The Road to Accutane (aka. isotretinoin)
I sometimes giggle to myself over the fact that I look pretty good for someone who needs the equivalent of a gut renovation on my face. Tomorrow, I’m having surgery to remove my adenoid (not supposed to be there!) and make sure it’s not hanging around for nefarious purposes. At the same time, my surgeon will fix the nose damage probably caused when I got kicked straight in the face while playing soccer as a kid. I’m excited that I might finally be able to draw breaths in time with meditation apps (at this point, my nose can’t hoover air fast enough to keep up).
Then there’s next year’s jaw surgery, which I’ve already written about.
I’m a medical minimalist. I think we all are, if possible, right? I don’t know many people who aim to spend tons of time at the doctor for fun. I was a bit on the extreme side, though, and well into my 30s, I only went to the doctor to get a prescription for something urgent like an ear infection.
I still remember having terrible, untreated acne and calculating the distance between my house and the nearest derm. Too far, way too far, I thought. The office was practically visible from my porch, but it was cognitively too far for me at that moment because I was broke, unsure about how to take time off from work for something like medical care, and worried about what would greet me in the examination room.
I started trying to treat my acne with these sketchy “peels” from Amazon and eBay, shudder. Next, I discovered kbeauty, but my skin got worse after trying Benton products (2014 wasn’t a great year for the brand). Curology, then called Pocketderm, was my lifeline, my first attempt to really attack the problem — it was prescription medication minus the in-person office visit, bingo. My early prescription contained my first dose of tretinoin, a drug that has delivered miraculous results for some skin, but made me almost turn inside out due to the irritation and itching (probably from one of the inactive ingredients).
(My hair is dyed in the last photo–that’s not a color correction trick. I grabbed these photos because they have the best lighting and camera resolution of the bunch–this isn’t meant to be a true before and after, just a rough overview of how much my skin changed. Since May 2016, I’ve been in something of a holding pattern.)
I tried the new drugstore 0.1% concentration of Differin and it was magical. It wasn’t enough to clear my acne, but the gel formula clicked with my skin. After an episode of alopecia areata, I finally had a derm and I tried a stronger dose of tretinoin, then the prescription strength version (0.3%) of Differin.
Differin aka. adapalene is the most wonderful thing. The gel feels fine on my skin and it turns my clogs into rockets that either shoot out of my face or shoot into the skin covering them, often with significant inflammation. At first it sent clogs pounding to the surface in clusters. Now they just come up endlessly, usually solo, but sometimes in twos and threes and even fours.
Endlessly. The whole experience feels endless. I’ve spent more than four years trying to peel and cleanse and apply prescriptions and my skin is certainly better than it was before (and I have fewer fine lines, BONUS!), but the end isn’t in sight.
My Differin routine is a bit dramatique. I take a shower and cleanse. Then I apply Differin all over my face while wrapping my robe around me in a way that leaves my body covered, but my neck and chest bare so that the fabric can’t transfer the gel beyond the line of demarcation. In cases where I’ve failed to do that, my neck has promptly been burned so badly that it looks red and a bit like cling wrap. After about an hour of holding my head carefully so my jaw doesn’t touch my neck or chest, I take a second shower and rinse the Differin off thoroughly and cleanse my neck to wash away any traces of the medication.
After drying off, I slap on some Dapsone, an antibiotic and anti-inflammatory gel that seems to zap the life out of any spots where skin has been broken.
I’ve become excellent, god-level even at extractions.
I can do a peel that would make most skin shed like a snake only to re-emerge perfect.
I’ve spent…gah, let’s not even go there.
I am also wanting to do some other things with my time; 90 minutes is a lot of time to spend each night on skin that isn’t anywhere near clear. The rest of me could use some attention and time and care.
All of this is to say that when my dermatologist looked up from my chart after completing my annual skin examination and said “You’re seeing me to get clear. Do you want to try Accutane?” I wavered in a way that I’ve never wavered before.
I tend to prefer the longest, most minimal route possible. I once fired a nutritionist when she suggested that I see the hospital’s weight loss surgeon due to a Trump-related weight gain (I’ve since lost 50 pounds, mostly out of spite).
Accutane is a famously gnarly drug. It can cause major birth defects in fetuses conceived while a patient is taking the drug or in the month after. Muscle weakness. Joint pain. It has been linked to depression and even suicide. In one instance, a woman’s old nose job grew bone spurs. Skeletal muscles that are healing after surgery can develop necrosis due to the patient being on Accutane. The process of getting the drug, if you’re a woman able to get pregnant, is mind-bendingly complicated. Like, I manage budgets and large-scale events at work and I have several documents noting when various tests have to get done and my windows for getting prescriptions.
“Do you want to try Accutane?”
Yeah, so I obviously said yes.
Not sure if there’s research on this, but I feel like there’s a danger threshold, and once someone hits that, every other decision is like “well, whatever, fuck it, let’s just do it.” General anesthesia, a rogue adenoid, and the idea of my jaw getting sawed up and plated back together wore me down and by the time my derm slid the acne nuclear option across the table, I pounced like Alessandro joyfully taking out a mouse that made the unwise decision to try to slide down the pipe in the living room.
And the thing is? I want clear skin and I wanted it four bloody years ago, not four years from now. I can feel the deep clogs embedded in my jawline still. I have in places what a facialist called milia except not around the eyes, just…on my jaw. Over time, the amount of inflammation and oil seems to have changed the way my skin works in some ways, keeping my skin in a holding pattern since I hit a breakthrough in April 2016.
Barring some sort of unexpected halt to the plan, I’ll get my first dose of isotretinoin in early August. I hope to document the journey here and review some products from the perspective of someone with dry skin for the first time. You can follow the journey on here and on Instagram Stories (I’m @fanserviced).
Now, uh, time to box up my precious acids for the *checks watch* next year. EEP!