When I was a child, it was easy to hate myself. A scrawny kid of 12, I was either too much or too little of just about everything. Too skinny, too hairy, nose too big, chest too small and far too sensitive to not take every mean-spirited comment to heart. Eventually, I grew into my features and out of others. I got waxed, got contact lenses, got my braces off and by the time high school rolled around, my appearance was the only aspect of myself I was actually confident in. By that point, I felt like I deserved to like myself.
And then my skin got bad, which would lead to me joining the other two million people taking Accutane, a last-resort drug used to treat severe acne. However, Accutane has intense side effects, which means the choice to go on it is a serious one to make.
I didn’t even notice my poor skin for the longest time. As always, it started out with a few pimples. Once they left, new ones would take their place. I also developed general anxiety and began picking at my pimples and my lips. By the time I was 15, something was always bleeding. And somehow, I didn’t hate myself. I was frustrated that, despite my intense skin-care routine, my skin was not healthy. But I’d slap on some foundation and live with it. Every so often, I’d switch skincare routines. Sometimes they would help. But the problem never went away completely. New acne began to blend in with the scars. I bought a stronger foundation.
By the time I graduated high school, my acne had never looked worse. And yet, my skin did not get thicker with age. I soon found it astonishing how many people felt the need to comment on my skin as if they knew or understood the first thing about it. One day at work, I was taking payment from a customer. I’ve never loved the waitress uniform I had to wear —the shirt cut low enough that the red spots across my chest were impossible to hide.
“Does that hurt?” the old lady asked as her partner stuck her card in the debit machine.
“That rash across your chest.”
My heart plummeted. I looked her in the eye, unsmiling. “That’s acne,” I said.
This wasn’t the first time a stranger felt the need to comment on it. Months earlier, I was at Walmart without any makeup on. As I searched for the vanilla yogurt I like, a short woman with red lipstick tapped me on the shoulder.
“What do you use for your acne?” she asked.
“Um… a lot of things,” I said, laughing through the discomfort.
“Well, you should use Proactive,” she commented. “My niece had skin worse than yours and it cleared right up.”
There were a hundred things I wanted to say just then, but I am meek. So I thanked her for the insult.
Feeling desperate, I finally went to a dermatologist. She looked at my face for under a minute before announcing, “Your scarring is pretty severe. At this point, the only thing that might help you is Accutane.”
Accutane, also known as Isotretinoin, is a drug that was developed in the early 1980s. It’s used to treat cystic acne. A doctor will only prescribe it if nothing else will work. Thirty per cent of patients who finish an Accutane cycle never deal with acne again. However, the side effects are nasty. My already cracked lips would become unbearably dry as they do for 90 per cent of users. My nose would bleed daily. “Keep an eye on your mood,” I was told, “because depression is a possible side effect.”
For over a month I would get nosebleeds every day. Some of them were pretty bad. Photo by: Kendall Bistertzan
According to the 2014 Encyclopedia of Toxicology, “it is unclear how this emotional instability arises. These effects appear to be strongly correlated to use of Accutane since the effects subsided following discontinuing use of the drug, but reappeared when use was reinstated.” However, in an interview with Dermatology Times, Penn Medicine Lancaster General Hospital’s Dr. Patrick Feehan says that “when suicidal ideations and depression were cited as side effects, I found people much more likely to be depressed and commit suicide before they went on the Isotretinoin. Any teenager that has problems with acne can have mood changes; 99 per cent of patients actually become less depressed on this medication.” As of 2001, the drug now comes with a depression warning, not long after Bart Stupak testified that Accutane radically altered his sons’ personality, leading the 17-year-old boy to die by suicide.
Depression wasn’t the only possible side effect I had to worry about. My eyes and hands could dry out, my hair might thin, I was at risk of joint pain and I was to take every necessary precaution to ensure I wouldn’t get pregnant. In fact, the capsule containers come printed with a pregnant belly crossed out on them.
“Two types of contraception at all times,” I was reminded. That’s because Accutane causes severe birth defects in fetuses that can affect their nervous system, eyes, heart, glands and skeletal systems. However, this danger wasn’t officially addressed until 2002 when the director of the FDA’s Center for Drug Evaluation and Research, Janet Woodcock, wrote that “a significant proportion of fetal exposures have occurred because patients were already pregnant. These events are entirely preventable.” That’s why, regardless of my sexual history, I get bloodwork done before each prescription renewal.
At 20-years-old, I began the first cycle of a drug I hoped I would never have to take. Thanks to my age, I was still covered under both of my parents’ insurance. This would greatly reduce the cost of the pills that are priced at four dollars each.
I was not alone in my struggle. My roommate, Emma Turnbull, was beginning her second cycle of Accutane. In a way, she had become my mentor. We shared Vaseline for our cracked lips. She taught me how to cover up the initial flare-ups caused by the drug. Our bathroom garbage was littered with the hideous anti-pregnancy wrappers. She was an Accutane veteran and, like me, had decided that clear skin was worth the cost of the side effects and hefty price tag.
She began her first cycle in August 2018, following a severe breakout several months prior. She had tried several topical treatments and oral medications, but nothing worked. Finally, her doctor recommended Accutane, and she was more than happy to oblige.
“I did my bit of research on YouTube and looked on WebMD on all of that, so I was like, ‘Oh crap, I’m gonna die of a heart attack or all this.’ But to me the positive things outweigh the possible side effects,” Turnbull explains.
She was on Accutane for 280 days (and was 22-years-old, meaning that at four dollars a pill she paid roughly $1,120) and began seeing results after roughly three months. Her skin only stayed clear for a couple of months, but during that time she finally felt alive.
“Having acne, I was always so self-aware and so self-conscious. I hated going out places. I hated taking pictures or doing family events, so when my skin did clear up a little bit, I was so happy. For the first time in my life, I could go without makeup, which I loved.”
Despite the side effects, and having to endure a second round of Accutane, she stands by her decision. I, however, am still unsure.
My mood didn’t worsen on the drug, but it could have. I often wonder what sort of hardships I would have faced if that had been the case. I was willing to trade in side effects — some potential ones being detrimental to my health — for a shred more self-esteem. Yet it has been four months and my hands are cracked, my pillowcases are stained with blood, my wrists and knees creak like those of the elderly and my skin is still covered in angry red flares.
Accutane has not yet been a fair trade.
The actual Accutane capsule. Photo by: Kendall Bistertzan
But this drug has not made me hopeless. In fact, for the first time in years of trying countless skincare lines, topical treatments and antibiotics, I know there is a statistically reasonable chance my skin could clear up. After all, most patients don’t see results until month five or six. Maybe for the first time in my adult life, I will feel comfortable in my own skin. And who knows? I just might venture to Walmart without makeup on.
Editor: Isaiah Lindo | firstname.lastname@example.org