It started at fourteen, a cluster of tiny pimples in the center of my forehead, a third eye. My mother bought me Clearasil wash and Stridex pads and Oxy cream. None of it worked. Mysteriously, the patch cleared up in a few months, establishing a pattern that would go on for the rest of my life: awkward acne, resistant to treatment, that eventually cleared up for no apparent reason.
Then I turned 30. Suddenly the acne was persistent, no longer limited to my face, consistently covering my back, often my chest. This is somewhat common for many women: changing hormones, the body saying Hurry the fuck up and breed. I tried more creams, more washes, antibiotics, hormone blockers, supplements, a change in diet. Nothing worked. There was one option left.
Isotretinoin, commonly referred to as Accutane, is the only proven cure for acne. I’d toyed with taking it before but concluded my acne wasn’t bad enough to account for the risks. It’s an extreme medication, essentially poisoning the body with Vitamin A, the side effects numerous and severe. Chapped, flaky lips are a guarantee. It is likely your skin will experience the same. Other possibilities include excessive thirst, greater sensitivity to sunlight, hair loss, nosebleeds, rashes. And then there are the extremes, things like developing Crohn’s disease, permanent muscle or eye damage, or death. But the effects that scare me most: depression, suicidality, psychosis.
I have bipolar disorder, type 1, the most severe kind. I oscillated through depression for years, attempted suicide four times, have been officially psychotic twice. These are facts. It took most of my life to get stable, through tons of therapy and psychiatric medication. So now, it seems stupid to potentially give up all this hard work to get rid of moderate acne, but my psychiatrist and dermatologist aren’t concerned. I’m so sick of the acne, so sick of being made insecure by something so objectively stupid and small, that finally I decide to risk it. I will do it. I will go nuclear.
Anyone who wants to get on Accutane is required to sign a page-long release, initialing here and here that you understand the side effects. And if you are a woman capable of childbearing who admits to having sex with men, you also get to initial a second page-long form, which contains diagrams of babies with elongated heads and haughty faces.
Then you get sent home with an illustrated book that goes into detail about birth defects and birth control. You have to agree to two separate types of birth control. I have a copper IUD, 99.9 percent effective, and no moral reservations when it comes to abortion, so I lie and claim I’ll also use male latex condoms. Every month, I will take a pregnancy blood test, wait for the results, and then answer a short yet tedious quiz about birth control. From there, I have exactly seven days to fill the prescription; otherwise, I’ll have to begin the process again.
I spend hours reading acne forums, Reddit threads, and beauty articles about Accutane. I even go through academic journals, charts and numbers about effectiveness and risks and dosage. The day I get my prescription, I deploy the arsenal of moisturizing products I’ve been storing up since I initially decided to go on Accutane.
I learn there is something inherently different about buying beauty products when the goal is to hydrate rather than deslick. With acne products, it is implicit that you are gross; you need to get rid of the oils bubbling out of your body. But hydrating products are there to add, not subtract, making me feel like I soon will be fragile and delicate. Even the color schemes of the products are different: instead of sickly oranges and greens, the packages come in hues of aqua and rose.