Under My Skin: Accutane has become a popular form of acne treatment, despite its demanding treatment process and slew of harmful side effects, due to the pressure to have clear skin

Then-eighth grader Kate Whitefield glanced down at her pregnancy test result — tossing the “negative” to the side.

Well, obviously.

She knew a positive result was impossible and thought it was unnecessary for her to be on birth control.

To her, it was simply a “formality” she had to follow to take Isotretinoin, better known as Accutane. Though, taking a pregnancy test at each dermatologist appointment is actually an iPledge requirement — a program used to prevent pregnancy in people taking Isotretinoin — even for those being sexually inactive. 

“I was 14,” Whitefield said. “I assure you, [pregnancy] was not a risk in any way, shape or form. But I still had to do all that stuff.”

As a 14 year old, she felt like she had no choice. The heavily researched skincare routine packed with dermatologist recommended cleansers and prescription-grade topical creams that she had been using two to three times a day since fifth grade was no longer effective. 

Accutane, a drug used to treat severe cystic acne — acne deeply rooted in the skin — seemed like the only option. The curative six month prescription had the power to improve her acne for much longer — her self-esteem and confidence improving with it.

Accutane has become a mainstream acne treatment despite the demanding treatment process and slew of potential side effects. As other antibiotics fail to cure cystic acne, teenagers who see the medication as a last resort must deal with its potentially harmful side effects: back pain, increased sun sensitivity, dry skin, lips and mouth.

The treatment course has become one of the most popular and effective forms of acne treatment. 19% of East students have been on Accutane at some point, according to an Instagram poll of 191 voters. Junior Reid Minto is one of them.

Prescription-strength acne lotion wasn’t effective for then-freshman Minto — only peeling off his skin, without clearing the cystic acne with it. After Minto failed prior creams, his dermatologist handed him an Accutane warning pamphlet that unfolded to be 4 feet long.

“[Going on Accutane] definitely seems kind of intimidating, but the dermatologist talked us through all of the side effects,” Minto said. “She had a lot of other people who had gone through with it, so I didn’t think that there was too big of a risk.”

While birth control or pregnancy was never a concern for Minto, both he and Whitefield were required to complete monthly check-ups with their dermatologist, bi-weekly blood tests and sign a form pledging abstinence — required for all genders — according to Minto.

Despite the hassle, Minto recalls the constant monitoring to be worth it for the curative acne treatment that he wasn’t able to find in any other form of medication. Accutane’s rate of success — around 85% — is the reason pediatric nurse practitioner in dermatology for 16 years and East parent Dr. Karna Bock thinks it’s so widespread. 

“They want to get clear skin, that’s the desire,” Bock said. “Accutane is more of a curative treatment, since it’s going to get kids pretty clear and keep them fairly clear after the treatment course is done.”

Many Accutane users have tried other antibiotics like tretinoin or prescription-strength acne lotion, which are often effective for less severe acne, yet yield less permanent results for severe, cystic acne. For Minto, this was the difference — Accutane was a cure.

“Probably for the first three, maybe four months, I had just as much acne if not slightly more, because my skin was getting drier and it didn’t really feel like it was working. Then, in the final month or two, my acne started dramatically disappearing and it would stay gone, which is something that it hadn’t ever [done] before.”

Reid Minto, Junior

Testaments to Accutane’s effectiveness are why it was recommended to senior Marin Bryant by her dermatologist as well — after consulting dermatologists for acne treatments since eighth grade and using other products like spironolactone and other various pills. 

Being two months into the process, Bryant has yet to see the disappearance of acne that occurs in the last months of treatment. However, she has noticed the common symptoms like dryness of the skin and mouth, as well as back pain.

“I was just so excited to finally be done with the acne journey,” Bryant said. “I do learn about a new side effect every day. I’ll be like, ‘Oh my back hurts, oh my skin is really dry.’” 

Despite its prevalence amongst East community members, Bock says dermatologists prescribe Accutane as a last resort — the big gun, she calls it, due to its potentially extreme side effects.

“It’s a medicine that we’re going to be a little bit more thoughtful about before we pull it out as a treatment for some cases,” Bock said.

Side effects range from dry skin and chapped lips to birth defects when a user is pregnant. Unless a patient has failed a number of other acne treatments or experiences disruptive cystic acne, dermatologists avoid prescribing the medication, Bock said.

After hearing of the possible side effects on TikTok, then-sophomore Elison Holy would lather through the burning sensation that came from rubbing a prescription topical ointment onto her face in an attempt to treat her pimples which spread down the center of her face. She refused to go on Accutane.

“I had heard that it makes your acne worse. And that was my main big thing. I was like, ‘I don’t want that. I really don’t want my acne to get worse.’”

Elison Holy, Senior

According to Bock, the medication can intensify acne in the first few months of treatment. However, this result is less common than side effects like increased sun sensitivity and dryness of the lips, skin and eyes.

Despite her protests, Holy’s dermatologist ultimately decided that Accutane was the best option. While the six-month treatment did clear up her skin, it didn’t come without one of the most common side effects — dry skin.

“I hated it,” Holy said. “My skin was just really dry, like, really dry. And so were my lips. It was the worst dry skin I’ve ever seen in my entire life. I’d apply so much lotion and so much chapstick and it’d just do nothing.”

A less common symptom, however, would be increased depression and anxiety — a symptom that Bock says is controversial amongst dermatologists and not proven to be associated with Accutane.

“I don’t necessarily think the medication is causing these problems,” Bock said. “I think sometimes we encounter patients that are on this medication and are just going through a lot.”

The association between Accutane and mood disorders is not proven, however, mental health issues stemming from acne certainly are, according to Bock. Teenagers struggling with acne are more likely to suffer from depression and anxiety due to the severe social stress it can cause.

“[Acne] sometimes [causes] more absences from school and mood disorders — other things that are associated with mental well-being,” Bock said. “So there’s definitely a relationship.”

While nearly every teenager will experience acne at some point, a stigma still exists around acne, according to Bock. For Whitefield, this negative perception of acne and the high beauty standard for skin forced by social media contributes to the social stress that comes with having acne.

“There’s this idea that, if you have acne, you’re unclean,” Whitefield said. “It’s like, ‘Oh my gosh, do you not wash your face?’ It makes it seem like you don’t take care of yourself. And I know that’s not true, because I washed my face two to three times a day as an 11 year old and still had oily skin and bad acne.”

The desire for lasting clear skin is what makes Accutane so popular, according to Bock. Even though she encourages teenagers to consider potential side effects before treatment, she emphasizes that the drug has cured thousands of cases of acne and contributed to improved self-esteem.

“When I was on Accutane, I saw it as a  last resort,” Whitefield said. “But since then, I’ve known several people that have been on Accutane. I thought it was sort of a very rare thing when I was on it, but it’s more common than you would think.”