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Is Accutane Right For Me?

By Amalah

Dear Amy,
I’ve researched your archived articles regarding acne and found little feedback from Accutane users. I know you suggest the Philosophy line, which I’ve tried, it made my skin go crazy! I have moderate acne which has developed over the course of the last few years, and I am 33 years old. I recently decided to quit spending the endless dollars trying the various acne remedies (ex/ Proactiv, Philosophy, Neutrogena, and so on…), and finally visited a dermatologist. He’s supposed to be the most qualified physician around, he took less than 5 minutes looking at me before he stated that I needed to try Accutane, that was it- no other suggestion. I am fine with this if it gets the job done, I just don’t know much about it.
Once the nurse entered the room, I was flooded with information/warnings/counseling. This somewhat concerned me, though I understand there is a huge liability associated with the product and birth defects (which won’t be an issue for me, no babies anywhere in this future). I’ve since scoured the internet looking for some more information, but what I really want is some users feedback, not clinical studies/doctor recommendations/etc. The nurse told me “not to worry”, “lots of people use Accutane with little to no side effects”, “we see great results”, etc. Yet the pamphlets state things like “if you start to feel like you are going to take your own life, stop taking this medication…” ummm, ok. Anyways, if you could please let me know your thoughts on this product it would be greatly appreciated!
Thanks !!
-Stella

Well, I wish I HAD lots of thoughts about Accutane, but I’m afraid I know probably less than you do. I know all about the birth defects warning and…that’s about it. Obviously, it’s pretty powerful stuff and thoroughly works its way around your system if it’s capable of crossing the placenta enough to eff with fetal development, so I don’t blame you for being cautious. In fact, I commend you for it, since I think too many people just blindly accept what’s on the prescription pad without taking some time to really research the drug, especially in this day and age of pharmaceutical commercials and glossy magazine ads. (“Oh! Zelnorm! With all those commercials with the women showing off their tummies! That was cute, sign me up! Oh wait…never mind.”)
A little Googling of my own reveals that lots of people have posed the question on message boards and other answer services — here’s a thread at the makeuptalk forums and Yahoo Answers. There’s definitely a mix of first- and second- and even third-hand reports here, but it’s clear that the side effects are definitely not something you should take lightly or feel silly for worrying about. Here’s the FDA’s take on the downsides as well. Depression and other psychiatric problems are very much noted, as is liver damage.
Perhaps the best and most informative site I came across is the forum at acne.org. There’s an entire subforum dedicated to Accutane — treatment logs, polls, before-and-after photos, you name it. Spend a few hours here and I think you’ll get a sense of how often the scary-sounding side effects actually happen and whether the risk is worth it in your particular case.
Now. After just that teensy bit of research, here’s my big question: You identify yourself as having “moderate” acne. Accutane is intended for severe acne. Full stop. It is a last-resort type of treatment, and even the FDA considers it a “high-risk” drug. From the link I provided:

Accutane should be reserved for cases of “severe recalcitrant nodular acne,” according to the product’s labeling. This type of acne is resistant to standard acne treatment, including oral antibiotics, and is characterized by many nodules or cysts–inflammatory lesions filled with pus and lodged deep within the skin.

Does this sound like you, at all? If you aren’t sure, just do a Google Image Search for “accutane” or “severe recalcitrant nodular acne” and take a gander at the faces and bodies that come up.
Obviously, it doesn’t sound like you got your prescription from a doctor who operates out of a van down by the river or anything, and without seeing photos of your skin I couldn’t even begin to question his recommendation. (Oh, and there’s also the little thing about me NOT BEING A DOCTOR.) It certainly does sound frustrating, since you’ve tried just about everything I would recommend to someone emailing for advice. So in that regard, yeah, maybe you ARE ready for a last-resort treatment regimen, but I’m still having an issue with the whole “moderate acne” bit, because that runs counter to a lot of the general info and advice I’ve come across.
So. Obviously I hope some readers will chime in here with any Accutane experiences — good, bad, middling — but beyond that I’m just going to repeat the suggestion of the acne.org forums. Look at the “before” photos and ask yourself if your acne is in the same realm and if you really do, in fact, have any business messing with this stuff. Maybe get an account of your own and post a photo and see what the other Accutane users think. Or poke around the other areas of the site and see if there’s a regimen or product that you might want to try first. (The basic acne.org regimen can be done fairly inexpensively, and I know we’ve had many commenters sing the site’s praises before.)
And again, GOOD FOR YOU for being suspicious and cautious. Personally, what little I’ve read in the past couple hours while working on this column scared the crap out of me, so I don’t know what I’d do either. (But to be fair, the Internet is sooooo good at scaring the crap out of me, just in general.)

Amalah
About the Author

Amy Corbett Storch

Amalah

Amalah is a pseudonym of Amy Corbett Storch. She is the author of the Advice Smackdown and Bounce Back. You can follow Amy’s daily mothering adventures at Ama...

Amalah is a pseudonym of Amy Corbett Storch. She is the author of the Advice Smackdown and Bounce Back. You can follow Amy’s daily mothering adventures at Amalah. Also, it’s pronounced AIM-ah-lah.

If there is a question you would like answered on the Advice Smackdown, please submit it to amyadvice@gmail.com.

Amy also documented her second pregnancy (with Ezra) in our wildly popular Weekly Pregnancy Calendar, Zero to Forty.

Amy is mother to rising first-grader Noah, preschooler Ezra, and toddler Ike.

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