Isotretinoin 101: How Selma Hayek Became a Patron Saint

by Madeleine Hawks

Here’s my story about acne. The year is 2009. I’m in Paris on a month-long postgrad spree.  I notice that I’m getting more acne than I’ve ever had previously. I had some acne as a teenager and a little in college, but senior year in college, my skin was pretty much crystal clear.  So there I was in Paris, beginning to rethink all the sugary pastries, warm yeasty bread, sunny/sweaty walks, and undecipherable French cleansers in Stephanie’s shower. From what I had read, I knew all of these could have been the triggers of the sudden change in my skin.

Upon finding this couch-side when I woke up on my first morning in Paris, I said to my host: “What is this?”; Stephanie: “Your breakfast”; Me: “It looks like a heart attack”;
Steph: “Welcome to France!”

After returning to Virginia, I started a new high stress nanny job in DC and moved to a new house in Alexandria.  My acne had gotten quite bad. I thought it may have been environmental. The mysterious DC swamp? Was there mold hidden in the walls of the house? Was I using the wrong pillows?  I proceeded to try every diet you could imagine. No dairy, no wheat, no soy, no meat, no alcohol.  Then I experimented with supplements, vitamins, juice fasts, beauty regimens. I spent a ton of money. Like, literally piles of cash went to Whole Foods and natural health stores.

A rare example of down-time on the nanny job: at the canal in Georgetown

When that wasn’t working, I called in professionals for spa treatments like chemical peels, facials, massages for de-stressing.  I consulted the fascinating Alexandria guru who specializes in aloe treatments. I tried acupuncture (which I adored but could not afford – it was very relaxing!).  I tried birth control pills again hoping it was a hormonal issue.  This whole time, I kept hoping.  Patience! Surely, if I keep a positive attitude, things will get better!  Yet, during this, my acne was just consistently awful.  I had painful cysts and overall my face always looked highly pigmented, so there was never any leaving the house without makeup.

Now, here’s the thing: Adult Acne? It’s not so uncommon anymore, much to the chagrin of myself and lots of other men and women.  Acne outside of teenage years is a very topical issue (oops, that was an acne pun – sorry I’m not sorry) that has been getting increasing attention in the news.  The New York Times recently published an article about it.  The article is nice but at the end I’m still like “well, what’s the solution!?”.  As with all health issues, of course, there is no one solution. You have to make the right choice for yourself. And the worst part is, no one  knows really what is causing this trend in adult acne.

This year I finally caved and marched to the nearest dermatologist at UVA and said “Give me whatever drugs you want. I’m desperate.”  This is not something that I would normally say, but I had had my fill of experimentation for 3 years.  So I was given a testosterone inhibitor in case I was dealing with spontaneous imbalances.  No dice.  I tried an antibiotic, which just led to other health issues that were only remedied with copious amounts of kombucha and garlic, like a true hippie.

At this point, I said the words I thought I would never say for a number of reasons (fear, my mom’s voice in my head, and just plain skepticism): “What about Accutane?”. The rest, dear reader, is history.  After taking a pregnancy test and signing a scary, bright yellow book of rules about avoiding pregnancy, I started my course in Isotretinoin.  That’s the generic name for a drug that is usually called Accutane (like tissue is called Kleenex by some). I walked out of the office with the same old optimism.

This is what it was like on a good day, sans makeup, back in the dark days, on the morning I started taking the medication:

Isotretinoin seems pretty harmless, at least in concept. It’s meant to be a permanent solution because it changes the ability of your skin to produce nodular acne. However, it can also be extremely dangerous for pregnant women and their babies.  You absolutely should not get pregnant on Isotretinoin because your baby could have terrible birth defects. And you also can’t donate blood.  There has also been a linkage between depression and Isotretinoin, which made me nervous because I’ve suffered bouts of depression as well.  In reality, my acne was likely causing some of my depression because I was hyper-aware of it. To me, it seemed like I was wearing a weird mask that everyone had to consciously overlook in order to talk to me.

I talked to a lot of people before I started taking Isotretinoin; friends who had taken the medication with success. I asked them a lot of prying questions about what their side effects were and how their skin is now. After accumulating  enough jury-rigged and unscientific research, I felt satisfied that I could do this.  Then I read this article with Selma Hayek for Lucky magazine on my way home from a conference in LA last month. She talks about her history with acne and self esteem and how she eventually turned to Accutane and pulled her life together. I must have been in a delicate state due to lack of sleep, jet lag, and end-0f-semester-panic, but I nearly started crying tears of joy on the plane. Hallelujah! I had a patron saint of beautiful skin!

My course with Isotretinoin is 6 months long and each month I report to my dermatologist to take a pregnancy test and check in before I can get the next month’s supply.  So far, for me, the Isotretinoin routine has been very simple and effective; in other words: MAGICAL. Seriously, I thought I was just a lost cause! But I’m a month in and it’s really starting to change my skin. When I was visiting family last week, I suddenly realized that I was out in public for maybe the first time in a year without wearing makeup. I was shocked and oh so happy.

Aside from the incredibly wonderful changes in my acne, I only have a few other side effects:

1. I can’t go 20 minutes without putting on chapstick; I probably apply it in my sleep. The medication is very drying all over, so my skin is generally dryer, but my lips are super dry.

2. I have to watch out for sunburn.  That’s new for me because the medication makes your skin more sensitive and thinner, hence it burns more easily.  I’ve already gotten some weird tan lines just from eating lunch outside a couple times last week. Awesome.

3. I’m still spending a pretty penny for this treatment. It really ain’t cheap. Luckily, I am still on my parents’ health insurance, which helps a lot. But each visit costs about $20 in a co-payment for me and then I spend between $40 and $60 on the lab tests (which is just a really expensive pregnancy test).  And at the pharmacy, my cost per month is $64.99.  So, in sum, it costs me about $135 a month! Yet, if I think of how much money I have spent on other efforts that have not worked for me, I am too embarrassed to even begin adding up the tally. I’ll consider $135/month for 6 months a worthwhile temporary cost for a long-term solution. I’m only a month in on this treatment but I’m already seeing great results. Hopefully the next 5 months go just as smoothly!

Does it scare me to think about the idea of taking a medicine so strong that it causes birth defects? Heck yes, it does! Do I worry a little that my skin will be forever dry and sensitive? Oh my, yes. But I weighed the alternative and I just couldn’t see any benefit in not taking that risk. I wasn’t happy in my own skin! It will still be a while before all the redness disappears.  And I still continue to have some acne, but it’s nearly insignificant. Progress! This is what a makeup-free day looks like now:

Ever thought about asking your doctor about Isotretinoin? Have any acne horror stories? Success stories? This is a very personal story for me, but I’m sharing in case you are in my boat. I would have liked to have read something like this about 3 years ago myself.

You can also get in touch directly with questions or comments. I’d love to hear from you!

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25 responses to “Isotretinoin 101: How Selma Hayek Became a Patron Saint

  1. Ok, so I have to ask: after you shared your naturopathic acne treatment from a few years ago, what made you decide not to try that route again (the intense diet with naturopathic consultation, that is)? Or maybe you did and you can just say that.

    The before/after photos are pretty amazing, though, I gotta say!

    • So I didn’t go too far into that, because this post is just so dang long. However, I did go back to the naturopathic physician – the same one, in Fredericksburg. She didn’t propose the same diet again but gave me some supplements to try. The thing is, when I had visited her the first time, I had a different type of acne and it wasn’t as severe. I had experimented with diets on my own, based on what I had learned from her and from reading a LOT on my own. In sum, the oatmeal thing worked once upon a time, when I was still dealing with teenage acne. The acne I was experiencing recently was a horse of another color, if you will.

  2. I feel you on the battle with acne (and actually followed a similar pattern – my skin towards the end of college was great following pretty bad acne in high school and into college). I just got on a Retin-A/Benzoyl topical regimen and my skin has transformed. I relate to so many of the feelings you wrote about – not wanting to leave the house without make-up and just always feeling conscious that I had bad skin. Thanks so much for sharing!

    PS Had you tried Retin A?

    • Glad to hear I’m in good company! Like I mentioned in response to Laura, I cut out some important details to make this post somewhat manageable to read. I did try Retin-A too! For a few months, I really had my heart set on that regimen working. It really did not work for me and just made me have weird peel skin, which of course just exacerbated my feelings of embarrassment. It was basically a face circus! I’m so glad it’s working for you though! It’s reassuring that not everyone needs such an intensive treatment as Isotretinoin!

  3. I feel you on this entirely! After being really annoyed with my skin in college, I went on accutane sophomore/ junior year in college and it worked for me. Now my skin is pretty good, unless I’m super stressed.. but that’s another story 😉

    • Woof, stress is pretty much inescapable, especially for grad students! I’m happy that it worked for you too, Kari!

  4. Thanks for sharing Madeleine! I too have struggled with acne since my teen years. I was prescribed many antibiotics, both topical and oral for years as well as oral contraceptives, I tried proactive, though no other “home remedies” until an MD finally suggested accutane. Similarly to your experience, accutane worked wonders for my skin. After about 8 months on the drug, my non-facial skin (body skin?) started to break out in weird fluid-pus filled vesicles everywhere! I had no idea why this happened- and still don’t, but it scared me and this side effect, combined with the others you mentioned (my lips peeled ALL the time!) caused me to discontinue my use of accutane. Now, my skin is still not perfect but I find if I don’t mess with it (no moisturizer, soaps, as little makeup as possible) it is totally manageable. I wish that I would have taken the more natural, non-pharmacological route to see if I could have avoided all the drugs and side effects. As your experience proves, however, some situations call for medical intervention and can relieve much angst and suffering.

    • My doctor is putting me on a strict 6 month regimen. I wonder if you were on it too long? I thought everyone had pretty much the same routine length just because it’s so taxing and drying! I totally sympathize with getting hopes up on something that seems to be fixing the problem, only to find out it is making it worse after a certain point!

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    • Hi Sarah! I just finished with Isotretinoin last week! I had a great experience and am very happy with the results. Since using Accutane I have had to deal with a few changes. For one, my pores are a little larger, which is actually good at preventing cystic acne. Another issue is that I have super chapped lips, especially the corners, which can be painful. I also have more redness, but that’s mostly when I’m in the sun and I’ve been told it will be less noticeable soon. So for products, I use an oil-based cleanser at night, which I’m going to write a post about soon, so check back! I sometimes moisturize but mostly don’t. My most important product lately has been petroleum jelly, for my mouth. I don’t like using it one bit, but it’s the only thing that keeps my lips from looking and feeling uncomfortably chapped. I think that is supposed to go away as well, once my skin adjusts. I also sometimes make a lip scrub with honey and sugar to exfoliate my lips if they’re super chapped. Honestly, now that my skin is working properly, I don’t have to bother with many products! I hope that helps!

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  10. Thank you so much for sharing your story, I also got my acne after my college ,I am 23 now .I am on 2nd month of isotroin 20 tablet, i hope i get my beautiful skin back, do scars disappear with isotroin too ?

    • Scars do take a while, but will probably go away! Your dermatologist will likely give you a retinoid prescription about a month after treatment, which can be applied topically to help with scars. Good luck!

  11. Great post! I just finished my 40mg, 5 months today 🙂 I’m so happy to be done and it’s nice to know there are other people out there fighting a similar battle. You look very happy in the post Accutane pictures!

  12. Thank you SO much for sharing! I’ve been debating it for the past 2 months and just decided last week to go ahead with it. The whole “birth defects” thing made me panic about getting pregnant in the FUTURE (as in, over a year from now) My doctor has be on the 6 month plan as well. Week 2 seeing more of a disaster than I did before, but I hear that’s normal. Even after just a month your skin is really starting to look incredible. Makes me excited! 🙂 Thanks again for sharing.

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