complete guide to accutane for acne

“Help! I’ve tried EVERYTHING to get rid of acne but nothing works. Am I doomed forever?!”

I get this question a lot. Over the years, I’ve noticed these acne sufferers fall into two categories:

  1. Those with mild to moderate acne who’ve been trying random skincare products without success.
  2. Those with severe, inflamed, aggravated acne that doesn’t react to topical treatments.

If you fall into the first group, don’t feel bad. The skincare world is a minefield full of snake oil sellers. Most of the products targeted to acne-prone skin don’t either have what it takes to get rid of acne or are so harsh, they make things worse, not better! Ugh!

What you need to do is get yourself a salicylic acid exfoliant ASAP (you can find my fave picks here). If that alone is not enough, spot treat with either benzoyl peroxide, sulfur or tea tree oil.

If the problem keeps coming up, it’s time to take a look at your diet and stress levels. Try going on the low glycemic diet and do some form of mindfulness, like meditation, to reduce stress.

For more help, check out one of these guides:

Then, leave this page. You don’t need to read the rest of this article.

But if you fall into the second group, if you’ve tried all the most effective topical treatments and overhauled your diet and lifestyle without results, if your acne is so severe that only prescription meds can heal it, it’s time to go nuclear.

It’s time to consider going on Accutane.

What Is Accutane?

Accutane is the drug name. The active that makes it work is Isotretinoin, the most powerful form of vitamin A.

Accutane is the weapon of last resort. The one you use when nothing else works for your acne.

You can’t buy it in the shops. It’s prescription only. If you’re considering it, you need to see a derm. She’ll prescribe you a low dose (usually something from 0.5mg to 2mg) for 15-20 weeks (in some cases, the treatment can last up to 10 months!).

Yep, even nuclear weapons take their sweet time to work.

Related: What’s The Best Form Of Retinoid For You?

Struggling to put together a skincare routine that banishes shine, pimples, and blackheads? Download your FREE “Best Skincare Routine For Oily Skin” cheatsheet to get started (it features product recommendations + right application order):

How Does Accutane Work?

Accutane stops your body from producing oil. Like, almost completely (we’re talking an 80% reduction here).

Are you starting to see why it’s used as a last resort now?

Here’s how it works. When everything’s well, oil pumps out of your sebaceous glands into your skin, where it acts as a natural moisturizer. That’s why normal skin is naturally so soft and smooth.

But if you’ve got acne, your sebaceous glands are into overdrive. They pump out way more oil than your skin needs. The extra oil can’t flow out of your pores normally anymore. It’s trapped inside.

Here, it mixes with dead cells and all kinds of other crap. Soon, the blob becomes so big, your pore’s clogged.

P. Acnes, the bacteria that causes acne, feeds on this excess oil. By reducing oil production, Accutane literally starves the acne bacteria to death.

That’s not all it does either: 

  • It regulates cellular turnover (the skin’s exfoliating process) so dead cells slough off your skin instead than falling inside your pores
  • It reduces the size of your oil glands
  • It has anti-inflammatory properties that reduce the redness and inflammation associated with acne

It’s basically one stop shop for all your acne needs.

Related: Adult Acne: Why It Happens And How To Treat It

Does Accutane Have Any Side Effects?

There’s a reason Accutane is the weapon of last resort. It’ll get rid of your acne alright but not without wrecking some damage first.

Here’s what you can expect in the short term:

Yep, your skin will get all dry and flaky. Your wrinkles will look way worse. Your face may have more spots than ever.

This can take a huge toll on your confidence and self-esteem. Don’t let it get you down. Journal, meditate, find a way to relax and destress. This is the worst hurdle. Once you’re past it, your skin will look its best ever. I promise you.

And in the long term:

  • Abnormal bone growth 
  • Birth defects (it’s mandatory for women to take birth control when prescribed Accutane – they won’t give it to you if you don’t agree)
  • Depression 
  • Dry eye syndrome
  • Joint pain
  • Inflammatory bowel disease 

Scary, right?

With the exception of birth defects, the long term side effects (you can’t escape the short term ones, sorry!) usually appear only in less than 10% of patients. Chances are you won’t ever experience them.

It’s like taking aspirin or other meds. They all have long list of side effects but most people never get them. Still, it’s important to be aware of what you’re getting into and that there’s a small chance you could be the exception.

WARNING! Because Accutane has a long list of potential side effects, including birth defects, you won’t be prescribed it on the spot. You’ll have to do blood tests and regular follow up visits to check that everything’s fine. If you’re a woman, your doctor will ask you about your sexual history and discuss with you birth control options. You’ll also have to do a pregnancy test every month. I know it seems unnecessary for acne, but they do it to avoid the risk of surprise pregnancies while on Accutane.

Related: How To Survive a Purging Period

Is Accutane Worth It?

I wouldn’t try Accutane as your first treatment. But if you’ve tried everything without success, Accutane is worth the temporary pain.

Accutane is successful in 95% of patients. The results are often permanent. 

Accutane doesn’t just clear up your skin. It gives you a confidence boost. Now you won’t have to deal with acne anymore, you’ll feel much more comfortable in your own skin.

Accutane Tips And Tricks

WARNING! Your derm will prescribe you a skincare routine and teach you how to make Accutane work for you. Listen to him/her! The tips below are probably the same a derm will give you but if your doctor told you to do something different, go with his/her advice. He/she is a doctor. I am not.

1. Go Back To Basics

Skin gets super sensitive on Accutane. To minimize the risk of irritation, keep your skincare routine as simple as possible. In the morning, cleanse, moisturize and put on sunscreen. In the evening, cleanse and moisturize.

Stay away from exfoliants, alcohol-laden toners, harsh anti-acne products and anything with a strong fragrance. Don’t wax.

I don’t usually recommend basic moisturizers without antioxidants or powerful anti-aging superstars like vitamin C, but that’s exactly what your skin needs now.

As a rule, if you wouldn’t put it on your newborn baby, don’t use it on your skin now. That’s how sensitive it gets on Accutane.

Related: The 3 Skincare Products Everyone Needs

2. Eat Before Taking Accutane

Studies show that Accutane is more effective when taken 1 hour before, 1 hour after, or with a meal. Especially when that meal has a high fat content. 

It goes without saying – but I’ll say it anyway – that’s not an excuse to binge on unhealthy crap. Healthy fats include salmon, avocado, tuna, nuts, olive oil, flaxseeds and chia seeds. Get your fix from those. They’re delicious.

The Bottom Line

I can’t stress this enough: Accutane is the treatment of last resort, only for those severe cases that don’t respond to any other treatment. If that’s you, then consult your doctor. Accutane isn’t pleasant but the results are well worth the temporary side effects.