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Beauty Pretty and pain: my experience with acne, Accutane, and expectations

Jan. 30, 2019
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Photo by Charlotte Bae

My earliest memory of acne takes place on the floor of my childhood bedroom, my head resting in my mother’s lap as she pressed the looped end of a small metal rod—lovingly dubbed “the pimple extractor”—into my cheek. I remember protest, then resignation. It is hardwired into our bodies to resist pain, to squirm and fuss until the sensation subsides. This was my initial reaction to the probing of my pores. After a moment, though, I gathered myself. I deferred to the discomfort based on a knowledge programmed so seamlessly into my thinking that it feels almost as instinctual as resistance to hurt—this blemish is an aberration. I’ll be better off if it’s gone, by whatever means are required. I was eight years old.

It wasn’t until I was eleven that my skin truly began to escalate. Upon the onset of puberty, cystic pimples began springing up across my face, and their presence became intertwined with my perception of self. I tried to cover the bright red acne splotches with makeup, to little avail. I squeezed and poked and prodded. I attended semi-regular dermatologist visits, and slathered my face in prescribed creams. My acne was severe, not by a metric of surface area covered, but in its persistence. I was told repeatedly throughout my adolescence that within a couple years, a couple months, or a couple weeks on whatever new product I was using, my skin would be pristine. This was never true, but it didn’t keep me from trying things.

When your worst physical insecurity is also your most visible one, there is little that you won’t do in order to see it gone for good. By fifteen, I was on birth control in an attempt to regulate acne-causing hormones. The pill did help to quell the acne that spread over my chest and across my shoulder blades, but did little to reduce the markings on my face. This prescription, recommended by my dermatologist, came after years of topicals that, against my belligerent skin, were largely ineffective. At this point I was beginning to lose my patience with medicine, and started to explore other methods of skincare for persistent, cystic acne. I tried microdermabrasion, a treatment meant to reduce the appearance of acne scars, enlarged pores, and active acne, which involves exfoliation by a diamond-tipped pen. The pen is used to scrape the outermost layer of the skin, then suction off the excess. The process is not outright painful, but it is the type of sensation you want to bat away with your hands, the kind of discomfort that makes your toes curl. I also experimented with essential oils, particularly tea tree oil, whose antibacterial properties make it a popular natural spot treatment. The oil is deceptively strong, and even when diluted with water it stung my sensitive skin. I stopped using it before bed after waking up with a mild chemical burn. I tried masks, coconut and jojoba oil, switching up my makeup, and cutting out dairy (I didn’t last more than a week). And when none of that worked, I bent over the vanity and went to work with the pimple extractor. My acne seemed incurable.

I hit a low point at the start of my senior year. I was coming into my final year of high school feeling confident in the person that I was evolving into. My writing was getting stronger, I felt closer to my friends, and, while the application process was certainly daunting, my heart was light with the promise of better, more stimulating years ahead—college. But even then, I was off balance. Whatever confidence I had in my character could be extinguished by a passing glance at my reflection in a store window, or a confrontation with my bathroom mirror. This was supposed to be over by now. And yet, there was my face, staring back at me in the glass, covered in cysts so inflamed that full-coverage foundation was less of a mask and more of a formality. At least she’s trying. Turning eighteen would mark seven years of never feeling pretty. Never feeling even just okay with how I looked. Never feeling whole. That kind of turmoil over a period of years—formative years—can do a lot to deteriorate one’s emotional state. I spent a lot of time crying at the beginning of my senior year. One day, the sight of my skin made me cry so hard that I decided it was time to do something drastic. I had to try Accutane. I had to.

Accutane, for the unfamiliar, is a sort of nuclear option for acne sufferers. Accutane, as Isotretinoin is formally known, is a vitamin A derivative, taken orally over the course of anywhere from three to eight months. It activates a process of programmatic cell death in the sebaceous glands, where oil known as sebum is created. The buildup of this sebum can lead to clogged pores, which, when infected by acne-causing bacteria, results in blackheads, whiteheads, and the cysts with which I had become overly familiar. Accutane is widely touted as a decisive, permanent cure for acne. A quick Google search can convert a skeptic to a believer. In researching the drug, I was flooded with before and after pictures, featuring cases far more dire than my own which resolved to pristine, radiant skin. The results I saw in others granted me a renewed sense of hope. These blemishes on my face could, in fact, be a conquerable occupant.

In conjunction with all the promising results, however, my research turned up a laundry list of side effects, some of which were described with almost affectionate annoyance from those who’d found success with the drug, and some of which were expressed through parental alarm and complete disavowal. Almost every Accutane story I read or watched described dryness of the lips, eyes, nose, and hair, as well as increased fragility of the skin in general, causing tearing, rashes, and greater sensitivity to sunlight. Some users detailed experiences of painful migraines as well as muscle and joint aches. The most frightening reports included descriptions of escalating depression and even suicides that had potential linkage to the drug. For many of the more serious side effects, cases are rare, and whether or not they can be directly correlated to Accutane is questionable. Even so, they remained present in the back of my mind as I embarked on my six-month Accutane journey, quieted by the promise of an end to my distress, and, of course, the promise of pretty.

Each month on Accutane I needed to get my blood drawn before my prescription could be renewed to ensure that the increased triglycerides in my bloodstream as a result of the medication hadn’t reached threatening levels. I also had to take a pregnancy test, as Accutane is a notorious teratogen. Accutane users must commit to abstinence or the usage of two or more forms of birth control due to a high risk of birth defects while it’s in their system. Drinking is also strongly discouraged, as Accutane users are at an increased risk of liver damage. Within the first two months of Accutane, I suffered from the occasional nose bleed, and experienced an “initial breakout,” a sudden worsening of acne as an immediate response to the drug. For the entire course, my lips and face were so dry that I took to fingerpainting a layer of Aquaphor over my entire face each night before bed in an attempt to combat tearing. An eczema-like rash would shoot up the backs of my hands and around my wrists every now and again. I drank water like it was my job just to stave off the pulsing headaches Accutane wrought. But, all of this aside, I was lucky enough not to suffer the worst of the side effects. My hair didn’t fall out, my body didn’t hurt, and my mental state only improved as my skin got better and better.

Today my skin is almost perfect. While I still suffer from the occasional breakout, my face is smooth and largely unmarked for the first time since my childhood. Since my course ended in April of 2018, the way that I think about myself has changed drastically. The reflection that once brought me to tears now sparks in me a triumphant grin, a genuine feeling of confidence. For me, Accutane was a miracle cure, not only for acne, but for a deeply entrenched self-loathing that actively undermined whatever self-love I could derive from my talents, my relationships, and my accomplishments. It’s being able to look back on this broken self-image that gives me pause. How could I have internalized standards of aesthetic beauty so deeply that pain—in the form of a tool that prodded, in the form of chemicals that stung and treatments that scraped, in the form of a monthly needle in my arm and torn lips and the potential for far worse than what I endured—seemed like a reasonable price to pay for conventional attractiveness?

As my relationship with beauty has evolved, I’ve begun to pay closer attention to the role of cultural coercion in how I use my autonomy. Using Accutane was a choice that I made. I knew what the side effects were, however uncommon some of them may have been. I understood what I was getting myself into. It’s the motivations behind that choice that concern me: wearing makeup around my own house so that I didn’t have to face my face, comparing myself unrelentingly to my peers, feeling disgust at my own appearance, and assuming that others did, too. This anxiety about the way that I looked, learning from societal standards to view my skin as aberrant, was what drove my choice. “Acne” and “ugly” had become synonyms in my mind, because that was what had been reinforced in nearly every mainstream representation of beauty to which I was exposed. Even as I consumed body-positive media and read feminist works, I couldn’t apply the standards of acceptance and love to myself that I had learned to apply to others. I made the choice to try Accutane because I couldn’t exist comfortably in contrast with expectation. I had to take action to undo the damage that was being done to my sense of self. Under those stakes, of course some amount of pain seemed worth it. It was worth it. But I am reluctant to treat accepting and enduring this pain as my choice, because doing something drastic felt like a necessity.

I’m not anti-Accutane. I’m not embarking on some anti-treatment crusade. If you’re struggling with persistent acne, physically or emotionally, I highly recommend discussing the possibility of starting Accutane with your dermatologist. My skin is clear, my side effects were mild, and my relationship with my appearance has improved exponentially. Everyone deserves to feel the way that I do now. But taking the time to interrogate a culture that tells young women that pretty has to hurt, that discomfort is mandatory if you want to be able to hold your own gaze in the mirror, is worthwhile too. Acne is not the aberration. A culture that perpetuates self-hatred—that makes us choose pain—is.