“Help! I’ve tried EVERYTHING to get rid of acne but nothing works. Am I doomed forever?!”
I get this question a lot. Over the years, I’ve noticed these acne sufferers fall into two categories:
- Those with mild to moderate acne who’ve been trying random skincare products without success.
- Those with severe, inflamed, aggravated acne that doesn’t react to topical treatments.
If you fall into the first group, don’t feel bad. The skincare world is a minefield full of snake oil sellers. Most of the products targeted to acne-prone skin don’t either have what it takes to get rid of acne or are so harsh, they make things worse, not better! Ugh!
What you need to do is get yourself a salicylic acid exfoliant ASAP (you can find my fave picks here). If that alone is not enough, spot treat with either benzoyl peroxide, sulfur or tea tree oil.
If the problem keeps coming up, it’s time to take a look at your diet and stress levels. Try going on the low glycemic diet and do some form of mindfulness, like meditation, to reduce stress.
For more help, check out one of these guides:
Then, leave this page. You don’t need to read the rest of this article.
But if you fall into the second group, if you’ve tried all the most effective topical treatments and overhauled your diet and lifestyle without results, if your acne is so severe that only prescription meds can heal it, it’s time to go nuclear.
It’s time to consider going on Accutane.
What Is Accutane?
Accutane is the drug name. The active that makes it work is Isotretinoin, the most powerful form of vitamin A.
Accutane is the weapon of last resort. The one you use when nothing else works for your acne.
You can’t buy it in the shops. It’s prescription only. If you’re considering it, you need to see a derm. She’ll prescribe you a low dose (usually something from 0.5mg to 2mg) for 15-20 weeks (in some cases, the treatment can last up to 10 months!).
Yep, even nuclear weapons take their sweet time to work.
Related: What’s The Best Form Of Retinoid For You?
Struggling to put together a skincare routine that banishes shine, pimples, and blackheads? Download your FREE “Best Skincare Routine For Oily Skin” cheatsheet to get started (it features product recommendations + right application order):
How Does Accutane Work?
Accutane stops your body from producing oil. Like, almost completely (we’re talking an 80% reduction here).
Are you starting to see why it’s used as a last resort now?
Here’s how it works. When everything’s well, oil pumps out of your sebaceous glands into your skin, where it acts as a natural moisturizer. That’s why normal skin is naturally so soft and smooth.
But if you’ve got acne, your sebaceous glands are into overdrive. They pump out way more oil than your skin needs. The extra oil can’t flow out of your pores normally anymore. It’s trapped inside.
Here, it mixes with dead cells and all kinds of other crap. Soon, the blob becomes so big, your pore’s clogged.
P. Acnes, the bacteria that causes acne, feeds on this excess oil. By reducing oil production, Accutane literally starves the acne bacteria to death.
That’s not all it does either:
- It regulates cellular turnover (the skin’s exfoliating process) so dead cells slough off your skin instead than falling inside your pores
- It reduces the size of your oil glands
- It has anti-inflammatory properties that reduce the redness and inflammation associated with acne
It’s basically one stop shop for all your acne needs.
Related: Adult Acne: Why It Happens And How To Treat It
Does Accutane Have Any Side Effects?
There’s a reason Accutane is the weapon of last resort. It’ll get rid of your acne alright but not without wrecking some damage first.
Here’s what you can expect in the short term:
- Dryness (dry skin, dry lips, dry mouth)
- Photosensitivity
- Purging (usually lasts 3-4 weeks)
Yep, your skin will get all dry and flaky. Your wrinkles will look way worse. Your face may have more spots than ever.
This can take a huge toll on your confidence and self-esteem. Don’t let it get you down. Journal, meditate, find a way to relax and destress. This is the worst hurdle. Once you’re past it, your skin will look its best ever. I promise you.
And in the long term:
- Abnormal bone growth
- Birth defects (it’s mandatory for women to take birth control when prescribed Accutane – they won’t give it to you if you don’t agree)
- Depression
- Dry eye syndrome
- Joint pain
- Inflammatory bowel disease
Scary, right?
With the exception of birth defects, the long term side effects (you can’t escape the short term ones, sorry!) usually appear only in less than 10% of patients. Chances are you won’t ever experience them.
It’s like taking aspirin or other meds. They all have long list of side effects but most people never get them. Still, it’s important to be aware of what you’re getting into and that there’s a small chance you could be the exception.
WARNING! Because Accutane has a long list of potential side effects, including birth defects, you won’t be prescribed it on the spot. You’ll have to do blood tests and regular follow up visits to check that everything’s fine. If you’re a woman, your doctor will ask you about your sexual history and discuss with you birth control options. You’ll also have to do a pregnancy test every month. I know it seems unnecessary for acne, but they do it to avoid the risk of surprise pregnancies while on Accutane.
Related: How To Survive a Purging Period
Is Accutane Worth It?
I wouldn’t try Accutane as your first treatment. But if you’ve tried everything without success, Accutane is worth the temporary pain.
Accutane is successful in 95% of patients. The results are often permanent.
Accutane doesn’t just clear up your skin. It gives you a confidence boost. Now you won’t have to deal with acne anymore, you’ll feel much more comfortable in your own skin.
Accutane Tips And Tricks
WARNING! Your derm will prescribe you a skincare routine and teach you how to make Accutane work for you. Listen to him/her! The tips below are probably the same a derm will give you but if your doctor told you to do something different, go with his/her advice. He/she is a doctor. I am not.
1. Go Back To Basics
Skin gets super sensitive on Accutane. To minimize the risk of irritation, keep your skincare routine as simple as possible. In the morning, cleanse, moisturize and put on sunscreen. In the evening, cleanse and moisturize.
Stay away from exfoliants, alcohol-laden toners, harsh anti-acne products and anything with a strong fragrance. Don’t wax.
I don’t usually recommend basic moisturizers without antioxidants or powerful anti-aging superstars like vitamin C, but that’s exactly what your skin needs now.
As a rule, if you wouldn’t put it on your newborn baby, don’t use it on your skin now. That’s how sensitive it gets on Accutane.
Related: The 3 Skincare Products Everyone Needs
2. Eat Before Taking Accutane
Studies show that Accutane is more effective when taken 1 hour before, 1 hour after, or with a meal. Especially when that meal has a high fat content.
It goes without saying – but I’ll say it anyway – that’s not an excuse to binge on unhealthy crap. Healthy fats include salmon, avocado, tuna, nuts, olive oil, flaxseeds and chia seeds. Get your fix from those. They’re delicious.
The Bottom Line
I can’t stress this enough: Accutane is the treatment of last resort, only for those severe cases that don’t respond to any other treatment. If that’s you, then consult your doctor. Accutane isn’t pleasant but the results are well worth the temporary side effects.
Accutane is honestly one of the best decisions I’ve ever made! I’ve tried many products over the years and at 22 years old, it was ridiculous how bad my skin was with no signs of improving. I’m starting month 3 now on this stuff and my skin completely clear (no actives) and so smooth! I can’t remember the last time it was like this. Although I have a lot of acne scarring that will take time to heal, I’m still so happy it’s such a confidence booster.
Now yes, the skin will be sensitive and at first I was only cleansing, toning and moisturising, but I’ve slowly introduced other products (exfoliater, serums, masks) in my skincare routine and it’s doing really well.
I also recommend starting a instagram account to track your progress and follow other accutane accounts. It’s such a useful way to get help or support from other people going through the same thing. Even when posting your bare face there is no judgement, in fact everyone is so encouraging on your progress.
I just want to also add that the process of starting accutane may differ depending on where you live. I live in Australia and I was never asked about my sexual life, nor do I need to take a questionnaire/pregnancy test each month. After I had my first derm appointment, I took a blood test the next day and one week after my initial appointment I started accutane.
And lastly, DO NOT WAX. Seriously, that was the biggest mistake I made. Just don’t even think about it.
I hope this helps!
Ebony, thanks so much for sharing you’re experience with Accutane. It’s very helpful and I’m glad Accutane is helping you.
Also thanks for mentioning the Instagram accounts. This process can be very isolating and finding people who understand what you’re going through and support you can make all the difference.
Been on accutane for a bit over a month and the desertification has begun! Though I still have spots healing from moderate adult acne leaving “icepick scars” facially and at times black marks deep in the skin for the more cystic type ones on my legs and chest, as well as more blood blister types on my back and sides that turn red, purple then black. For my face’s new Saharan Adventure I’ve taken to blistex daily conditioning lip balm and the old classic Ponds Cold Cream Cleanser and Ponds Moisturizer. I thought to try it remembering how oily it made my skin as a teen once, and said hey, I could use that right now! lol. It’s a bit fragrant, but so far its the only thing hydrating enough, hypoallergenic, and it’s only about $5 a pot. I’m pretty low income, so all those blogs about using 5 different $50 skin stuffs were not very helpful for me personally. Thanks for the tips here!
Becca, thanks for sharing your experience. I hope the tips here help you. I’m glad you found a few products that work for you. Who said you need to spend a lot of money to get good skincare? Cheap products can work well too.
Gio, this post is fantastic! Sending it to a friend who told me she’s considering Accutane and my first reaction was NO, it’s so dangerous! But obviously you can provide much more valuable info on it than me, haha. Although the side effects do still scare me a lot and makes me scared for her – or anyone, for that matter. It really is a last resort, isn’t it… :s
Renee, thanks! I hope this post can help your friend make the right decision for her. The side effects are scary indeed but, if you’ve tried EVERYTHING without results, it’s the less of two evils. Still, I’d look into changing diet/lifestyle (if she hasn’t done it yet) first. 🙂
If only dermatologists could recommend looking at diet and your site first, it might actually help a lot of people before going down the route of Accutane (Roaccutane in the UK). I’ve taken it twice with success, but only lasting for a few years each time. Then I developed Rosacea, not redness but pimples. I stumbled across your site and with your help and advice my skin is better than it has been in a long time. I know what foods are my triggers so that also helps. And Salycilic Acid and Sulphur have helped with the rash under my skin. ?
Michelle, aww thank you! So glad to know my blog has helped you.
I agree. Sadly, doctors are trained to automatically prescribe meds. And yes, sometimes you need meds. But often, looking at the root cause of the problem and making a few lifestyle changes can fix the issue.
Hi Gio! Great post! I think it will help a lot of people not to be so scared of taking Roaccutane. I know a lot of people focus on changing their diet and lifestyle and are against taking strong medication for skin issues, but sometimes you need that helping hand.
I was on relatively low dose Roaccutane for 8 months, best decision I ever made and it was not a horror story like a lot of people make it out to be, you just have to be prepared on how to handle some of the most common side effects. I had a big purge at first, crazy dry skin, very dry and cracked lips, dry eyes, it was uncomfortable to start with but once I found the right products it really wasn’t that bad considering at the end my skin was the best it had ever been in my life.
My advice whilst on Roaccutane is to BE GENTLE, so so gentle with your skin. Strip your skin routine back to basics, just a very gentle mild cleanser. At night time I would smother myself in Diprobase or Aqueous cream a few hours before bed. This is a night time only thing because Diprobase is so sticky and you could never ever wear makeup on top of it! I would walk around the house with this horrible sticky white face but I didn’t care because i was like “ahhh my skin is just soaking up all this moister haha’.
Vasline won’t cut it for Roaccuate level dry lips, Carmex and Blistex worked for me.
DONT WAX.
Don’t put anything else on your skin, wash, moisturise, and then probably more moisturiser, but that’s it.
If you can avoid wearing makeup, do it. Makeup did not sit well on my Roaccutane level dry face. I am a mega oily gal, and at the start of the day I would do my makeup, within 2 hours my skin was peeling, flaking, my foundation had cracked and sunk into all my dry creases, it was not pretty!! So in the end I gave up.
Be patient, it took about 1.5 months before my skin started to chill out with the dryness and the purging and I started noticing massive changes in my skin really quickly after that.
You hear all these horror stories about “Roaccuate ruing your body”, yes there are more series side effects like reduction in bone mineral density, or that its extremely harmful to an unborn baby. But the reduction in bone mineral density is only really and big concern if you are on Roaccuate as an adolescent, as this is when you acquire much of your bone mineral density for the rest of your life. Also if you take part in regular high, impact exercise/resistance training, you’ll be fine. Its not going to crumble your bones if you take Roaccuate as an adult. Also the whole pregnancy thing wasn’t an issue for me, I was already on the Depo injection and had zero intention of getting pregnant.
If you and unsure, I SAY DO IT, and invest in a shit load of moisturiser and you’ll be fine 🙂