’ve been forgetting!” And that’s how I coped—by pretending I was in on the joke.

I made fun of myself to survive the day, but that time in my life was brutal. The physical pain from my condition combined with the emotional torment and relentless verbal assaults put me in a severe depression. I felt my acne was a prison sentence and I’d be serving it for life. I wondered what I’d done to deserve the punishment.

Thanks to my mom’s relentless advocacy, I ended up in the Houston dermatology practice of Esta Kronberg, M.D. My mom had dragged me from my pediatrician’s office to multiple dermatologists’ offices in the hopes of finding a treatment that could improve my skin. I had actually run out of options by the time I saw Dr. Kronberg.

She took one look at me and immediately told me about a drug called Accutane, or isotretinoin. She warned me about the possible side effects, including birth defects if I became pregnant, peeling skin, joint pain. It all seemed worth it when the payoff was so irresistible—about 85 percent of patients no longer have acne. (At the time, the drug was relatively new, and its connection to depression and inflammatory bowel disease was less of a concern. More on that in a minute.)

“It’s a miracle drug for acne, and I prescribe it every day,” Dr. Kronberg told me during a recent phone call. “When I saw you and how miserable you were, I knew offering Accutane would be the best treatment for you.” (I was shocked that nearly 30 years later she remembered my case. “Yours was so severe,” she said. “I still tell patients about you.”)

A form of vitamin A, isotretinoin shuts down the oil glands, slows the rate at which oil glands shed their lining and reduces inflammation. As a result, there’s less to clog the pores and less for acne-causing bacteria to eat.

I noticed a change in a couple of weeks. My breakouts gradually became smaller and less inflamed. My skin was completely oil-free—I had to vigilantly moisturize or I developed patches of scaly, peeling skin, which were still more welcome than acne. My lips became chronically chapped, but I never experienced any side effects worse than needing lip balm. By the three-month mark, I was completely clear—no cysts, no whiteheads and no blackheads.

I started wearing my hair away from my face. I ate pizza for the first time in public—something I would never have done in the past for fear of inviting the obvious taunt. I stopped dreading the approach of another person. And when I heard my name yelled, I no longer preemptively winced in expectation of some commentary about my skin. I started to look forward to the future and feel optimistic that my skin would no longer be a distraction.

Ironically, since 1998, the FDA has issued warnings about a suggested link between isotretinoin and depression. “The risk of depression is very rare, and most patients experience relief as their skin improves,” Dr. Kronberg says. The American Academy of Dermatology says that no evidence-based causal relationship between isotretinoin and depression has been established. The AAD says the same about a possible connection between the drug and inflammatory bowel disease, another potential adverse reaction about which there has been some concern. (There may, however, be some connection between acne and IBD.)

Dr. Kronberg says such concerns should still be factored in during treatment, and she monitors patients for any signs of complications. “There’s a lot of misinformation about the drug. I urge people to have a conversation with a doctor,” she says. A typical course of treatment is five months of a dosage based on your body weight with monthly visits to your dermatologist to monitor your progress and check your blood to ensure that levels of triglycerides, cholesterol and other lipids aren’t elevated, a potential side effect while taking isotretinoin. Other than the monthly blood draws, the treatment was painless for me.

As a result of my experience with isotretinoin, I’ve been fortunate enough to spend the last three decades with skin that’s clear and smooth. Now my complexion is completely unremarkable—and I’m totally fine with it.

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