Recently, I've embarked on my second course of Accutane (Isotretinoin, to be more exact). For those of you who think acne means a little red spot you treat with an adorable dot of benzoyl peroxide, Accutane is like a severe Sudanese drought in pill form. Your body basically halts oil production, which means your lips crack like the floor of the desert but you can go a full week without washing your hair or needing dry shampoo (a consolation prize). At the end of a 4-5 month course of medication, you will have the most beautiful, baby fresh skin and the impact lasts years. I was in high school when I went on my first course of Accutane. My acne started to re-emerge 2 years ago, not as badly as it was before Accutane but still bad. As of right now, my 23-year-old skin looks like I’m 16 again…and not in a good, “just prepubescent-looking enough to be Bradley Cooper’s next girlfriend” sort of way.
Accutane is not for the faint of heart and I was hesitant to go through it all again. Besides the fact that you molt like a reptile for months and put yourself at a risk for Chron’s disease, there are lots of blood tests involved and you basically have to sacrifice a goat and pledge your first born child to the Accutane gods just to convince them that you won’t get pregnant while on the medication. I tried every birth control, antibiotic, retinoid, laser, and peel I could get my hands on. I even tried that “eliminating dairy” thing that all the health nut masochists swear by for clearing up my skin (But come on, who voluntarily chooses a cheese-free life? That’s cruel and unusual). Nothing worked, and I still had to spackle on Dermablend (aka the makeup they use to cover tattoos with) just to look presentable.
Rather than try to ride out whatever wave of adult hormones was pummeling me and risk permanent scarring, I decided to give Accutane another try. But a little preparation can go a long way in helping you feel and look better while the medication does its thing! I created this survival guide for myself and anyone else braving the metaphorical desert on Accutane.
If you gave yourself a panic attack after that “Accutane skin” Google image search, just remember that the only way to avoid looking like a Komodo dragon peeling off your exoskeleton is to hydrate your skin. Don’t freak out, treat your new skincare routine like a daily trip to the spa. This is your chance to use all those moisturizing products you felt too oily to indulge in before. You’re also killing two birds with one stone: soothing your irritated skin and practicing skin care habits that your older, wiser, wrinklier self will thank you for!
Start your daytime skin care routine by wiping your face with micellar water on a cotton round. Oil and grime builds up on the skin surface when you sleep so it's important to cleanse in the morning, even if your skin feels clean. Because micellar water is made up of tiny oil molecules, the water attracts any oil and dirt on the skin without drying the skin. Take care not to rub the cotton round too harshly on your skin and try to use upward motions! Simple's micellar water is cheap and effective but the Bioderma version is a cult favorite. After the micellar water, cleanse with a soothing, PH-balanced cleanser like Glossier's Milky Jelly. I'm obsessed with this product because it has this magic ability to make my skin both clean AND moisturized (possibly because it uses poloxamer, the mild cleansing agent found in contact lens solution). It's really important that your cleanser has no harsh ingredients or chemical fragrances! (Milky Jelly passes this test and smells good due to being 1/4 rosewater). You might be used to a rougher cleansing method from your pre-Accutane days but it's important that the way you wash your face doesn't irritate your skin now that it's extra dry and sensitive. Check out this video for a crash course on cleansing your skin the French way.
It might be tempting to go to town exfoliating if your skin has become flakey on Accutane but don't exfoliate your face more than twice a week. Avoid harsh microbeads or chemicals and opt for something soft like Elemis' Gentle Rose Exfoliator. Lip exfoliation will most likely be a daily part of your routine as the lips seem to really dry out on Accutane. The best exfoliation method for lips is to dry them and use a toothbrush or wash cloth to brush away dead skin. I recommend a sugar scrub if the skin is stubborn, which you can either buy from Lush or make yourself.
The first thing I moisturize is my lips right after they've been exfoliated. Your doctor will most likely recommend Aquaphor or Vaseline but in my experience, nothing has worked as well as Homeoplasmine, a French favorite and miracle worker! After my lips, I mist my face with Avene Thermal Spring Water. Having a moist face before moisturizing boosts the efficacy of the moisturizer (besides, it's pretty refreshing). After misting, I apply Neutrogena's Hydro Boost Water Gel to my face and the top of my neck. I love this product because it has hyaluronic acid (which is basically a tall glass of water for your skin). Plus, it's super lightweight and non-greasy so it plays nice with makeup and other products I might use during the day. If I'm planning on going sans makeup, I'll follow the moisturizer with a Coola sunscreen on my face, neck, and ears.
Cleansing in the evening is identical to the daytime routine except a creamier cleanser should be used if removing heavy makeup. The Liz Earle Cleanse & Polish Hot Cloth system is a perfect addition to an Accutane users arsenal because its soothing lotion texture cleanses without being abrasive or stripping to your sensitive skin. I also added Biore Deep Cleansing Pore Strips to the exfoliation process. As tortured as my pre-Accutane skin was, I actually never had a problem with blackheads. About 2 weeks into my course, blackheads covered my chin and nose area. Because dead, dry skin might cause a build up in certain areas of your face during Accutane use, be warned that blackheads may be a new skin issue you might have to contend with. The good news is that they're much easier to deal with than whiteheads! A well-placed Biore strip can uproot them pretty easily.
Serums might seem like a superfluous step in a skincare routine but their high potency ingredients can really help you achieve your skincare goals. Since moisture is the primary goal for Accutane users, choose a serum with hydrating properties, like Vichy's Aqualia Thermal Dynamic Hydration Power Serum. Serums are some of the most costly skincare products but they can make all the difference when your skin is going through a drastic change like Accutane. Mist your face with Avene Thermal Spring Water before applying serum or moisturizer. If your lips are really suffering, you may want to try applying a lip mask before bed so your lips can soak in the ingredients while you sleep. Laneige Lip Sleeping Mask is so nourishing that it helps repair lips and makes them appear more voluminous in the morning (a cheaper alternative to the Kylie Jenner filler route). The final step of your evening routine should be a heavier, fragrance-free moisturizer. I use Vanicream, which is often recommended by dermatologists. The formula is very heavy so a little goes a long way and I try to give it time to dry before I go to sleep. Moisturizing at the very end of your routine seals all the products that were placed on the skin and creates a barrier against pollutants that may attempt to penetrate your skin's surface while you sleep.
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I have the world’s oiliest hair so a week ago when my stylist said my scalp was dry, I knew it had to be the Accutane working its magic. My first time on Accutane, not having to wash my hair constantly was one of the biggest perks of the medication. Now, as a slightly less oily adult, I’m more concerned about my hair drying out too much and causing breakage or dandruff. My stylist recommended a weekly mask and to use a heat protector/leave in moisturizer after every wash. My hair is pretty receptive to moisturizing products so my masks are not very advanced: I either put a reparative conditioner or coconut oil on my hair when it’s warm and damp and let it set for 15 minutes before rinsing it. With a drier scalp, it’s also important not to over-shampoo or use shampoos that have oil-stripping properties (basically anything that says it’s “clarifying” or for volume).
As your doctor should have informed you, Accutane can do a number on your insides. Beyond just a pregnancy test, the monthly blood tests required for Accutane also monitor your cholesterol levels, which are at risk for being elevated while on the medication. Your doctor most likely recommended a low fat, high fiber diet to combat a rise in cholesterol while on Accutane. During my first course, my high school diet was made up predominantly of pop tarts, resulting in high cholesterol and digestive issues. Don’t put yourself in this position! In addition to taking the “low fat, high fiber” diet advice to heart, add supplements that will lend additional support.
There are many different “green” supplements on the market but I try to find formulations that have organic barley grass, spirulina, wheatgrass, blue green algae, spinach, and chorella. If the idea of adding leafy greens to all your meals makes you wince, supplements like these will be your new best friend! These will boost your fiber intake while also providing you with super nutrients and antioxidants. Make sure to follow label recommendations while taking the supplement! If you want to get the full benefits, certain formulations suggest that you don’t take the supplement with hot liquids or on a full stomach.
Unless you have an allergy, Metamucil is pretty harmless to your system and the main ingredient (psyllium husk) is a natural, gluten free fiber with many health benefits. Because my gag reflex can’t handle the orange goopyness of liquid Metamucil, I take 2-6 capsules of Metamucil daily. The label recommends that you take the capsules 2 hours after or 2 hours before taking anything else so it doesn’t mess with the effectiveness of other medications or supplements (usually I set an alarm to take it at 1 pm). Taking 6 capsules daily will help lower cholesterol, if that is your main Accutane concern, but you’ll still increase your fiber intake even if you take a smaller amount. I’ve never had any digestive issues with Metamucil but if you’re worried about any laxative-effects on your system, see how you feel after 2 capsules before taking more.
Accutane absorbs through fat so your doctor most likely recommended that you take your pill with a meal that has a healthy fat (such as avocado) so that the mediation can absorb into your system easier. After reading about the benefits of eating coconut oil, I joined the cult and now take my Accutane with my daily spoonful. Not only does a spoonful of coconut oil provide the fat for the medication to absorb, it also helps keeps things running smoothly in my digestion system. If the coconut oil tastes too waxy for you, add a dot of your favorite organic preserves to the spoonful (raspberry preserves + coconut oil = a flavor combo made in heaven).
Even in college, I never considered myself much of a drinker. However, when my doctor told me alcohol was off limits during Accutane use, I suddenly found myself getting cold sweats over the thought of a mimosa (not really but I did feel a little parched). Although I am not recommending or suggesting that you put your health at risk or ignore your doctor, it’s slightly unrealistic that an adult would not have a single sip of alcohol throughout a 5 month course of Accutane. Drinking on Accutane is a bit like drinking while taking a couple of Tylenol. Not good for you but also not fatal if you don’t have a pre-existing condition. If you were to have a single glass of wine at dinner (hypothetically, of course), what could you do to alleviate the stress on your liver? Besides hydrating like there’s no tomorrow, I recommend taking a shot of 100% cranberry juice (or more than a shot, if you can handle the bitterness). The antioxidants in the juice provide support for liver function without raising cholesterol levels.
BODY & MAKEUP
It seems like one the biggest variations for Accutane users is how the medication impacts body skin. I barely noticed anything different about my body skin on Accutane until I got a spray tan. My flaking fake bake revealed splotches of skin on my arms and chest that were significantly drier than other areas. Learn from my mistake: don't neglect the skin on the rest of your body! Even if the skin on your body doesn't feel dry, moisturize anyway. Invest in a moisturizing body wash that doesn’t have any drying ingredients or synthetic fragrances. After day showers, I use coconut oil to moisturize so that it has time to sink into the skin. After a night shower, I moisturize my body with a lotion that has no fragrances or drying ingredients but will also absorb into the skin quicker so my bed sheets don't get greasy. Ditch your foaming shave gel and switch to a cream that doesn't have many drying chemicals. Your shave will be closer and the skin on your legs will be more moisturized! Don’t exfoliate more than twice a week and don’t go overboard when you do! Dry, splotchy skin might beg to be sloughed off but being too aggressive when exfoliating will only irritate your sensitive skin. An exfoliating tool, like a Baiden mitten, can help you remove all the dead skin more effectively so you won't feel the itch to overdo it. (Also, don’t get a spray tan. Not unless you’d like to look like a leper returning from Cabo.)
Makeup is a tricky thing on Accutane, especially if any of your old products were formulated for oily skin. Foundations or powders that looked amazing pre-Accutane can look frightening while on Accutane. The best solution is to use a brand that has your shade and try to find a formulation that doesn’t have any sabotaging ingredients and plays nice with drier skin. I’ve found that tarte’s BB cream primer has the best coverage and texture for me. If you’re wary of makeup clogging your skin but can’t live with anything too sheer, these products deliver serious coverage while also being natural and oil free. I’ve found that the primer has enough coverage for me on most days and its creamy texture melts into my skin beautifully. The only downside is that they are limited in their range of shades.