A Man’s Guide
to Accutane

Accutane medicine

A Man’s Guide to Accutane

What guys should know about the acne drug of last resort

About seven months ago, I was sitting in my dermatologist’s office when the topic of Accutane came up. I had seen her twice before about a new kind of breakout I was suffering from: large cysts near my nose and on my chin. They weren't as noticeable as a bright red zit, they were deeper and way more painful. At their worst, they'd swell up as if I'd been punched in the jaw.

Two different antibiotics didn't knock it out. Then the doctor sent a sample to the lab and diagnosed “gram-negative folliculitis.” This is actually more of an infection than traditional acne. And it effects guys because of they way our facial hair grows. But the best treatment is also known as “the drug of last resort” for acne.

Isotretinoin (commonly referred to by one of its earlier brand names, Accutane, even though that was pulled from the market in 2009) is basically a pimple's kryptonite. At it's core, it's a vitamin A derivative, similar to the retinoids used in topical anti-wrinkle creams but when taken in capsule form, it's considered to be the best cure-all for even the worst cases of acne.

Of course, like many prescription drugs, it comes with a laundry list of “possible side effects.” And the effects of Accutane have become something of a cautionary tale (Google at your own risk). The drug has been FDA-approved since 1982 and the most common side effect is dryness of the skin, nose, lips and eyes. Joint pain and sensitivity to light can be expected. But it's also been associated with fatigue, chest pains, elevated liver enzymes and depression. While studies have not conclusively proven that the drug causes these conditions, they remain among the risks of taking the medication.

Honestly, I didn't know much about it when it was suggested, but I knew that it was serious medicine. Besides, wasn't this meant for teenagers? I'm a grown man in his thirties. “Is that really necessary?” I asked. But the doctor assured me, “Your cysts will just keep coming back,” she said. “There's no better way to knock this out for good.” She said it wasn't a “last resort” at all, but rather the most successful treatment.

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Accutane pills
Accutane pills

So how exactly does it work? Basically, isotretinoin shrinks the oil-producing glands within your skin, thus making it a less inviting place for acne-causing and acne-promoting microbes to flourish. That also means it tackles the excess oil, inflammation and clogged pores that allow bacteria to grow—all while improving cell turnover. Because this is essentially everything that causes breakouts, a round of isotretinoin usually clears skin up for good.

In fact, it's such a potent medicine that you have to enroll in an online program that monitors your progress and bloodwork (yeah, there are monthly blood tests) to ensure your lipids and liver function are up to snuff (the medicine raises them), that you're not trying to get pregnant (birth defects) and that you're not donating blood. Due to the drug's impact on the liver, patients are advised not to drink. Full disclosure: I didn't always follow this advice but I never got drunk.

Getting a little nervous? Yeah, I was too. Was it worth it, I asked myself, all for a few damn deep-rooted zits? But they not only hurt, they were also affecting my self-esteem. A recent survey found that acne severity was, in fact, associated with higher levels of anxiety and the associated “perceived stigma” led to sleep disturbances, headaches, respiratory infections and gastrointestinal problems. So, yeah, that's not good. But what about these gnarly side effects?

I'm can now report, after six months of taking the drug daily, that the worst part for me was the fear of taking the damn medicine. I let message boards, random social media posts and horror stories nearly talk me out of taking isotretinoin. Thankfully, my dermatologist walked me back from the edge and reminded me that if things got bad, I could stop taking the pills and the side effects would stop.

I also realized that men and women have different skin. And much of what I read was targeted to or written by women. Which is why I'm sharing my experience with you now. I handled the drug well. In fact, I took it for six months and never had to tell anyone about it.

About two weeks after my first dose, my skin was noticeably clearer and the cysts had all but cleared. They were much less painful and any inflammation was gone. It seemed like each month, my skin improved and if a zit popped up, it disappeared in about 48 hours. The key, I learned, is to take the medicine on a full stomach. For good measure, I'd swallow an Omega-3 capsule (the good fats help the medicine absorb into the system) before taking my isotretinoin.

Your lips are where you'll first notice the forewarned dryness and I've never applied more lip balm than while on this drug. Sometimes, during a meal, I'd find my lips were tight and dry and needed to be swabbed with balm. That was weird. I noticed dryness in my eyes as well. Finally, sometime around month three, when my dosage was upped, I noticed slightly sore joints after working out. But nothing intense enough to cause me to stop. And it only lasted about two weeks.

All in all, it was pretty mellow. While everyone's experience will be different, I think the myths and fears around this drug have overshadowed the very real benefits. It was more frustrating to have to set-up monthly blood tests during a pandemic and pick-up my prescriptions than it was actually taking the medicine itself. Now my skin is clear, healthy and pain-free—and because of the way this works, permanently changed for the better. Yes, my skin got dry and tight. At times, I'd have some peeling and itching like I had gotten a sunburn, but being proactive about my skincare and making sure I was staying well-moisturized was key to keeping my skin feeling good while taking the medicine. So, if you're starting isotretinoin, or just want some gentle products that work wonders on dry skin, here are the staples that got me through the past six months.

Best Products for
Isotretinoin Side Effects

OKeeffe's Cooling Lip Repair Balm

$8.99 for 3-pack by O'Keeffes

For Lips

Cooling Lip Repair Balm

Cooling Lip Repair Balm

You need to take care of your lips while taking this drug. I'd heard that once the corners of your mouth split (ouch!), they take a long time to heal. So I applied and reapplied this hardworking balm so that never happened. Plus, you can lay it on thick because it's not shiny.

$8.99 for 3-pack by O'Keeffes

For Skin

Ultra Repair Cream

Ultra Repair Cream

This non-irritating cream was my go-to moisturizer because it's rich yet light and absorbs into skin quickly. It's gentle enough to relieve irritation and redness. I slathered it on before bed and during the day if I was feeling dry. But during my normal morning routine, I applied my usual SPF moisturizer.

$13.50 by First Aid Beauty

Systanne High Performance Lubricating Eye Drops

$10.99 by Systanne

For Eyes

High Performance Lubricating Eye Drops

High Performance Lubricating Eye Drops

I definitely experienced dry, itchy eyes. Even some dryness in the area around my eyelashes. But these soothing, slippery eye drops provide instant, long-lasting relief. I would also dab it around my eyelids, which seemed to help calm the irritation.

$10.99 by Systanne

Necessaire Fragrance-Free Body Lotion

$25 by Nécessaire

For Body

Fragrance-Free Body Lotion

Fragrance-Free Body Lotion

I didn't need to switch out my usual shower soap, but I did have to double down on daily rub-downs with body lotion. This fast-absorbing multi-vitamin moisturizing lotion is fragrance-free, so it didn't irritate my dry skin. And the large bottle lasted a lot longer than I thought it would.

$25 by Nécessaire

Aquaphor Healing Ointment

$4.99 by Aquaphor

For All Over

Healing Ointment

Healing Ointment

Say hello to your new best friend while taking isotretinoin. This ointment can be applied to any particularly dry spot. Sometimes I'd dab it on a spot before applying my usual lotion to ensure it stayed hydrated. And I'd apply it to my lips before bed to ensure they didn't dry out overnight. But be warned: a little goes a long way.

$4.99 by Aquaphor

NOTE: Items featured in this story are independently selected by the editorial team. Purchasing via our links may earn Valet. a portion of the sale, which helps fund our editorial mission.

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