Isotretinoin 101 Follow Up – What Happens After Accutane?

Isotretinoin 101 Follow Up Accutane

On the first day of classes this semester, I got an email from a Get Clean, Girls reader on a quest for clear skin. We’ve traded a few emails, at which point I realized I should just write a follow up for other acne sufferers who might be curious about Accutane. Here’s the original email:

Dear Madeleine,

First of all, I want to thank you for great and personal view on acne treatment with some kind of magic (isotretinoin), and I must say your article was like an injection of hope. Thank you.

In the past, like you, I tried everything, low carbs diet, high antioxidants diet, high vitamin, zinc + selenium, French thermal waters + dermocosmetics (gentle yet sebostatic), plankton, I quit micro-anabolic exercises (I play and teach tennis), antibiotics, anti-inflammatory drugs (oral, topical) – you know exactly what I mean. I was afraid (I study medicine but I really did and I’m still afraid) of magical retinoid, but your article was like an epiphany.

Now, I start isotretinoin and I’m full of hope. I’d like to ask you about your current state: are you still happy with the results? You finished your therapy at the end of November and I’m totally interested of the remission/results.

Once again thank you and I wish you infinite crystal clear skin (which harmonizes with your pretty face).

Greetings from Poland,

And here’s a summary of the responses that followed, including answers to other questions that Wojtek had:

I’ll start by clarifying that I am now finished with my isotretinoin routine. I had my last dose in October, after 6 months of using the prescription.  My skin is still clear and is roughly back to its normal qualities.  At first it was rather red (showing a little hyper-pigmentation  and dry/sensitive.  Now, my skin is the normal color and is still on the dry side, but more balanced. I am pleased with the results of the isotretinoin routine and do not at all regret the decision to use the prescription. However, I also don’t regret the decision to try everything else first just in case it was some problem I could solve on my own, naturally. My skin is very clear and I feel comfortable with or without makeup now, finally!

Honestly I think the longest-lasting side effect was that the inside of my nose is very dry. It is still sensitive and dry, although I no longer have the occasional bloody nose.  I also had very chapped lips, even after I finished the prescription. In the past month, that problem has gradually gone away and I’m back to using chapstick occasionally rather than having to apply Vaseline almost constantly.

As far as skin care routine, I am sure everyone varies in what works best for them when their skin is being manipulated by isotretinoin. Regarding sunscreen, I’ve always loathed using it since I was a kid – I hate the smell and feel of it. I did use it on days when I knew I would have long periods of full sun exposure. Otherwise, I tended to wear big floppy hats and sunglasses and hope for the best. I honestly didn’t have much of an issue with this method – no sunburn or excess peeling, etc.

Skin Care Routine (Morning):

I got into the practice of using honey in the morning (if anything) or as a mask at any time of day. As a wash, I rub it all over my skin and then rinse with cool water.  If I am using it as a mask, I like to let it sit on my face for 10-30 minutes. I invested in Manuka honey a few months before I began the prescription because I had read about it having strong antibiotic properties. Honestly, I’m not sure that I noticed a difference between Manuka and locally-sourced honey. Manuka is rather expensive, so if you haven’t experimented with honey in the past, I would recommend starting with something from a local farm first. Other times, I don’t wash my face in the morning at all – it’s pretty dry and even water can be drying in the morning.

Skin Care Routine (Evening):

I wear makeup generally every day, so I wash my skin at night. I started using an oil wash method (which I wrote about in my blog post about coconut oil). I highly recommend trying an oil method as your skin starts clearing because it is cheap, gentle, and effective. You can really use any type of oil you like, although jojoba is generally recognized as the most neutral oil for all skin types (it acts similarly to your natural sebums and doesn’t clog skin easily).
After I finished my isotretinoin routine, I purchased a very simple Dutch bar soap for dry skin from a local shop on a whim. I love the way it smells and feels on my skin (nourishing without making it feel greasy).  However, on nights when my skin is looking dry or weak (usually related to lack of sleep or not drinking enough water), I use the oil method.

Skin Care Routine (Moisturizing):

I have been sticking to oil moisturizers as needed (sometimes at night, sometimes in the morning, sometimes not at all): coconut (richest), olive (medium), jojoba (lightest). I consistently had to use petroleum jelly (Vaseline) on my lips when I was on the prescription because my lips were painfully chapped at times. Happily, I now just use chapstick as needed.

My dermatologist also gave me a Retin-A topical retinoid prescription on my last visit; it basically acts topically in similar way to the internal use of isotretinoin by supplying high doses of Vitamin A to cause healthy skin cells to quickly populate.  She said it is useful for anyone with any type of troubled skin: acne, wrinkles, etc. I have tried it a couple of times and so far haven’t been happy with the result. I still have the tube in my medicine cabinet and will likely experiment in the future as my skin continues to regulate post-isotretinoin. So far it has been drying and makes my skin red, without me seeing any benefits.

Don’t forget about the importance of drinking water while using this medication.  I don’t measure how much water I drink, but I’m naturally thirsty and love to drink water. So I would say, give your body as much as it craves. Sometimes you have internal indicators (thirst) and sometimes you will see visible indicators (dryness). I will add that some people experience intestinal dryness: constipation or other discomfort. Be careful about this as well, but drinking water can certainly help!

Overall, I would say that my own experience with isotretinoin is fairly common, based on what I’ve read, talked to  my dermatologist about, and what other people have told me. My reaction to isotretinoin was pretty mild and the main issues I had were: chapped lips, dry nose, and overall sensitive skin. My skin started improving pretty drastically within the first month and was consistently clear since then. I’m really happy with the results!

If you have more questions or want some reassurance about starting a course with isotretinoin, don’t hesitate to get in touch like Wojtek did: Thanks, Wojtek!


6 responses to “Isotretinoin 101 Follow Up – What Happens After Accutane?

  1. May I ask what dose(s) of isotretinoin you took? I am about to start taking it myself and (based on my research) I am interested in possibly just taking 20 mg per day. I do not have severe acne and I already have dry skin and scalp issues so the long term side effects scare me.

  2. I took Accutane 10 years ago and I wouldn’t recommend it to anyone! You will be left with horrible side effects that will last your whole life. It is not worth it. I wish I could take it back.

    • Kristal, I’m so sorry that you had a bad experience with Accutane! I wonder what your long term effects are – likely dryness would be a big one. I know that Accutane is definitely not for everyone, and not a decision to be taken lightly. I certainly had my reservations for a long time, and still am not 100% confident that it was the only solution for me.

  3. I’m curious if your acne has continued to be resolved? I’m starting accutane this week after a similar 5 year battle. Appreciate any feedback and encouragement.

    • Yes, I have not had significant acne since I completed my Accutane prescription. I have experienced the occasional breakout, but it is manageable in size (not cystic) and goes away quickly.

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