What's The "Last Resort" In Treating Acne, And Is It Really The Last Resort?
Google the drug "isotretinoin," the generic drug name for Accutane, and according to the Mayo Clinic, you'll read that it "is used to treat severe disfiguring, nodular acne." They say isotretinoin should only be used after other acne medicines have been tried and failed. So why is it still so commonly prescribed for mild to moderate acne and sometimes even brought up on the first doctor visit?
When you are self-conscious about your skin, it can be hard to be objective about whether your acne warrants starting this serious drug. Many people may take it when it's unnecessary, yet others may choose to suffer when they could benefit from isotretinoin. As acne professionals who have cleared countless clients without it, and so many of those clients had even previously taken it unsuccessfully, here’s what we think.
Aestheticians really only want one thing for their clients – to see results. Our business and conscience depend on it. Acne is a chronic condition that makes it hard to treat with temporary medications (learn more here and here), because by taking oral medicine alone, you don't receive the education to understand your skin and acne. Often, once you go off the medications, you can be left worse than when you started. However, there is a time, a place, and a client for temporary medications, and a good aesthetician will also be honest about that.
If you have been told isotretinoin could answer your prayers but are looking for a second opinion – here it is. No, we are not doctors, but let's discuss the benefits of working with one regarding isotretinoin and acne.
The bottom line is that isotretinoin can work. But it requires at least four months of a heavy dose of oral vitamin A, which is hard on the liver, so you have to do regular blood work to monitor. Additionally, it is known to cause birth defects, and for that reason, patients on the prescription cannot donate blood. The large dose of vitamin A in your system reduces the size of your oil glands, reducing oil production. Oil is a significant factor in the creation of a pimple, so the hope with taking isotretinoin is that less oil = fewer pimples. You've likely heard that isotretinoin dries your skin, both your face and body, but it also causes dryness of the lips, eyes, nose, and mouth.
It doesn't exactly sound like a miracle drug, right? Especially when thinking fully through the side effects. They can range from mild (i.e., chapped lips and sensitive skin) to medium (i.e., nosebleeds, flaking skin and lips, and dry eyes), and they can even heat up from there. If you don't take precautions in the sun, you can get second-degree burns. Joint and bone pain can make it challenging to participate in sports. The list goes on and on and gets more serious, and some can be long-term.
The truth is some might have no side effects outside of minor lifestyle changes and dryness, which can be managed with topical moisture. Their acne may clear and never come back the same way – they will recommend it to their friends as a lifesaver drug. Others will have severe and chronic consequences, or after a few months, their acne comes back because they never addressed the root cause. And they may even take isotretinoin multiple times, increasing their risks. Our point is that some people jump to the med way too fast, while some suffer through stubborn acne for too long without just taking the pill. So when they say "last resort," you can see that leaves quite a bit of grey.
An honest opinion on when it's time
Finding an acne specialist and effective acne-treating products used to be difficult, but now it's easier with the internet. And if you don't live near one, most acne specialists even offer virtual consultations. It may be hard to see the value in spending $100+ on a virtual "facial treatment" but you will soon see how much education and lifestyle plays a role in treating acne. This is the direct opposite of dermatology appointments, which are short and hard to come by. To treat your acne, you need education above everything else. Isotretinoin gives you no education and does not set you up for future success, considering that acne is a chronic disease and will possibly show its head again in your future.
We are getting to the point here. Try an acne specialist aesthetician and the recommended products and lifestyle changes before you try the "last resort" drug. Any old facial treatment doesn't count. If your treatment provider doesn't have an in-depth consultation and requires you to stop using what you are using as well as give diet and lifestyle advice, then they aren't going to give you results. You can easily find reviews now where people share stories of getting clear skin. An aesthetician who can clear your skin will be confident and have every answer to your questions. They will be digging in (it may almost feel like an interrogation!) and talking you through everything. This is absolutely not a relaxing treatment.
If you have been working with someone you trust, taking their recommendations, using your products every single day, and have made at least a hearty effort to change your diet and after at least six months you aren't seeing any results, ask their professional opinion on if you should consider isotretinoin. A good one will give you a good answer, and they can help walk you through the side effects and even aid in limiting the dryness by recommending professional products. Sorry, doctors, but there's better out there to pair with isotretinoin than CeraVe. Your aesthetician can help treat the scars after your round of medication is done, and they can provide out-of-office support you won't get from a dermatologist's office. Why would they do all that? They have invested their career in seeing people get better skin and have possibly even been right where you are now.
We just want you to really save the last resort drug until the last resort – AKA after you've tried an acne-specialist aesthetician. You may not want to wait those six months, but isotretinoin takes at least two months of prep work and then still time to see results. Getting facial treatments and a jumpstart on professional skincare will limit the amount of time it takes isotretinoin to work and your odds of having to do it again. A good aesthetician will teach you how to care for your skin, a skill you want to have.
Results aren't linked to how severe your acne is but more how committed you are to putting in the work it takes to change your skin. Most of the results simply come from washing your face and using your regimen twice a day every single day and giving up junk food beauty aisle skincare. If you can't commit to that, sadly, the last resort may be the only option for you.
In case it wasn't clear, we like isotretinoin and are glad it exists – because despite making lifestyle changes, following all of the "acne rules," and using all of the right products, there are still clients whose skin won't clear. Isotretinoin has saved many people from lasting acne scars and emotional stress. We want to ensure it's actually used as the last resort so that you acquire the life-long tools you need in the battle against acne.