I always joke that the two best decisions I've ever made were Accutane and Alabama.
From the age of 14, my skin was always my biggest insecurity. I remember getting into high school (a private, all-girl school where makeup was all but forbidden) and picking at my skin between classes at the mirror in the bathroom. Whenever we'd have joint events with the boys' school in the first two years of high school immediately after school, I'd sneak to the restroom and hurriedly brush on Bare Minerals before my friends noticed I was gone and made fun of me for wearing makeup (none of them had acne or understood why I felt so self conscious).
I was always the one at sleepovers traipsing to the bathroom to spend 15 minutes going through my skincare routine (something I haven't grown out of). It got really bad my junior year of high school when my life became a stressful mess: I was in my first few AP classes, I was preparing for the ACT and going on college visits. I remember junior fall vividly, because I started getting very frequent, painful cysts on my chin and jawline.
I also had extremely oily skin, just like my dad. I hated how I always looked greasy no matter what I did, but he assured me it was a good thing because #TeamNoWrinkles (and it's true, he's in his 50s and doesn't have a single wrinkle!).
This wasn't the worst, however. By summer before senior year, I had decided to take the plunge and bring out the big guns: Accutane. The strongest acne medication on the market, Accutane (and other generic versions of the drug; mine was actually called Clarivis) requires monthly blood tests to ensure your liver is still functioning properly — it's that strong! You're also required to go on birth control, since an "Accutane baby" is incredibly deformed. Blood tests and birth control aside, it's a few thousand dollars... Not a cheap decision, and I'm so grateful my parents decided my self esteem was worth it.
Externally, you're required to use only the most gentle of cleansers and the thickest of moisturizers, because it legitimately makes your face peel off. It's a fun time.
In preparation for my treatment, I had to cease all other medications and products (this included a slew of antibiotics, expensive prescription creams and high-end cleansers) for a full month so my body was in its natural state and ready for the strong medication.
Funny thing is, I hadn't thought those things were working for me. I thought my skin was bad before. But I had no idea how bad it could get...
After a month off my plethora of products but before starting the medication, my skin was terrible. I had 10-12 cysts on my cheeks and forehead alone. My hormone levels were so thrown off, and I felt like a monster. I was so excited to finally start Accutane and get it under control.
Then, to my embarrassment, it got even worse.
The first two months of Accutane were traumatically awful. The standard dosage is one milligram per kilogram, and I weighed about 46 kilograms. The doses were only available in increments of 20, so I started on 40 mg. After two terrible months of breaking out worse than I thought possible, I urged my dermatologist to bump the dosage. I started on 60 mg by my third month.
My face was bright red all of the time. I mean, I was a bumpy tomato, and that's no exaggeration. My own friends were very supportive and never made a big deal out of it, but I definitely know of others who talked behind my back about how "disgusting" I looked. I don't think I'll ever fully recover from some of those comments.
I was only on 60 mg for two months (by this time, it had begun to calm down) before I started reading horror stories online about people who had gone on Accutane and had their acne come back a few months later with vengeance. These people concluded they either (a) hadn't been on the pill long enough or (b) weren't on a high enough dose (most said they were on 20 mg or 40 mg).
Since I was already on 60 mg (too much for my weight), I was hesitant to ask for more, but I was desperate to fix my face. My blood tests were coming back well, so I approached the topic with my dermatologist. Always incredibly receptive to my feelings, she bumped me up to 80 mg: the maximum legal dose (because believe it or not, you have to sign a contract before you can start), and almost twice as much as I should have been on for my weight group.
Most people do Accutane for six months, but I stayed on for eight. I was so worried about it coming back and having to take it again since my initial reaction to the medication was so extreme that I wanted to make absolutely sure that mine would be gone forever. Plus, it was so expensive that I knew I couldn't justifiably ask my parents to pay for it twice.
By the end of my treatment, I had no acne to speak of — just some pretty bad scarring. Word to the wise, do not pick your face. I remember sitting in AP European History and scratching at the itchy, dry bumps until the skin would peel off (too much information, sorry). I was so miserable and felt so bad about myself, and I spent way too much time obsessing over how I looked, which translated to me picking at it constantly.
Three years later, and I've only had one cystic pimple since: It was on spring break my freshman year of college, and it went away quickly. My skin is still pretty scarred, but it's improved with time.
This is how Accutane works: It's basically an extreme dose of vitamin A (like, a ridiculously high amount) that physically causes your oil glands to shrivel up and die. Doesn't that sound so dramatic? I love it. It also explains why my crazy oily skin became combination/normal after the fact. I would include before-and-after photos, but I legitimately don't have any. I went to great lengths to avoid being photographed during those first few months (I know, I'm ridiculous).
Because nobody really knows exactly what causes acne, the only way to really prevent it is to attack it at its source — the oil glands. This is also why Accutane pretty much works universally for everybody, but is treated as a last resort (because it's dangerous). Some people get so dry on the medicine that they have to sleep with Aquaphor on their face, but mine was so oily to begin with that it just made it a little on the dry side (LOL).
Because it can impair liver functioning, you're not allowed to drink on the medicine. This wasn't a big deal for me since I was in high school, but now as a 21-year-old, I think it would be more difficult (just something to keep in mind if you're considering it). I already had liver issues, so I lived in fear that one day a bad blood test would come back and I'd have to quit the medication. I seriously think I willed my liver to fight it out, because I was SO desperate to finish my course.
If you were unsure what fueled my obsession with skincare before, I'm sure you have a better idea now after hearing about this debacle. I'm still self-conscious about my face and my experience with acne still shapes the way I feel about myself, which is a little sad, but I know everyone has something they don't like about themselves.
Thank you for reading. If you have any questions at all about the medication or are considering starting it, please let me know. Everyone's experience is different. All in all, I credit the drug with saving my self esteem, and aside from picking, I wouldn't have done anything differently.
You are beautiful, inside and out!
All things beauty.