The long and painful journey of Roaccutane (isotretinoin)

When I first started on Roaccutane, I searched for various peoples experiences on the drug.

The problems I found were:
1) The writers or youtube videos were mostly from people the the USA. Anyone above the poverty line in America will have been seeing a dermatologist since they were about 5, and the FDA approvals and drug doses of Roaccutane are vastly different to the UK. Both these factors meant that whilst they could be helpful, they also had to be taken with a pinch of salt.
2) The writers or youtube "stars" were all about 12. They therefore had no other skin care concerns beyond the acne. No aging to worry about. Yes I wanted to fix my acne, but I also don't have teenage skin that bounces back from anything. Similarly 99% of them had oily skin which can tolerate the same force of product as a rhino, I do not.
3) It was almost impossible to find any advice one what skincare you GENUINELY can and can't use whilst taking the drug, because they just recommend moisturiser and lipbalm...oh and the wondrous cetaphil. As a 28 year old product junkie, this was not going to cut it.

For this reason, I feel this blog post might be helpful to some thinking about starting the medication.

So, lets start on a bit of education about why acne occurs, because then the understanding of how to fix it will make more sense.

The cause of acne on a skin level has a number of facets.
1) Generally more oil is produced. This may be all over the face or in certain areas. In reality, only a very small percentage of the population have a true oily skin, and these are the only people that should be using skin care lines dedicated to acne.
2) The oil is stickier than in someone without this problem.
It is worth noting that testosterone boosts the product of oil which is why during pre menstrual or menstrual times you can get spots, particularly along the jaw line.

3) The skin cells around the "pores" - pores being the area around a hair follicle - are sticky and lazy. This means that rather than the body natural exfoliating and losing these skin cells, they stick, layer up, block the oil which naturally occurs around a hair, and cause a big blockage.

This blockage can present as a blackhead or white head (closed or open comedones)

The trapped oil as discussed above, becomes trapped and forms a white blocked area. If exposed to the air this discolours and turns dark - making a black head.

If the area becomes infected with bacteria, which is mostly likely will be as nice sticky skin cells and oil are an ideal breeding ground for bacteria, the area becomes red, inflamed, and will often contain pus. This is your spot.

I am now going to insert a few photos. Please be nice. This is my skin at its worst and at its regular slightly less than awful state.

This was at a calmer time, however you can still see all the bumps under the skin waiting to arise,
and the spots that are present are the typical ones I would get

Comedones ahoy

So I started taking my Roaccutane in October 2017. I was started on a low dose. All dermatologists do things differently, some blast you with the max dose from the start, but considering the list of side effects of isotretinoin is as long as your arm, and is powerful enough to cause foetal abnormalities, I was quite happy to start slow.

By January I was on the max dose of 60mg. In the UK Drs are only allowed to give a max of 1mg per kilo body weight, in the USA the doses can go up to double.

I noticed in the first month a bit of a "purge" of my skin. Roaccutane reduces keratin in the skin, switches off your oil glands and causes your skin to "turnover" (shed and replace itself) more quickly. Therefore all the crap that was lurking in the pores ready to give months of hell, instead gives the hell in a shorter faster burst.

That being said, I did not have a single cystic spot for the whole time I was on the medication unless it was self caused by the dreaded picking.

Very soon on, my lips felt like they were going to fall off, and I don't mean the bit of dryness you get from going out in the cold, I mean crack-until-they-bleed dry. Fortunately I had products on hand to deal with this, to the point where the dermatologist was concerned I was not metabolising the drug as my lips did not appear dry (score). Despite this, every smile or yawn caused another split and even wiping with a towel would cause a layer of skin to come off.

I used many products I probably shouldn't have which led to extreme chemical burns, then flaking like a shedding snake, then finally peeling.


My body skin did not suffer at all except for a slight bit of dryness on my knees.

Beyond the more superficial side effects, I had a constant upset stomach, my knees ached to the point I could not run for the last month of treatment and are only just recovering a month post finishing it. My feet and ankles were also extremely painful which, as someone who spends most the day on their week, was unpleasant. Whilst I had no back pain I did spend a fortune on physios to fix the various neck and shoulder pains I had. Also, your eyes will be dry, and your nose will feel like the Sahara desert but with added bleeding. Be prepared for your tissues to be blood stained for the next 6 months.

So...back to the superficial stuff.

I have made a table of things I found helpful, and REALLY not helpful as well as links to the products. Feel free to shop around for better prices.

Product	What for	Outcome
Snowfire ointment https://www.amazon.co.uk/Snowfire-Ointment-Stick-emollient-ointment/dp/B002YIXRRO	Lips, cuticles	This is the only lipbalm I have ever used at night but it became a necessity to have one in every bag, every room of the house, my car, because every other lip balm , at worst – burnt , at best – did nothing. They are also reaalllyy cheap. Bear in mind there is absolutely nothing glamourous about it. It smells funny and makes your lips a bit white. 3 months into roaccutane you wont care.
Cereve hydrating cleanser http://www.boots.com/cerave-hydrating-cleanser-236ml-10246701	Facial cleanser	Nicer to use than the bog standard Cetaphil, but is fragrance, soap, preservative etc free. This one also contains ceramides which are crucial for restoring the skins barrier which is destroyed by the sun, air con, heating, roaccutane and products you shouldn’t use when taking roaccutane…
The ordinary advanced retinoid 2% http://theordinary.com/product/rdn-advanced-retinoid-2pct-30ml	If you are concerned about aging or skin texture	Whilst I knew the roaccutane would clear the acne from the pore level, as a product junkie I was unprepared to give up the lovely smooth even skin you get from using a topical retinol. I – stupidly – tried using my usual beloved Neostrata retinol NAG and woke up looking like a beetroot with intense burning painful skin, this progressed to skin so flaky it looked like I had painted PVA glue on my face which then dried, then it all peeled off. This one by the ordinary is wonderful and causes no irritation at all.
La Roche-Posay Effaclar Duo+ 40ml http://www.boots.com/la-roche-posay-effaclar-duo-40ml-10169551 The ordinary Niacinamide 10% Zinc 1% http://theordinary.com/product/rdn-niacinamide-10pct-zinc-1pct-30ml	While your skin is still purging the crap and you have a few spots or still have the fear of getting them	The effaclar duo contains the beloved benzoyl peroxide and salicylic acid (2% - the only percentage that actually works). It vastly improved my skin before even considering roaccutane and caused no irritation whilst still on it. The Niacinamide and zinc work in a plethora of ways to hydrate, limit inflammation and calm the skin. Niacinamide also has anti-aging benefits
Skinoren 20% azelaic acid cream – prescription only https://www.pharmacy2u.co.uk/skinoren.html	Bumpy skin	Whilst the roaccutane cleared my spots and any comodones (clogged pores/bumps) on the majority of my skin, I still suffered with them on my chin. Not only is azaleic acid great for exfoliating the poor it is also a great anti-inflammatory, so much so that it is one of the front line treatments for rosacea which is about the most inflammatory cosmetic skin condition out there . It also works in preventing melasma, which I also suffer from so this was a triple winner.
Dermalogica active moist https://www.dermalogica.co.uk/active-moist/14,en_GB,pd.html La roche posay toleriane fluid http://www.boots.com/la-roche-posay-toleriane-ultra-fluide-40ml-10189529 toleriane rich LIMITED AREAS OF THE FACE ONLY https://www.lookfantastic.com/la-roche-posay-toleriane-riche-soothing-protective-cream-40ml/11091889.html	Oil free moisturisers that actually moisturise	It is beyond a struggle to find oil free products that are moisturising enough to use during the drying process of roaccutane. Similarly, if you are anything like me, I became sensitive to EVERYTHING, so fragrance was also a no no . Also be prepared to use 2 different moisturisers for different areas of your face. I do not suffer with black heads, comodones etc around my eyes and cheek bones but these dried the most so I used Toleriane rich in these areas
Hyaluronic Acid 2% + B5 http://theordinary.com/product/rdn-hyaluronic-acid-2pct-b5-30ml If you want to be fancy.. NIOD Multi molecular hyaluronic acid complex http://niod.com/product/multi-molecular-hyaluronic-complex-15ml	If a moisturiser alone is not enough	My skin has now become used to having an oil free moisturiser over the whole face, with maybe an added top up with something heavier just around the eye/cheek bone area, however there are days it needs something more. These products do not clog. Hyaluronic acid and glycerine are “humectants” i.e. they attract and hold water, up to 100’s of times their weight in water in fact. They are therefore very helpful in products to keep the skin hydrated and less like a snake shedding itself.
Vaseline body moisturiser worked perfectly fine for me. It has a slight fragrance but I believe they do a fragrance free and even with my prolonged chlorine exposure I felt moisturised even until the end of the day https://www.superdrug.com/Vaseline/Vaseline-Intensive-Care-Essential-Lotion-400ml/p/320602	Body moisturiser	I swim every day, so I was fully prepared at the start of treatment for my body skin to crack into a million pieces and fall off. I did not experience any issues. I also had waxing done on my body with no problem, but you would have to check this.
Ren evercalm ultra comforting face mask https://www.renskincare.com/uk/evercalm-ultra-comforting-rescue-mask.html	Emergency situations where you have used one of the products below that you shouldn’t have and have burned yourself like a sun dried tomato.	This was the only thing that took down redness that wasn’t a leave on product. I did not want a cream that was left on because all the healing ones are packed with oil, shea butter etc so this mask was a good compromise, particularly for times when I needed my skin to look ok, e.g. parties where I just needed it to CALM THE F*** DOWN.
SkinCeuticals Protect Sheer Mineral UV Defense SPF 50 https://www.amazon.co.uk/SkinCeuticals-Protect-Sheer-Mineral-Defense/dp/B005GK7C64 You can also get this in the tinted form as this does leave a white cast on the skin, which can be hidden by make up if needed EltaMD UV Clear Broad-Spectrum SPF 46 TINTED https://eltamd.com/product/uv-clear-broad-spectrum-spf-46/	Sunscreen	I used to HATE sunscreen. I would use it and immediately or post holiday get more spots. I realise now that the sun has a temporary anti inflammatory effect so will, whilst exposed, reduce the spot size. It also however increases oil production, increases the thickness of the skin and increases the cells clogging the pores. Therefore as soon as you come home BOOM even more spots than you had before which is enough to render that lovely golden tan completely pointless. Of course the sun is also extremely damaging, increasing lines, wrinkles, dark spots and cancer risk. Physical sunscreen is a must. This one caused absolutely no break outs at all. Yay
Eye drops	For dry eyes	I was prepared for hellish dry eyes, especially considering I immerse myself in diluted bleach at the pool most days, so I used these for the first month of my treatment, and didn't seem to need them beyond that! They also do some with hyaluronic acid which are meant to hydrate longer but I found these perfectly fine.
DO NOT USE  - mistakes I made
Chemical peeling agents. Glycolic acid, neat salicylic acid, retinols. This is the burn I had an several occasions...		JUST DON’T DO IT. Retinoids however I have found to be fine, see above. I would not start using them if you have never used them before however. My skin was tolerant to the much higher levels prior to taking Roaccutane
Micro needling		JUST DON’T DO IT.
Foaming face wash		Unless you want your morning and evening routine to sting like hell and for it to not matter what you put on top because the skin surface is so dry it won’t absorb anything…don’t do it.
Facial hair removal		JUST DON’T DO IT.
Oil		I realised this quite late on. It is extremely confusing to know what to do with all the beauty press urging people with oily or acne prone skin to make sure they are hydrated. Whilst an oil like the clarins lotus oil might do wonders for an unbalanced skin, a clear skin that just gets spotty due to hormones etc , on a skin with true acne it will just lead to blocked pores. It is beyond a struggle to find oil free products that are moisturising enough to use during the drying process of roaccutane
Spot squeezing		Do not do it. Do not do it with your nails, do not do it with a tool. All that happens is you peel off the layer of skin over the spot leaving a red oozy mess with the spot still happily in tact underneath

Hope this helps !! This is where I am now. I still have a bit of bumpyness on my chin however it has gone from 1000 comedones to maybe 20 and is decreasing daily.

I could have filtered this or done my hair but I wanted to show my face, in A LOT of daylight, no make up.
There is still some redness and scarring but no spots and smooth skin!

http://skinspecialistinrajendranagar.com/what-causes-acne-whats-the-difference-in-a-normal-skin-and-a-skin-with-acne/
https://www.amazon.com/Cliganic-Blackhead-Remover-Extractor-Instructions/dp/B013P26K9O