From Acne to Perfect Skin: My Complete Experience with Accutane

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1. Confronting Reality: My First Appointment with the Dermatologist
2. The First 3 Months of Treatment: Facing the First Isotretinoin Pill, Beyond Fears
   1. Assessment and Side Effects
3. The 4th Month of Treatment: Increasing the Dosage
   1. Assessment and Side Effects
4. From the 5th to the 8th Month of Treatment: The Intensity of Isotretinoin’s Effect Becomes Evident
   1. Assessment and Side Effects
5. 9th Month of Treatment: The End
   1. Assessment and Side Effects
6. My Doses: The Calculation

At the age of 35, I find myself embarking on a course of Isotretinoin*! As mentioned in my previous article, I was aware of the controversy surrounding Isotretinoin and the potential side effects of this medication. Despite my apprehensions, desperation ultimately took over. My skin was the daily battleground of a constant struggle. Every day, I scrutinized my reflection in the mirror, yearning to put an end to this situation. So here I am, with a heavy heart, ready to start my Isotretinoin treatment…

(*sold under the name Accutane)

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Confronting Reality: My First Appointment with the Dermatologist

On November 2, 2021, I had my first appointment with the dermatologist to begin my Isotretinoin treatment. Seated in the consultation room, my dermatologist approached me with a lamp in hand and scrutinized my face. The state of my face was engrave into my memory. Pimples covered the area from my jawline to the halfway point of my neck, scattered across its entire surface. A few also appeared on my forehead and shoulders.

The verdict was clear and without any doubt: I was dealing with persistent moderate hormonal acne. Typically, before resorting to Isotretinoin, the ultimate acne treatment, dermatologists often prescribe an antibiotic called Tetracycline. But this time, the decision was different. My past experiences said a lot, so we decided to take the most direct approach instead of spending time on a treatment that might not work once I stop.

After being briefed on Isotretinoin, I addressed all the concerns that were troubling me: anxiety, potential hair loss, treatment duration, and more. After my concerns were eased, I was handed a small brochure and a document to sign. This document was sworn statement confirming that I was aware of the teratogenic effects of the medication and, therefore, it was strictly prohibited to become pregnant. Due to an unpleasant past experience, I also made it clear to my dermatologist that taking birth control pills was out of the question for me. She trusted my decision, emphasizing the imperative not to conceive during the treatment and at least one month after its completion!

Upon concluding this question-and-answer session, my dermatologist prescribed a blood test before commencing the treatment, a step that would be repeated regularly throughout the course.

This blood test is essential to: 1) monitor the condition of our liver (since Isotretinoin can increase liver enzyme levels – transaminases) and 2) conduct a pregnancy test for women. It’s crucial to note that donating blood while on Isotretinoin is strictly prohibited, extending to at least one month after the treatment concludes. This restriction is in place to avoid any potential risk of severe birth defects if a pregnant woman receives blood from an Isotretinoin user.

Without much hesitation, the day after my consultation, I went for a blood test on an empty stomach. Three days later, having received the “green light” from my dermatologist to start the treatment, I took my first Isotretinoin pill.

The First 3 Months of Treatment: Facing the First Isotretinoin Pill, Beyond Fears

We embarked on the treatment with a daily dose of 20 mg until my next appointment, scheduled three months later. Indeed, the dose is supposed to gradually increase throughout the treatment.

After the evening meal, I take my very first pill. For some unknown reason, anxiety builds up to the point of shedding a few tears. Among all the potential side effects, it was anxiety that terrified me the most. The thought of returning to the anxious state I experienced a decade ago made taking each pill a significant challenge in the beginning.

The initial side effects, marked as very common in the leaflet, appeared after a week of treatment: dry skin, chapped lips, and drier hair. After a week, my skin tightened after every wash, prompting me to use a thick moisturizing balm to nourish my face (my skincare routine article under Isotretinoin here!). Lip balm became essential, and as for my hair, it became less greasy rapidly.

To paint a picture, I have thick and straight hair that tends to be oily. Before the treatment, I had to wash them every two days, but a week after starting the treatment, I could extend the washes to every three days.

The dryness of my skin, lips and hair was not excessive, but enough for me to realize that the medication was starting to take effect.

During the first two days, I also suffered from severe headaches. Admittedly, I am prone to basic migraines, but how could I know if this was due to Isotretinoin? I observed that these headaches occurred after each increase in the medication dose, so I concluded that it was indeed related to the treatment.

Assessment and Side Effects

The initial anxiety associated with taking the medication had completely dissipated over the days. It had become a routine, and having not experienced a panic attack, I concluded, whether rightly or wrongly, that it wouldn’t happen throughout the treatment. Either way, it helped me mentally, and it proved true, I didn’t have a single anxiety attack during the treatment until the end. My skin, lips, and hair were becoming progressively drier, and I could leave my hair unwashed for 5-6 days (convenient for lazy days)! I also had some nosebleeds (Something that has happened regularly to me since childhood) and gum bleeding, but nothing too concerning.

Regarding my acne, I experienced the purge effect! Before starting the treatment, I had many microcysts on the jaw and neck, and I believe Isotretinoin was gradually bringing them to the surface. I still had a lot of blackheads on the nose and chin, and the rosacea persisted on the cheeks.

So, I didn’t see improvement in that aspect.

The 4th Month of Treatment: Increasing the Dosage

On February 2, 2022, I had my second appointment with the dermatologist. The session lasted 10 minutes; she asked about how I was feeling, we discussed my side effects, and reviewed the results of my blood test from three days prior. Everything was normal! Since everything was going well, my dermatologist decided to increase the Isotretinoin dosage, going from 20 mg to 30 mg per day, and scheduled our next appointment for a month later!

Why so soon? Given the dosage increase and considering my history of anxiety, she preferred to see me more quickly!

On the same evening, I took the 30 mg pill, and in the next couple of days, I experienced headaches and pain on the left side of my gum, which disappeared after a few days.

Assessment and Side Effects

No new side effects appeared. My skin, lips, and hair were becoming progressively drier, so I took all necessary measures to hydrate them as often as possible.

No more nosebleeds or gum bleeding! These effects only occurred in the first three months of treatment, and as the treatment progressed, nosebleeds and gum bleeding ceased.

Regarding my acne, the purge effect was still present. Many pimples appeared, mainly located on the right side of my jaw and the beginning of the neck on the same side. However, my blackheads and rosacea completely disappeared. No more blackheads! Despite the pimples, the overall condition of my skin visibly improved. My pores seemed to have tightened, giving an effect of radiant skin! I was delighted!

From the 5th to the 8th Month of Treatment: The Intensity of Isotretinoin’s Effect Becomes Evident

The following appointments followed the same pattern: checking the condition of my skin, reviewing the blood test results, and prescribing Isotretinoin. The dermatologist decided not to increase the dose, considering the side effects that appeared during the 5th month of treatment. Therefore, we stuck to a 30 mg dose throughout the entire treatment until its completion!

Assessment and Side Effects

My hair, lips, and skin were becoming increasingly dry. To illustrate, I decided to test how long I could go without washing my hair, and I managed two weeks. Even then, they weren’t greasy; I washed them only because I felt unclean for not washing them for two weeks. This gives you an idea of how dry my hair was.

As for my skin, it was extremely dry. I regularly moisturized my face but paid less attention to my body. Consequently, eczema appeared on my arms, but after daily application of a good moisturizing cream, the eczema disappeared. The same applied to my lips, with hydration several times a day. Forgetting my lip balm by the end of the day resulted in my lips cracking until they bled.

My eyes had also become very dry, and I had to use highly moisturizing eye drops. There was even a morning when I struggled to open my eyes due to the dryness. Generally, using eye drops regularly greatly helped me throughout the treatment.

I felt a dryness in my throat as well. Coughing fits occurred due to this dry sensation, and my pharmacist recommended glycerin lozenges to relieve my throat.

My cholesterol levels had gone up a bit, so I became mindful of my diet. It’s worth noting that I am not a very athletic person, and I assume this contributed to the rise in my cholesterol, even though I have a slim physique. For the remainder of the treatment, I stopped consuming foods such as chips, burgers, pizzas, etc.

However, what bothered me the most during the 5th month of treatment was the muscle pain. It was dreadful; as soon as I got out of bed, walking became a struggle. I had pain throughout the lower part of my body, as if I had persistent muscle soreness, and I was extremely fatigued. Even though I am not a very athletic person, I enjoy walking a lot, but even that became difficult for me. This situation persisted until the end of the treatment, with fatigue and pain intensifying over time. For me, it was the worst side effect I experienced throughout the treatment. Pain in the lower limbs right after waking up, an inability to walk for extended periods, and persistent intense fatigue until the end of the treatment.

Regarding my acne, the purging period continued until the end of the 5th month and the beginning of the 6th month of treatment. My dermatologist was quite concerned and warned me that if the purging persisted in the 7th month, additional hormonal tests would be necessary to understand the reason. Fortunately, by the middle of 6th month of treatment, my acne had completely disappeared. No more pimples, no more blackheads, no more rosacea; my skin was extremely beautiful and radiant! I finally had the clear skin I had always dreamed of! For the first time in my life, I went to work without makeup! Me, the girl who used to put on makeup even to go get bread around the corner! I stopped using makeup altogether, or at least I stopped using foundation, which significantly reduced the time needed for my daily routine. And I had regained confidence in myself!

9th Month of Treatment: The End

July 31, 2022, marked the day I took my last Isotretinoin pill. After 9 months, I had reached the end of my treatment. On August 1, 2022, during my final consultation, my dermatologist informed me that the maximum dose had been reached, and the result was perfect, so there was no need to continue the treatment. She prescribed a final blood test to be done one month later and asked me to come back for another appointment in a month (coming soon my post Isotretinoin article).

Assessment and Side Effects

At the end of my treatment, the persistent side effects included dry hair, skin, eyes, throat, and lips. Hydration (cream, eye drops, lozenges) was imperative!

The cholesterol level, which had increased in the 5th month, had stabilized in the following months due to increased vigilance in my diet.

Muscle aches and fatigue were still very present. I was extremely tired, feeling like I was dragging my body, not to mention the muscle pains. Making any movement was painful, right from getting out of bed.

As for other side effects that appeared at the beginning of the treatment, such as nosebleeds and bleeding gums, they had completely disappeared. I haven’t had nosebleeds or gum bleeding in the following months.

The side effect that scared me the most before starting this treatment, anxiety, did not manifest at all. Yes, initially, with the first pill, and it lasted for a week, but it had nothing to do with the medication itself. It was me who had put myself in that state initially due to fear. However, during the treatment, nothing! No anxiety, no crisis. I was really calm until the end of the treatment.

My Doses: The Calculation

As mentioned earlier, I reached my maximum dose after 9 months of treatment. I started with 20 mg from November 2021 to January 2022. My dose was increased by 10 mg after 3 months. So, I took 30 mg of Isotretinoin from February 2022 to July 2022 (a complete month).

The dosage, defined as the amount and frequency of taking the medication, is usually between 0.5 and 1.0 mg/kg/day. To prevent relapses, the maximum dose is calculated by multiplying our weight by 120/150 mg.

In my case, to calculate my dose, we did 58 kg x 120/150 mg = 6,960 or 8,700 mg, which was the dose range to achieve to prevent any relapse. My summary of doses per month and in total is as follows:

Month	Day/month	Mg/day	Total mg/per month
November 2021	30	20	600
December 2021	31	20	620
January 2022	31	20	620
February 2022	28	30	840
March 2022	31	30	930
April 2022	30	30	900
May 2022	31	30	930
June 2022	30	30	900
July 2022	31	30	930
Total :			7270mg

After 9 months of treatment, I reached the maximum dose of 7270 mg, which falls well within the range of 6,960 to 8,700 mg. It was therefore unnecessary to continue. The dermatologist clearly stated that extending the treatment would have been futile. My skin was in excellent condition, free from any pimples, blackheads, or rosacea. In short, my skin was beautiful and radiant!

Despite the side effects, I was overall very satisfied with my treatment. The results exceeded my expectations. I had never experienced such beautiful and radiant skin, and I felt delighted.

In retrospect, I am very pleased that I took the plunge, and even today, I am happy about it. My skin still acts up occasionally (with a few pimples and blackheads), and I still need to take care of it, but overall, that radiant glow persists. I approached this treatment with seriousness and maturity, closely listening to my body throughout the process. I could identify the slightest side effects as soon as they appeared, allowing me to find immediate solutions to ease them and to put things into perspective. The muscle aches and fatigue were particularly challenging, especially towards the last months of the treatment.

I would like to emphasize that it is indeed a very intense treatment. The array of side effects (fatigue, dryness, pain) can have an impact on one’s mental well-being, and I now better understand the controversy surrounding this medication. Taking this medication should not be taken lightly, and having a trusting relationship with your doctor is crucial. It is also very important to have a supportive environment that can help you cope with this significant treatment.

My final piece of advice is not to rush and to carefully consider before taking the plunge. I postponed this treatment for 10 years, but it allowed me to face it with a sense of perspective. Above all, listen to yourself!

While I still have a bit of acne today (post-isotretinoin article will follow very soon), I wanted to share my experience with isotretinoin, hoping that my testimony will help you. Feel free to share your apprehensions, doubts, and thoughts about this treatment in the comments!

Thank you for reading, and see you soon, Beautifully Moi!