Based on your experience, would you recommend accutane?
October 20, 2011 11:35 AM   Subscribe

I have jumped through all of the necessary hoops and next week I'll be starting my first dose of accutane. But now I've got cold feet. I'd like to hear from people who have been on the drug, or known people who have.

I am 25 years old and I have moderate acne. At times of the year it can be severe, but for the most part it's not too terrible. It's definitely hormonal and only on my temples, cheeks, and around my mouth and jawline. To put it in perspective, I always have countless white/blackheads, 5-10 small pimples and a couple of bigger cystic type pimples. Not the pictures you see where someones cheeks are totally overgrown with pimples, but not something that I can easily cover up with makeup either.

For eight years I have tried everything under the sun besides accutane: clindamyacin, retin-a, differin, two different types of oral antibiotics, spironolactone, birth control pills, proactiv, etc. I've resisted accutane thus far because I didn't think my acne was that severe.

My dermatologist says that I have treatment resistant acne, and accutane is the last thing to try. I'm ok with the pregnancy tests, blood draws, and the possible side effect of dry skin . However, I'm really scared of losing my hair and developing intestinal problems.

I'm also in a really intensive academic program that I won't finish until June 2013. I'm afraid the side effects will be severe enough to impact my performance, but I also don't want to wait until I'm done.

Some of the other treatments I tried worked but weren't worth the side effects in the long run (example - constant antiobiotic use caused me chronic yeast infections). I want to do accutane because while it may be tough for 6 months, hopefully the results are worth it.

I youtubed "accutane videos" and all I got were horror stories that are totally freaking me out. I need some perspective.
Have you ever been on accutane?
What were your side effects?
Would you recommend it?

(And yes, I saw the hairpin article today, which further fueled my paranoia.)
posted by pintapicasso to Health & Fitness (52 answers total) 5 users marked this as a favorite
I have not been on Accutane, but several people close to me did it, and it was literally life changing for them. Their acne was more severe than yours, it sounds like, but it was a daily self-esteem issue for them, the side effects from the Accutane were minimal at most, and it has made their lives much, much better.
posted by brainmouse at 11:39 AM on October 20, 2011 [1 favorite]

Anecdata: I know several people who have been on accutane, though only guys. They didn't experience any horror-story side effects, but they all had extreeemely dry skin while they were on it. One guy's lips were perpetually flaky and chapped, which was pretty gross looking. But, after they had taken the required course of the drug, they were happily zit free with no regrets.
posted by phunniemee at 11:40 AM on October 20, 2011 [2 favorites]

My son went though every treatment possible for acne, until we ran out of options and had to do Accutane. Now we have had people ask us how our teenage son has such clear skin. He did have the dry skin and chapped lips, and he had to be careful about sun exposure because he was on it over the summer, but he didn't have any real issues. And now 18 months later his skin still is very clear.
posted by COD at 11:46 AM on October 20, 2011

I was on Accutane, though I was a teenager at the time. I only had to be on for 4 months, and I was on probably a mid-level dose - do you know your dosage level? If your acne isn't too severe, you may be on a relatively low dose, so some of the more severe side effects might not be as bad (IANAD, and it's been quite a number of years since I was on it, so I have no idea if that's true...just a hypothesis!).

The dry skin was pretty brutal, but lots of Blistex or similar and good cream was a lifesaver. I remember that I thought my face looked worse for a while, because of the super dry skin, but it really made a remarkable difference. I didn't have any serious side effects, though I do remember feeling down sometimes - not sure if it was the perennially itchy, dry skin, which made me self-conscious, or just generally being a teenager! It was definitely worth it, though. If you've tried everything else, and it's something that's a quality of life issue for you, I would definitely say go for it - and I'm not generally very pro-drug. Good luck!
posted by sabotagerabbit at 11:47 AM on October 20, 2011

A friend did the routine a couple years ago, and went through two months of worse acne than her normal. (It sounds like she had a little less than your description.) She also had issues with monthly blood draws to test for liver function. She had very dry skin, and very dry hair. We were talking one day, and as she put her hair up in a ponytail, three strands broke at the point where she was holding it all together. She said it happened all the time, and that her hair is still dryer than it was before. FWIW, I think she's overly self-conscious.

Her dermatologist said the two months of worse acne was the toxins being released through her skin - but he sounds like a total whackjob.
posted by doyouknowwhoIam? at 11:53 AM on October 20, 2011

Oh, the friend is in her early 40s.
posted by doyouknowwhoIam? at 11:54 AM on October 20, 2011

My sister was on Accutane when she was a teenager. The medicine pretty much made her crazy. Just, completely emotionally overwrought. In ways that she had never been before (and has never been since). She would just bawl. And if she wasn't bawling, she was raging. It was horrible. Don't overlook the potential mood altering effects of this drug.

It cleared up her skin though, and she didn't commit suicide, so there's that.
posted by jph at 11:55 AM on October 20, 2011

I was on it years and years ago (as a teenager) for six months or so. It was like a wonder drug! Acne all gone! Antibiotics, oxysomething wipes, prescription face scrubs, etc. never did anything, and then I went on the accutane and never had acne like that again. Super super dry skin though - cracking and bumps, especially on the back of my hands during winter. Normal watery hand moisturizer did nothing, but those heavy creams that come in a tub were great.
posted by Lady Li at 11:58 AM on October 20, 2011

I had three 6-month courses of Accutane in the 90s. I had very severe cystic acne and for me the results far outweighed the side effects. For me, side effects were very dry skin, lips, and eyes which would sometimes bleed, and very high triglyceride levels (though because of the severity I had been put on a dosage of >1mg per kilo body weight, which is not recommended). These stopped after I stopped using Accutane. I noticed no emotional problems apart, of course, from being really very happy that my skin was improving. I have since been able to control my more moderate acne with anti-androgen birth control.

At the time I remember being concerned about side effects and was told quite frankly by my dermatologist that "if there was another drug that did even a fraction of what this does, this would not be on the market". So, it's higher risk than the things you have already tried. As I say, it was for me worth it. But I did look significantly worse than many of the pictures on the internet.
posted by Cuppatea at 12:01 PM on October 20, 2011

Accutane was a miracle drug for me. I have a history of mild depression, and I didn't notice that it affected my mood whatsoever.

I was on a four-month course and didn't notice much improvement in my cystic acne till the very end, at which point my skin cleared up for four years. (Later, theater makeup caused it to flare up again, but it has never been as serious as it was when I went on Accutane.)

I had no intestinal problems, no hair problems. I didn't even have dry lips.

Stop reading scary stories!
posted by purpleclover at 12:01 PM on October 20, 2011

I took Accutane for 5 months about fifteen years ago for a bout of really bad cystic acne. Unlike anything else I tried, it cleared up my acne within two weeks. I felt vaguely and distinctly unwell while I was on it--almost like a constant, mild hang over (I didn't drink alcohol while on Accutane). I noticed odd side effects like my eyes being semi-stuck together when I woke up and when I accidently cut my hand it healed ridiculously quickly (I noticed that that particular side effect lasted well beyond the twenty weeks that I was on the drug). My skin remained completely clear for roughly five years after taking Accutane. Since then I might get a pimple once in a while. It's nothing like the acne I had right before I started taking Accutane. I also recall thinking that my skin felt different for a long time after taking it but I can't say whether I just got used to it or if my skin returned to feeling the way it did before (softer; more oily). Fifteen years ago there wasn't as much negative information about out there about Accutane. Had I heard back then that it causes suicidal ideation I might not have taken it. I did have my liver tested a few time to make sure it wasn't damaging me and I was fine.
posted by marimeko at 12:03 PM on October 20, 2011

Dried my skin like a baked potato. I was moody when on it, but then I was a 17 year old kid, so it's hard to have a baseline for that kinda stuff. Miracle drug for me, but my lips cracked and bled within 12 hours of the first dose. I bought Carmex by the palette.
posted by spikeleemajortomdickandharryconnickjrmints at 12:08 PM on October 20, 2011

Accutane was a miracle drug for me, even with the side effects I experienced.

I was on it most of my freshman year of college. I also had "treatment resistant" acne of the kind you describe. The side effects I experienced were, as I remember them: skin so dry it cracked without moisturizing with cetaphil multiple times a day, waking up with cracked skin because I had not moisturized at night, lips so dry that my one-pot-of-carmex-a-week habit could not stop them from essentially sloughing off, severe dry scalp such that I could not brush my hair near my scalp, and dry eyes that made it impossible to wear contacts, and general soreness in my joints and especially my hips and knees. I also cannot confirm that it made my existing depression any worse, because in addition to it, I was on depo provera for the required birth control.

Despite the terrible, terrible side effects, and having to go on 3 rounds of it, it was the best decision I ever made about my appearance and mental health. I could finally go out again, smile again, have my picture taken, all of it, like a normal person.

It has been more than ten years since I was on it. When things started changing hormonally for me as I got older, acne started up again, but it was definitely a different kind, and I went on yaz (birth control pill) to clear it up. If I go off the pill, it starts up again. If I stay on it, skin is fine, no breakouts. It's been this way for about four years now.

I have no regrets.
posted by juniperesque at 12:10 PM on October 20, 2011

My daughter, age 20, is on it now. We were likewise very worried about side effects.
1. Dry skin: yes, and a few nosebleeds, even
2. Joint pain: Yes, for a couple of days the second week and very scary, but it passed and has not come up again
3. Moodiness: yes, for about 3 weeks, but it seems to have leveled off and she is doing fine with it (and believe you me, she can be moody.)
No liver problems
Bonus: It seems to be working!!!
posted by SLC Mom at 12:14 PM on October 20, 2011

I am taking Accutane now; I am finishing the third month of an expected four-month course. I am 40 years old. My acne has been slightly more intense (but also more superficial) during treatment and the pimples are taking longer to resolve, I think because my skin is so dry now. I have had no side effects apart from dry skin and hellaciously chapped lips. Lanolin works better than any lip balm. Feel free to memail me if you want to talk privately.
posted by workerant at 12:15 PM on October 20, 2011

Accutane (well, sotret) was the best thing that has ever happened to me, seriously. I started my course in November 2007 when I was 22, suffering, from the age of 14, from chronic moderate facial acne and severe, cystic acne on my chest and back.

I'd regularly wake up with bloody sheets from pimples popping in my sleep, my undershirts would be riddled with blood spots from pimples that popped throughout the day. Every little bit of bullying that comes to a kid with acne came my way ("pizzaface", etc.). I had been a competitive swimmer, but quit for fear of taking my shirt off; my intense teenage desire to have sex with a girl was dampened by an utter terror of taking my shirt off in front of another person. Acne was a severe psychological and self-esteem problem for me.

Anyway, I took Accutane for nine months, never experienced any side effect but dry lips, and by June 2008 I was completely acne-free (and remain so today, despite a fairly poor diet, decidedly irregular face-washing habits, and other general carelessness). Once or twice a year, I get a single pimple on my hairline.

The burden this drug lifted from my shoulders was immense, and the improvement in my life is almost impossible to overstate. I understand that the side effects vary widely between individuals, and you might in fact be one of the unlucky ones who end up with colitis or IBS or chronic dry mouth or hair loss or or severe depression or kidney failure or whatever. But, as far as I'm concerned, If I had to roll the dice again, I'd do it in a heartbeat.
posted by downing street memo at 12:17 PM on October 20, 2011 [2 favorites]

Put me on the "it's a miracle drug" list. Had bad acne all through my teens and early twenties, was talked out of accutane several times by my parents, eventually bit the bullet and did it when I was 23, never looked back. My face was completely zit-free for about five years after that; it's very, very slowly returning now, but not nearly as badly as it was then.

So: Do it! Do it as early as you can! Acne wrecked my self-esteem, in ways I didn't even realize until after it was gone.

My only caveat is that the second and third weeks I was on accutane, I had easily the worst breakout of my life. What my dermatologist told me was that when you first start it, every little clogged pore that was in your face turns into a full-blown zit immediately. So if you can start it right before you're on a break from school, or at least when you don't have any big presentations or anything like that planned, that might be the thing to do.

For some reason when I was on my initial breakout, it happened in two stages; one week the left half of my face was a mess, then the next week the right one was. I fortunately timed the start for when I was on a break from school, so I didn't have to explain why I looked like a batman villain as often as I would have otherwise. After those two weeks I was clear, like, clear — and at that point I hadn't had an actual clear face since I was 12. My skin and hair was a little bit dry, but so long as I was diligent about moisturizing, it wasn't all that bad. YMMV, especially if you're in a dry climate — I was living in Seattle at the time, and the moist air / relative lack of sunlight may have kept my skin from drying out as much.

Accutane didn't cause me mood swings at all (other than making me so happy about having a clear face). I've read that the depression associated with having acne is actually significantly riskier than the mood swings associated with accutane...
posted by You Can't Tip a Buick at 12:18 PM on October 20, 2011

Taking accutane at 14 was the best thing I ever did. The dry skin sucked for a few months, and then I was acne free for 15 years (it came back at age 30).
posted by coolguymichael at 12:19 PM on October 20, 2011

I took accutane 2 years ago and am glad I did. It basically eliminated my treatment-resistant acne.

It is unpleasant to be on. My skin was horribly dry, my lips cracked and bled, etc. But none of these symptoms were permanent and stopped 1-2 months after the 6 month treatment period.

The acne has not returned (I occasionally get a pimple now but it's like 1 every 2 months or so which is not a big deal).

Basically, it was unpleasant to go through but if you experience permanent/semi-permanent relief as an effect it is worth it to me (not everyone does, but I think most people have some permanent relief).
posted by wildcrdj at 12:23 PM on October 20, 2011

I took it about 14 years ago when I was 13. It cleared my acne as if my magic, the price as noted by others above being uncomfortably chapped lips. There was much discussion in my peer group at that time about the inks between the drug and depression, and around that time at person from my town committed suicide which the kids at the time attributed to the drug. I have no idea whether the poor guy was even on the drug or not. But whether it was a real effect or whether it was something imagined, I stopped taking it half way through my course, staying with it for two months intead of four. I can't say for sure if that made any difference to my mood, and I was lucky that it had the desired effect and I have been acne free ever since.

So I guess my advice would be to go on it, have lots of lip balm handy, and if you start to think it's having an effect on your mood, stop.
posted by StephenF at 12:24 PM on October 20, 2011

Someone in another, related thread mentioned that their doctor advised them to take a Vitamin E pill when they took the Accutane dose and they didn't experience the horribly dry skin most people do.
posted by cooker girl at 12:28 PM on October 20, 2011 [1 favorite]

Yes to what so many people have said about the "miracle drug" ... chapped lips were awful, and everything else on me was wicked Sahara dry, but it lifted a burden both physical and psychological that was genuinely harming me. Please don't listen to the scary stories ... you will be glad you did this!!
posted by mccxxiii at 12:51 PM on October 20, 2011

I took it when I was in my teens, and had pretty bad acne; it did exactly what it said it would, and within a couple of weeks I had no more acne, ever, for the rest of my life. It was pretty sweet. Except, of course, for the whole "massively dry skin and disgusting flaky lips" business. That was awful and gross. But then I completed the treatment, my lips recovered, and I still had no acne.

That said, I was a teenager at the time; if I'd had mood swings or depression, I'm honestly not sure i'd have realized there was a problem, considering what hormones do all on their own.
posted by Tomorrowful at 12:52 PM on October 20, 2011

Tomorrowful describes my experience exactly.
posted by MustardTent at 12:54 PM on October 20, 2011

I had severe acne when I was a teenager and it was the only thing that worked for me. As others said, my lips were perpetually chapped, but the rest of my face wasn't so bad. Since coming off it, I've had some acne come back, but nothing like before. I just wish I had taken it sooner, since I have quite a bit of facial scarring from the years it was at its worst.
posted by fishmasta at 1:11 PM on October 20, 2011

My sophomore year college roommate (and HS buddy) took accutane. He carried chapstick with him at all times, but his acne cleared up.
posted by kavasa at 1:20 PM on October 20, 2011

I took accutane for about 6 months in 1996. I had terrible dry skin the whole time and hated it, but you know what? It is know many many years later and my skin is so clear it is like night and day. I don't regret a second of it.
posted by thatone at 1:24 PM on October 20, 2011

I took it when I was about 30. The first dermatologist I went to didn't see a need to do the routine blood tests you should do on Accutane, so I switched doctors, because I believe those tests are really important.

Beyond that, Accutane changed my life. My only regret is that I waited so long to use it.
posted by 4ster at 1:33 PM on October 20, 2011

A couple more things.

I know this is gross, but you will want to put a little dab of Aquaphor in each nostril at bedtime. Trust me.

And seriously, it causes major birth defects, so be extra careful.
posted by 4ster at 1:36 PM on October 20, 2011

i was on a pretty high dosage for about six months when I was 12 or 13. Craaaazy dry lips, nosebleeds all the time. Also eczema on my forearms which is a random side effect (only on the forearms, apparently!). It did what it was supposed to, though, and I didn't have any of the worst side effects, but I went to school with a kid who got massively depressed while he was on it.
posted by torisaur at 1:37 PM on October 20, 2011

Oh, also, I get the occasional breakout these days, but definitely not as bad as it was.
posted by torisaur at 1:38 PM on October 20, 2011

I used Accutane in college. My acne sounded pretty similar to yours and while I was on Accutane it pretty much disappeared. I did have dry lips and maybe slight depression, though I was often depressed back then so I don't know for sure. It stayed gone for maybe a year after I stopped taking the drugs, but it is back in full force now.

So, I would recommend it, but it may or may not be a permanent solution.
posted by chaiminda at 1:39 PM on October 20, 2011

Accutane is a wonder drug. I had such severe cystic acne as a teen that I had pimples and boils on my calves! I remember not being able to wear a backpack or I'd get back acne, no hat in the winter or I'd get head acne. no belt or I'd get acne where the belt is. Totally cleared it up and it was the only thing that did. Only regret is that I didn't do it until my 20s so a lot of scarring - both physical and psychological. Acne eventually flared up and did it again in my 30s. Now fine.

As for side effects, I am male and a bit hefty, and weight has some effect on side effects, but honestly, I remember some dry skin, some dry lips, and that is it. No aches, no depression, only one abnormal blood test when I went out drinking with buddies (DON'T DO THAT!) - was able to participate in anything I was doing before. The dry skin wasn't even bad enough for me to do anything about.

it is a tough drug, no doubt, but for people with severe acne and who suffer the psychological consequences of that, it is a true life-changer.
posted by xetere at 1:41 PM on October 20, 2011

Changed my life. Unless your folks-up bloodwork indicates that you have to stop taking the drug, here is what will happen: you won't have acne.

And you won't have people with normal skin preaching to you about what soap to use and what to eat and otherwise treating you like a dirty stupid person who would have perfect skin if only you were as clean and intelligent as they.

It's amazing.
posted by Lesser Shrew at 1:49 PM on October 20, 2011 [5 favorites]

I'm happy to see all the positive stories here. I had the cystic acne on my back, shoulders, and face during my teenage years and I did a year long course of Accutane. I had the sore joints, dry skin, and nose bleeds, but that only lasted as long as I was on the medication. I did have to have a follow-up course (only 6 months or so at half the dosage) a few years later when I started having stress break-outs upon going to college. No issues there either. An absolutely incredible drug, and I would do it again in a heartbeat.
posted by Osrinith at 1:50 PM on October 20, 2011

I had a great experience with Accutane. I took it for about 2 years when I was in high school (I'm a guy). I experienced very few side effects, although I did have to use lots of Aquaphor on my lips and (sometimes) hands when they got too dry. I also wasn't able to wear contacts due to overly dry eyes.
posted by rossination at 3:15 PM on October 20, 2011

I used Accuate back in the mid '90s. I don't remember all the side effects I had, but I remember the dermatologist's office jokingly referring to me as "Side Effects Girl." I don't regret the Accutane for a second. It didn't make me completely acne free, but it brought it down to a more manageable level. I still have mild acne to this day -- I can only imagine how much worse it would be without the Accutane.
posted by whatideserve at 3:34 PM on October 20, 2011

I had cystic acne, and went on accutane for I think 6 months. The dry skin has stayed with me, although not to the terrible extent as when I was on the drug. I am, however, significantly drier than I ever was before. I also notice more wrinkles than my siblings as I age and that I also am now prone to kidney stones, which I never had before nor has anyone in my family. Related? *shrug*

I still would have done it, although my acne was terribly painful and disfiguring (I still have a ton of visible scars from before treatment).
posted by lilnublet at 3:41 PM on October 20, 2011

There is a side-effect: You won't notice when your dadgum phone changes follow-up to folk up.

That said, without it, I'd be a mole person a avoiding all human contact except during the few summer months when I had tanned most of the acne away!
posted by Lesser Shrew at 4:18 PM on October 20, 2011 [1 favorite]

My experience with Accutane is very positive. I was on Accutane when I was 24 or so - also female. It was a while ago, but I don't remember having any side effects at all except for all the dry red skin... which cleared up as the months went on. I just remember the pills being so big to swallow! Accutane helped me to feel so much better (afterward) both physically and emotionally! I didn't realize how low my self-esteem had gotten due to the acne. When my course was through I didn't have a single pimple for about 3 years after that! Fantastic! Now I just get a few hormonal pimples and some rosacea outbreaks, which another drug keeps in check! Hope you have a positive experience, too, if you go through with it!
posted by LilBit at 4:48 PM on October 20, 2011

I took accutane as a teen in the mid-90s, after my dermatologist noted that he had been treating my acne for almost eight years. Both my parents and I were resistant to try something so extreme but considering we had tried so many other medications, we decided to proceed.

I did experience intensely dry skin and lip chapping, but nothing compared to the intense scrutiny of my parents as they monitored my every move and word for songs of depression or suicide. Oddly, I was in a better mood than ever because it looked like my acne was finally going away.

My dermatologist was originally going to require me to take a Pregnancy test with every follow up but he scrapped it because we were family friends. I can still recall the horrific illustrations of the birth defects printed next to each pill.
posted by hmo at 4:53 PM on October 20, 2011

I was on in the early 1990s. When I smiled, my lips would bleed. When I laced my skates, my fingers would bleed. I had terrible joint trouble that persisted a long time after I was on it. I was pretty moody, but I was a political appointee and going to school, so that did not help. I also gained a lot of weight from water retention and not being able to work out due to the joint pain (and the job and school).

I remember going to my dermo a couple of weeks or so after I'd stopped the drug and complaining that the joint and mobility problems had not gone away "rapidly" as the drug information said would be the case. He then pointed out that, medically, "rapidly" is 10 to 12 months.

You will need to drink a lot of water and always have a hard candy to keep your mouth hydrated. The dehydration will make your voice hoarse and your breath unpleasant. My breath was a problem for others during that period even with hard candies.
posted by jgirl at 5:50 PM on October 20, 2011

I did two courses of Accutane in college. I had the standard symptoms - constantly chapped lips (Blistex lip balm in the blue pot was a lifesaver - <3 menthol), dry skin, the occasional nosebleed. My hair did thin, but no one noticed it but me and a very insensitive hairdresser, and it all grew back and went straight back to normal once I was done. My triglycerides did raise, but I have a history of high genetic cholesterol.

All told, everything was manageable - the lips were probably the worst because it was such a constant thing, but it was really mostly an annoyance. Accutane wasn't my wonder drug - birth control turned out to be that later on (why my derm didn't suggest this before two courses of something as expensive and taxing as this, I have no idea!), but as someone who's had moderate acne since she was 10, I can absolutely nth the praises for clear skin boosting self esteem. It's fantastic. Do what you need to get it, don't sweat the temporary problems, and embrace your acne-free or acne-minimal future!
posted by AthenaPolias at 6:58 PM on October 20, 2011

I was prescribed accutane for cycstic acne that showed up in my early 20's- not as bad as yours, just a 1-2 cycts a month, but they were scarring. I quit after 3 weeks due to peeling skin and dry eyes. I couldn't stay out of the sun enough or avoid contacts. And I haven't had a cyst since, though I get the occasional pimple. Wonder drug indeed, and I didn't even finish the treatment. So .... I'd almost certainly go back on it if my acne came back, despite hating it.
posted by Metasyntactic at 7:40 PM on October 20, 2011

I took Accutane as a teenager and it completely got rid of my acne. My dermatologist prescribed some goop (I forget the name) for my lips because of the incredible dryness. If you are of the female persuasion, your physician will prescribe birth control if you are not on it already. I suspect (but have never had tested) that it may have permanently messed up my GI tract a bit, but not as bad as ulcerative colitis or Crohn's disease. Despite already having clinical depression before starting, I took Accutane and I don't remember it making any kind of difference in my mental health. Of course, YMMV.
posted by dhens at 7:47 PM on October 20, 2011

I have a friend who was on accutane. I had just started a much milder treatment for my acne, and she was telling me about how accutane completely cleared up her acne. When I asked her if she had any pictures from before she started accutane, she told me that she didn't like taking pictures much back then.

I couldn't imagine this outgoing, attractive friend of mine having skin so awful she couldn't even stomach photos of herself. She didn't mention any severe side effects, but if her acne was as bad as I had imagined it, then I can't imagine side effects from accutane being any worse than the side effects of acne.
posted by catwash at 7:56 PM on October 20, 2011

The depression I felt when I took Accutane for cystic acne in the 80's seems much more severe that what the others have mentioned here - but perhaps the drug or dosages changed, it looks like the others here took it later on. I can't necessarily put the blame on Accutane, either, I think my depression lasted well past the treatment so perhaps it had other causes. (By college I was no longer depressed). And, untreated severe cystic acne is likely to make a person depressed, so perhaps the best way out is through. Mine was pretty bad.

Do you have people who you're close to, and see on a regular basis, who will notice, and will help you if they see you feeling differently? I don't want to be the paranoid guy here but I think it's a good idea to tell your circle of friends and family, whomever, about accutane and its potential side effects.

As far as the dry skin goes, I remember that being annoying, but not insurmountable by any means.

Would I recommend it? Until I saw this post I actually thought it was off the market (not sure where I got that). Based on my own experience, I'm on the fence. After reading the posts here, I probably would. It sounds like the drug or its administration have improved, or I was just unfortunate with my issues when I took it.
posted by altcountryman at 9:29 PM on October 20, 2011

My brother was on it for a few years and the worse side effect was the sun burn. He got third degree burns on his hands when he forgot to sunscreen. He is a redhead so that didn't help.
posted by oryelle at 4:34 AM on October 21, 2011

My fiance took it a few years ago. It did wonders for his skin. However he was really hard to be around during that time. Supposedly it makes you more sensitive to testosterone - he was a 20-something male who already had a high sex drive and a short temper, so I think that was the culprit. However it was totally worth it, he looks great and is happy with the results.
posted by radioamy at 9:45 AM on October 21, 2011

I used Accutane for about 8 months when I was in 11th grade. I was diagnosed with cystic acne in my teens. It's worth remembering that acne itself is a symptom, not a disease or disorder, and very different things can be going on under the hood when people have it. People with really severe cystic acne are often suffering from an underlying bacterial infection, and all the usual provisos about not eating fried food, or having too many hormones, or all of it going away when you finish high school are not the case for people like me. Many of them end up having it for most of their lives and end up extremely pockmarked all over their bodies. I knew of people who were medically discharged from the military because the symptoms were so severe they couldn't carry backpacks or do other things in the field.

In my case, my doctors insisted on it because I also have a form of arthritis that is extremely sensitive to challenges to my immune system. Not so bad when you're just thinking of having a cold for a few days, but imagine instead having a chronic infection that is constantly activating your immune system, which then causes severe arthritic responses. By the time I was 16, they were seeing deterioration of some of my vertebrae, femur, sacrum and ilium. There was some talk of hip replacement surgery in my 20s. My clavicle dislocated spontaneously one day because the inflammation around the joint was so bad. (Yes. I was sitting there, doing nothing, lying still, and 'pop'. Yes it was crazy.) They felt like they had to put me on the Accutane and get the infection and the cystic acne under control.

My dermatologist felt that given my body size and the need to completely eradicate the underlying cause, I should be on a higher than normal dose. I can't recall whether it was 1.5 or 2 times the regular, and it's been 20+ years. I had all the symptoms people have described above - extremely dry skin, coming off in sheets, a mouth cracking open constantly, general exhaustion. The depression in my case was astonishing. I think a general awareness that it could cause that was just emerging, and I was much less closely watched for that than others have described here. Teenagers have their mood swings, I know, but this was the first time I ever had suicidal ideation. And I had a lot of it. In one particularly darkly comic twist, I tried to give blood at a drive during the midst of all this. Sat in the little cubicle, telling them I had never done drugs, had a tattoo, had unprotected sex, etc. They got to the seemingly idle question of whether I was on any medications. I mentioned Accutane. The woman asking the questions went white as a sheet and told me to go sit outside, and that she would have to speak to her supervisor. Moments later, seated among a couple friends and a bunch of non-friends, she said, "You have to go. You can't give blood... as you are now." Mmmmm... delicious high school rumors. Never let them tell you HIPAA laws aren't an improvement.

After 8 months, I stopped. And I became a fairly ordinary 17-year old, in terms of my skin. It never came back, I never had acne that even required over the counter meds. The arthritis symptoms stopped, though they would come back again over the years. (This is not the only trigger, obviously.) I have had periods of depression and dysthymia in the years that followed, but I doubt that we could definitively point to that med as the cause, and similar things have run through others in my family. I did not have my hip replaced in my 20s, and my illness is managed effectively today. I have great difficulty looking back on those 8 months at all, much less fondly, but in my case I think the med was the difference between a fairly normal life and a much more dramatically circumscribed one.
posted by el_lupino at 3:40 PM on October 21, 2011

I had severe cystic acne with wide body coverage, and went on (ro)accutane when I was in my late teens. It's been so long now that I've lost track of specific details like dosage (or even what year this was! Zounds!), but it worked after a fashion. The main side-effect was that, for several months, my acne got worse. Much worse. Most of the scarring I have now came from the massive cystic lesions I formed in those months. It was truly, truly awful.

What else? Frequent and often lengthy nosebleeds: at least every other day, sometimes more. Chapped lips. Opportunistic fungal infections in my nailbeds, on my arms, and at the corners of my mouth. Peeling skin. Depression and anxiety, though I was too young and emotionally inexperienced at the time to realize it.

However, despite all that, it did clear up the problem within 6 months or so. I've had relapses since, but never particularly bad ones, and I do still form the occasional cyst, but not at the same level I once did.
posted by Sonny Jim at 11:10 AM on October 22, 2011

I'm a little late to this, but I wanted to add my experience with Accutane here because they don't match anyone else's and it's important to understand the range of effects Accutane produces.

So, I took Accutane a few years ago, as a female grad student. The dispensation of Accutane in the US is very strict, with only some doctors allowed to prescribe it. Every month, my doctor would have to ask me what TWO forms of birth control I was on (condoms plus birth control, abstinence plus birth control, whatever) and enter it into the national database. Every month, I would have to take a quiz and verify which two forms of birth control I was on before I could pick up the pills at the pharmacy. The pill packet is quite obviously marked up with warnings and I think (can't remember for sure) that even the pharmacy had to ask what two forms of birth control I was on. I resented this hugely, even though I understood the rationale (nasty birth defects).

I did not have the dry lips/skin or moodiness that seem to be the common effects most people here list. I did have one incredibly dangerous side effect that ultimately curtailed how long I was able to be on the drug. My triglycerides (cholesterol) were way way way high. We're talking a normal person's is between 100-150, and high is something like 200+ and mine was in the 600+ range. I was having my blood drawn every week or two, a entire team of doctors conferred on my case every time I came in to decide whether it was safe to continue treatment, and the lab would have to triple check their results every time. Ultimately, they ramped down the dosage (after spending months ramping it up) to the very lowest dose and continued me on that until I'd reached my prescribed dosage level (it's based on weight).

So ultimately they tried to finish off treatment as quickly as possible and I think that's what led to the acne coming back as soon as I stopped taking the Pill (about nine months after ending Accutane). My skin had been beautiful up until that point, and continued to be beautiful on the Pill, but I can no longer take the Pill and that means the acne is back without even any improvement. It's heartbreaking to have suffered through such a dangerous medical condition for nothing!

So now I'm back on the path which might lead to a second session of Accutane. I have a friend who also had to do Accutane multiple times and still has acne occasionally. Anecdotally, this does happen (note all the people here commenting about how their acne came back after a while off Accutane).

I would note that as far as long term side effects are concerned, my friend who was on Accutane multiple times suffers from permanent joint pain among other things. I now have scarring issues (I never used to scar like this) among other things.

So take Accutane if that's the path recommended to you, but be aware it could have serious side effects and fail to work. It's still a miracle drug for many people and hopefully it will be for you as well.
posted by librarylis at 12:20 AM on October 23, 2011

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