Starting Accutane

I am going to start off by saying this is a really, REALLY personal post. It’s hard for me to even think about writing this all out never mind posting it to the internet. However, writing things have always been a way for me to deal with difficult situations and if my experience can help any other person dealing with similar circumstances, it’s worth it. Please read this post with a degree of sensitivity and know that I appreciate, in advance, your kindness and respect.

Struggling with acne is something that has, unfortunately, become a huge part of my life. Being fourteen and having acne wasn’t a huge deal as pretty much all my friends were going through it and everyone from my mom to my doctor reassured me that it was temporary and I would grow out of it. But I didn’t. Instead of getting better, it’s gotten much, much worse. I’ve been dealing with horrible, problematic skin for ten years now, and as I near my mid-twenties (eek!) I just want so badly to be done with something I was supposed to leave behind with my teenage years.  I don’t wan’t to go into my “acne story” (trust me… that’s a real thing… Google it!) here, as it would make this less of a blog post and more of a novel but if my experiences are something that would help you, let me know and I could make a post or video!

I’m going to summarize it all in three words: I’ve tried everything. I feel like I could have Ariel’s trove of treasures but instead fill it with empty bottles of skincare products and medicines. But nothing has worked long-term. It’s the epitome of frustrating, disheartening, embarrassing and so many other words that end in -ing. Near the end of 2015 I asked a doctor if he had any recommendations for me and he prescribed a high dose of Doxycycline, an antibiotic often used for acne treatment.  As he wrote the prescription, he told me: “if this doesn’t work, you’re gonna have to go on Accutane.”

I didn’t say anything at the time but hoped that the drug he prescribed would be the miracle I was looking for. I had casually looked into Accutane when researching different products to try and my reaction was pretty close to pure terror. I felt physically ill while looking into the side effects and had been under the impression that this drug was no longer available so I figured the doctor was mistaken.

I did see results from the Doxcycline in the two months that I was on it and went to my family doctor to see if he could prescribe some more so I could continue on the same path.

before and after

Results of two months on Doxycyline

I had taken pictures every couple of days so I could trace the effects of the drug, and altogether it wasn’t a great experience. To be honest, the pills made me feel pretty sick and taking them was complicated as they had to be taken at certain times and on an empty stomach. But I was willing to suck it up if I could see results. I showed my doctor the pictures and the bottle that the other doctor had prescribed me.

He told me that even though there were results it still hadn’t completely “cured me”.  He added that there was no way I could keep taking such a high dose of antibiotics indefinitely and that as soon as I stopped taking the medication that my skin would just revert to normal. Heartbroken, I left the doctors office with nothing but a referral to a dermatologist.

The earliest I was able to get an appointment was March, over three months after the appointment with my doctor. In that time my life pretty much fell apart. One pillar of my life after another toppled until I could physically feel my life caving in around me. I won’t go into the details… again, maybe a future post, but depression that I’ve been struggling with even longer than the acne was at it’s all-time worst and anxiety was taking over my life.

My dermatologist appointment finally came around on March 10th. I went straight from school to sit in the office, waiting for an hour past my scheduled time with my mom who joined me for moral support. The doctor came in and asked what I was there for so I explained my situation and history with acne. I brought up my experience with all the products and medications I have gone through. Without much hesitation, she said I had to go on Accutane. If it worked, the acne would be gone forever.

I couldn’t say anything so I just nodded and she left the room to get an information packet and a consent form.

My mom spoke words of encouragement and even though I was scared of taking this drug, which I felt now misinformed of it’s discontinuation, my mentality was that of, hey… this is really freaking scary but let’s just add it to the list of stuff going on right now. Really, I’ve got nothing to lose.

The waiver I was given to sign had two sections,  one just for females and one for all patients. The part “only for female patients”  had ten points that all followed the theme of I WILL NOT GET PREGNANT. One of the biggest side effects of Accutane is serious birth defects. This is most of the reason that Accutane scared me so much, images of the possible forms of defects that a baby can be born with if exposed to the medication are permanently etched into my mind. Fear tactics at their finest, folks.

The section “for all patients (male and female)” covers awareness of other side effects, a promise to participate in monthly blood tests, and follow up appointments with the dermatologist. A large portion is dedicated to reporting feelings of depression or “other mental changes”. Again, my heart broke. My last resort to clear my skin could amplify something I was struggling with already. I told this to the doctor and for the first time her demeanour changed. She asked, flat out, “Are you depressed?”. This is a question I have a really hard time answering because short answer, yes. But I hate talking about it. And then I started to cry.

In the doctors office.

With my mom.

I know. What a big tough grown-up I am.

The conclusion was that I needed to go back to my family doctor and get something to help with my emotional/ mental issues. I was given a blood requisition form, the prescription for Accutane, and informed that once the blood work was done and I had seen my family doctor, I had to phone the dermatologist and she could give me the go-ahead to start taking the medication, and to book my first follow up appointment.

The rest of the evening was pretty emotional. I read the booklet and did more research on Accutane (and continued to do so for the next week and a half) than I have researched for any school project in the history of my academic career. I am not a medical professional… heck, I’m not even a science student. This is what I have found to help my personal process and to inform myself. If this is a treatment you might have to undertake, I urge you to research the heck out of it and talk to your doctor.

Essentially, Accutane is a form of the drug Isotretinoin. It is still commonly known by Accutane; think of Accutane being Band-Aid or Kleenex while Isotretinoin is ‘adhesive bandage’ or ’tissue’. Accutane was discontinued in 2009 but Isotretinoin is still widely used and distributed under generic brand names, such as Claravis, which seems to be the most popular from what I’ve found, or Epuris which is the one I have been prescribed.

Isotretinoin is a very strong form of Vitamin A, called a retinoid. There are varying doses of the medicine which can be adjusted each month depending on the results up to that point. The initial dosage is determined by body weight (0.5 milligrams for each kilogram). Because of the other factors in my situation I am starting on a lower dose, at 20 mg per day.

This is where it gets tricky. What happens is the drug alters cell structures, making the glands that produce oil smaller and pores become less clogged which causes the acne to stop forming indefinitely. Accutane has actually also been used as a form of chemotherapy.

There is a long list of side effects, ranging from the dry skin and chapped lips that virtually everyone goes through, to rare but serious depression resulting in suicide.

accutane-side-effects

Source: http://www.acneremovr.com/spironolactone-accutane/

I found a lot of value in watching YouTube videos and reading blog posts that people made regarding their own experiences with Accutane. Doing this allowed me to prepare myself mentally and through the products in my medicine cabinet. The following are the most common symptoms and the ones that worry me the most, personally.

Chapped lips: Almost every account I read talked about how chapped their lips were, some even claiming that it ended up changing the natural line of their lips as well as cracking and bleeding. Almost everyone said wearing lipstick is almost impossible. I have pretty chapped lips anyway so it does concern me that this will get worse. Products that were recommended were various lip balms ranging from one found at The Body Shop to a First Aid Beauty one available at Sephora. Overwhelmingly Aquaphor was praised as a saving grace. I don’t currently have Aquaphor but plan on tracking some down. I currently use primarily Vaseline as well as other random lip chaps and glosses, with Smiths Rose Salve being a really nice one. I also own Bite Beauty’s lip mask which many people said worked well for them. Lip scrubs such as Lush’s Bubblegum and ELF’s original Lip Exfoliator are both products I have that I hope work well if I use them every so often.

Dry skin: Over the past year I have noticed that my skin has been changing from oily to combination leaning on the dry side, and it has been especially bad over the past few months as we’ve gone through winter weather. I have been researching and stocking up on the best products people have discovered through their experiences, as well as figuring out a regular routine to keep so I can make the dryness as manageable as possible. My biggest concern is that I need to exfoliate. I just feel gross if I don’t and this is one of the “no-no’s” on this medication because of extremely sensitive and thin skin. I’m going to try my best to see if I can go without it, but might try to lightly exfoliate once a week. I guess there’s no way to predict what will happen until I go through it!

Dryness of nose and mild nosebleeds: I keep Vaseline with me by the tub (literally) and I’ve heard that can really help this symptom. I hate the feeling of nosebleeds but if I can prevent it… here’s hoping!

Eye irritation: Every couple of years around allergy season I’ll have the most horrendously itchy eyes that persist for MONTHS. It’s not a fun experience but I suppose it prepares me for what could possibly come. I haven’t had any seasonal allergy symptoms yet (knock on wood) so I’m hoping my karma points will let me hold out on any of those for this year while I go through this medication.

Joint and muscle pain: I’d say this is pretty near the top of my list of concerns. I have really bad neck pain that triggers migraine headaches. I’m worried that this will worsen. I picked up a container of fish oil supplements that I hope will help prevent joint pain. Also, it is recommended to take Accutane with the fattiest meal of the day, although I was told to take it in the morning. I don’t often eat fatty foods for breakfast so I figure taking Accutane with the fish oil pills and my cereal/ smoothie will be the best of both worlds. Many people voiced that the joint and muscle pain was the worst part of taking Accutane and often the pain was so bad they considered going off the drug. There’s not too much else I can do pre-emptively other than hope for the best and perhaps start doing regular yoga/ pilates.

Temporary hair thinning: This was the first symptom I noticed on the form and the first worry I voiced. I know, how vain. All I could imagine was the medication not working AND me losing hair.  The dermatologist assured me that it’s usually temporary and it’s mostly because of the lack of oil being produced. No one that I found really said much about this side effect, just that they loved not getting oily hair and being able to go over a week without washing it. I do take hair/skin/nails supplements already so hopefully this helps (as well as with the dry skin and brittle nails people mention)

Depression: My biggest fear in this department was if it’s something I already struggle with… how am I going to be able to handle it getting worse? I am very lucky to have really supportive and understanding parents who have literally been my rocks through the last couple months. I’m hopeful that the medication I got from my family doctor will help and that through my skin clearing, I will gain confidence that will aid this process as well. I think a lot of what is currently happening is more situational depression, especially with the random bouts of crying and anger. Hopefully as time goes on, that lessens and the medication helps. Not too many of the cases I read/ watched talked about this. Since it’s such a personal topic, even when people mention experiencing these symptoms, they allude to having other situations in their lives causing them. I can’t be sure but after talking to my parents and my family doctor, I feel hopeful.

Two of the other concerns I’ve had are that Accutane also causes extreme sensitivity to the sun and delays healing. I am a ultra-pasty pale person that makes Casper the Friendly Ghost look radiantly sun-kissed. I burn like nobody else’s business even with sunscreen on. As this process will take me into the summer months, this is a pretty big concern. I have been looking into what sunscreens are the best for daily use, especially on my face. Summer 2016 is going to be defined by shade, SPF, and sunglasses! (and hats but that doesn’t start with ‘s’ so it looks less cool). Another point is that because of oil reduction, it takes a long time for any injuries to heal. I have badly wanted to get a piercing (third hole on both ears) but I have read really polarizing opinions online. Most people who are talking about the super horrible experiences were getting belly-button, nose, or cartilage piercings and the only mention of lobe piercings (one of the quickest to heal) said it should be fine if you’re vigilant on cleaning and moisturizing. I was going to do it, but figured as I have a lot of things working against me even before having a hole punctured through my body, I shouldn’t make the process harder than it might already be. My plan is to wait until my appointment in April to decide, that way I can see what my symptoms are and ask the dermatologist what her opinion is. We will see!

Epuris, the brand of Isotretinoin I was prescribed.

After reading other peoples blog posts and watching videos, I am surprised at how different people’s (non-skin related) experiences are. In the USA there is the iPledge program that involves taking a series of questionnaires and having to wait at least a month after being given the prescription before actually taking it. Some have a really strict contract of taking two types of birth control while others can just say they’ll be abstinent. I read cases where people have to pay $300 for the pills, $100 for the monthly blood test and upwards of $150 for each dermatologist appointment. Some people have a really hard time and doctors who are very resistant to prescribing Accutane. I read a couple cases where people had to drive upwards of five hours to get to their doctor. I’d say these factors vary mostly based on location and by the doctor (and maybe by the patient’s age) but, for reference, I’ll just mention what my experience is as a west-coast Canadian on a student healthcare plan.

The pills cost me $49.95, and I believe that I can send away to get some of that back. The dermatologist (and any other doctor) appointments are free, as are the blood tests. The referral process for the initial dermatologist appointment, as I mentioned, was a three month wait and it is a local office in the town where I live. For the recurring monthly appointments I just book them at each visit. My process to get prescribed Accutane was not difficult (I have always been more resistant than any doctor!), and it was the first recommendation of this dermatologist upon our initial appointment. I’m guessing this is because of my age and the length of time I’ve been dealing with acne. There is no iPledge program here and two methods of birth control weren’t even brought up besides her saying that a medication I am on covers that situation.

The entire process took twelve days, most of which were just because of me procrastinating my phone call to the office. I had my initial appointment on March 10th and was given the prescription but was told not to take the pills until I had gotten the blood test, seen my family doctor, and got everything cleared through the dermatologist. I went to the lab on Friday afternoon and got the blood test done, with the results available online that evening. I was able to get an appointment with my family doctor on March 14th, and he prescribed me a medication for my depression. I filled both those prescriptions the next day.  Theoretically, I could have begun taking Accutane then (making it a four day process), but I kept putting off the phone call to the dermatologist.

Today is March 22nd, 2016. This morning, as soon as I woke up I called the dermatologist’s office and was told everything looked good. I booked my appointment for next month and was told I can start taking Accutane today.

So as cheesy as it sounds, today I’m starting my “Accutane Journey”. I’m hoping to write weekly posts discussing the progress and updates along the way. I’m not going to lie, I’m pretty scared. I know the next few months are not going to be fun but I’m hopeful that the end results will be worth it. It is my decision to stop being a victim of negative circumstances and (sorry-) shitty situations. I’m fighting for myself and my right to be happy. Even if it starts with something as simple as feeling happy in my own skin.

BEFORE // Day 1: March 22nd 2016

Please let me know if there’s any other information I can provide or if there’s anything you’d like to know. Also, if you’re taking Accutane too, I would love to hear your experience!

Thank you, as always, for reading!

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2 Comments

  1. April 5, 2016 / 5:55 pm

    I am right there with you Adrianna!

    • Adrianna
      April 29, 2016 / 5:17 pm

      Thanks Rhea!! Love you! 🙂

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