Everything You Want to Know About Taking Accutane: A PA's Perspective

I’ve never blogged, grammed, storied, tweeted, or even mentioned my skin in any of my content. If you’ve seen my Instagram, you might be surprised to learn that I recently finished a 6 month course of Accutane for cystic acne. (But maybe not that surprised because my partner is a professional photographer/editor and I’m a makeup junkie.) ;) While I do feel a little guilty for “misrepresenting myself,” there is no way I could’ve continually posted content with my active breakouts, as I was so self-conscious of my skin.  

My struggle w/ acne started in middle school and over the years, I have probably tried every regimen known to woman, most recently things like Curology, La Roche-Posay, The Ordinary, topical retinoids, aztec clay masking, hydrafacials, and courses of doxycycline. Back in the day it was Stridex pads, Clean & Clear, and yes St. Ives Apricot Scrub. Nothing worked, and my acne started spreading to my chest and back. Fed up and armed with newly active health insurance, I made an appointment with Dr. Ardalan Minokadeh at SkinCare & Laser Physicians of Beverly Hills. He felt that I was a perfect candidate for isotretinoin (commonly known as Accutane), reassured me about all the scary side effects I’d heard about, and started me on Absorica (a brand of isotretinoin) 40 mg daily. In my teens I really wanted to take Accutane but my mom didn’t let me, she was worried about side effects. Love you, mom.

Pictured: 10 days before starting medication

In case you didn’t know → “Accutane” is a brand name for the medication isotretinoin. The original “Accutane” was approved in the early 80s but was removed from the market in 2009. Today, there are many different brands of isotretinoin on the market (Absorica, Clavaris, Mysorian, Zenatane, etc), but pretty much everyone refers to it as “Accutane” (& I will do so for the rest of this post). 

So now that my secret is out (and my acne is GONE!!!) I wanted to answer some questions that I had prior to starting and tell anyone who is considering it about my experience. I spent countless hours scrolling my phone reading /r/accutane, texting my dermatologist (thank you Dr A), and agonizing over the details. 

FIRST THINGS FIRST → I have no regrets, I have never had more beautiful skin in my entire life (even with the dryness), and I would recommend it to anyone who is tired of their cystic acne. I will talk about side effects too because it definitely wasn’t an easy medication to be on. Now, I’m working with my derm to address the scarring left over from my acne.  

Accutane FAQ

How does the medication work? 

Isotretinoin, a derivative of Vitamin A, works in 4 ways to address acne. It shrinks the oil glands in the skin, targets acne-causing bacteria, slows the turnover of cells (meaning less build up in your pores), and has anti-inflammatory properties. This mechanism is also the cause for the extreme dryness many patients will experience. 

Which brand of isotretinoin did you take? What was the dose?

I took Absorica 40 mg once a day for 2 months, then my dose was increased to twice a day for the remaining 4 months. Most isotretinoin products need to be taken with a fatty meal for proper absorption. Absorica can be taken with or without food (and I’m the world’s worst about skipping breakfast). Absorica usually requires prior authorization from your insurance. Without insurance, Absorica costs about $2800 a month, and you need to take it for at least 6 months. (Hey, pharmaceutical industry → you’re criminal.) 


Did you purge? 

Yes, for the first 2 months before my dose was increased to twice daily, my skin was a lovely combination of peeling from dryness and large painful bumps beneath the skin that would surface and bleed. After increasing to twice daily, it cleared up almost instantly and was pretty much perfect for the last 4 months of treatment (except for dryness, the dryness is still resolving now). Pictured: 70 days into treatment.

That’s pretty much it. I had to avoid pretty almost all other products because they irritated my skin too badly. 

What kinds of things can you not do while on Accutane?

It felt like I wasn’t able to do anything. I had to minimize my time in the sun (not easy in the summer in LA) and be obsessive about reapplying sunscreen. A combo of a facemask and large sunglasses helped a lot. I couldn’t get any type of procedure (facials, laser hair removal, botox, waxing, microneedling, tattoos, etc). My skin even became sensitive to shaving (I’m glad armpit hair is trendy now!) You should also minimize alcohol intake while on Accutane, as your liver is already working hard to process the medication. AND GOD KNOWS DON’T EVEN THINK ABOUT HAVING SEX (this is sort of a joke, see below).

What is the iPledge program? 

The iPledge program is a Risk Evaluation and Mitigation Strategy (REMS) with really strict prescribing & dispensing guidelines all aimed to prevent pregnancy. Any female taking the medication MUST be enrolled in the program and have a negative pregnancy test every single month. You actually can’t start Accutane on your first visit, you must take a pregnancy test, wait an entire month, take another pregnancy test and only then can you start the medication. (Males can start right away but whatev… the patriarchy.) You also have to be on 2 forms of birth control (aka condoms and The Pill or IUD and condoms) OR pledge abstinence for the next 7 months. There is no “I date women” option on the forms. Weird.  There is a very little window in which you can take your pregnancy test & pick up the prescription. If you miss that window, you have to start all over that month. On top of that, you must also take a very patronizing quiz each month demonstrating that you understand not to get pregnant or share your medication. You then enter your forms of birth control again before your pharmacy is allowed to dispense the prescription.  In my opinion, this wastes money on pregnancy tests and insults womens’ intelligence. BUT I DID IT and the clear skin was worth it.

Do you prescribe Accutane? 

Actually, yes. After taking it myself and learning about prescribing guidelines, I registered with iPledge to become a prescriber. I only have a handful of Accutane patients but we have fun, comparing our outcomes month by month, discussing side effects and skincare regimens. I keep an eye on their lipids, liver enzymes, mood, musculoskeletal symptoms, etc. If you’d like to talk about YOUR skin - register as my patient! I take virtual patients from all over.

So you finished your 6 month course - What now? 

Ever since stopping, my skin has been clear as can be. I still have scarring (both icepick and hyperpigmentation) left over from years of popping the same zits. I also have a lot of redness in the cheeks. I’m discussing a few different things with my dermatologist including microneedling and Fraxel laser treatment. I still try to be diligent about sunscreen and I’ve always had very sensitive skin anyway. See my end results below! Completely unedited, unfiltered photos with no makeup.

Thanks so much for stopping by and reading about my journey on Accutane! If you have questions, drop me a comment or DM me on Instagram @coutureinclinic.
Like skincare content? Check out my first time getting microneedling!

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