The most intense skin treatment I've ever done.

This is the beginning of my monthly diary.

Well guys, I have begun what is arguably the most intense skincare treatment I’ve tried in my near decade of working in the beauty industry: Accutane.

Walk with me…

My breakouts started in high school.

The first time a doctor recommended I go on Accutane, I was fifteen years old. And it’s been floated my way by dermatologists many times since.

If you don’t know what Accutane is, it’s an oral form of Vitamin A that targets the root causes of acne by reducing oil production, preventing clogged pores and calming inflammation. It’s really effective, but it can be pretty hardcore as far as side effects go. It’s a commitment, and while doable, I wouldn’t say it’s necessarily for the faint of heart.

When I was younger, Accutane was suggested because my acne was severe. I had constant, painful cysts that erupted in clusters along my cheeks and jawline. It hurt to laugh or smile, and the swelling would linger for months on end. I opted out of Accutane and went on androgen blocking birth control instead out of fear of the extreme dryness, and perhaps even spookier, the infamous “Accutane purge.”

My on-and-off again relationship with acne.

Years later, my skin concerns shifted. It was no longer about severity, because I had dedicated so much time and essentially built a whole career around understanding my skin, and created a routine (really a large arsenal of products, treatments, and professionals) that helped a lot. I got very, very good at managing my breakouts.

But the truth is, my acne never really went away. My breakouts maybe weren’t as extreme, but they remained persistent.

My acne would subside just enough to restore a sense of control, only to resurface again a few months later. Over and over again. And while they were no longer as cystic or monstrous, I was still dealing with inflamed zits which would leave scarring, and worse, dense clusters of closed comedones that were utterly maddening.

When topicals are enough, and when they’re not.

The thing is, a lot of people don’t need Accutane.

Over the years, I’ve seen both myself and others get their skin to a much better, or even totally transformative, place without it. But sometimes you need more help to go from managing breakouts to actually targeting the root cause.

And when I say I have personally tried everything in the name of finding the underlying issue, I really mean it: naturopaths, blood tests, antibiotics, retinoids, androgen blocking medications like birth control and spironolactone, cutting dairy, cutting eggs, cutting sugar, cutting alcohol, every laser, every microneedling treatment, using a special shower head, changing my pillowcases daily, and testing just about every skincare product in existence.

I mean, I even became a licensed esthetician, in large part, to better understand my own acne.

Then my friend’s transformation rocked me.

So, back to 2026. I have a close friend I would regularly text about acne. A few months ago, I met her for lunch and her skin was entirely transformed, clear in a way that was almost startling. She told me she had finally gone on Accutane, and described it as the best decision she had ever made.

She explained that she finally felt freed from the constant cycle of waking up each morning to check for new breakouts, panicking over every new hair product, having comedogenic ingredient checker websites perpetually pulled up on her phone, and living in fear that her period would trigger a week long flare up.

But she said the very best part was that her life no longer revolved around acne. That hit me hard, because it was exactly how I’d been living, day in and day out, through every good skin phase and every bad one, for as long as I can remember.

Accutane for reccurrence rather than intensity.

I suppose I didn’t fully understand that persistence, not just severity, is one of its primary reasons for Accutane prescriptions. I assumed your skin had to be a certain level of “bad” in order to rationalize the intense side effects of the drug. So even when dermatologists told me I was a good candidate over the years, I dismissed it, thinking that because my skin had improved, it probably wasn’t worth the time and effort.

What I failed to grasp is that Accutane working at the level of the underlying causes of acne, rather than simply managing surface symptoms, is exactly why it can be so effective for people whose acne is less dramatic, but chronically recurring and resistant to everything else.

What to expect during the early days.

Accutane is, in many cases, nothing short of transformative. I mean, one scroll through the Reddit r/Accutane thread quickly makes that very clear. But it is important to understand that Accutane is a journey that can take around six months (or more), and it requires a serious commitment. It’s not a drug to start lightly, the side effects can be gnarly, but in my experience, it’s manageable.

Three week progress picture.

It’s fairly common to experience a significant purge during the first couple of months in. And then, just when it feels like you’ve hit a new low, like clear skin might never be in reach, things begin to shift. From there, the acne usually steadily fades.

For many people, the results are long lasting. I actually personally know a handful who went from very severe acne to rarely dealing with it ever again. That said, “relapse” is still possible, and some do end up needing a second course.

Because you are controlling your body’s oil production, you get very, very dry all over: your eyes (which is utterly horrific), your lips (which is heinous) your hair (which is amazing, because you need to wash it less), your face and your body. You are constantly reapplying moisturizer and rehydrating your body throughout the day.

My accutane holy grails so far.

The side effects you’ve gotta know:

1. You absolutely cannot get pregnant while taking Accutane because it causes birth defects. This will be made very clear to you throughout the process of obtaining it.

2. You shouldn’t drink because it can cause liver damage (I don’t drink, so this wasn’t an issue.)

3. Even if you are just considering Accutane, I would start the process ASAP. There are several steps required before you can begin, including blood work, monitored pregnancy tests, and a mandatory waiting period through the iPledge program. It is all manageable, but the timeline can be slow, so it is better to get started sooner rather than later.

4. This drug can also cause serious mood swings and depression - and this is really not a joke, people - so I’m being hyper vigilant about this and making sure to keep my psychiatrist and therapist in the loop.

Some notes I’ve taken on my experience one month into 20mg of Accutane:

• My purge was really not bad. For the most part, I saw big improvement after the first two weeks. I know that’s incredibly lucky and not the case for everyone, and I’m sure some of you who had a rough purge want to throw tomatoes at me hearing that, but I think it’s important to say that while a purge is possible, it doesn’t happen to everyone. It was one of the main reasons I put off Accutane for so long, so I want to ease some of that anxiety. But I’m only one month in, so it could still happen!

• I eat a big scoop of peanut butter when I’m taking my Accutane (fat helps it process better) and I also take Claritin alongside it, which apparently helps with the purge - perhaps this is why mine hasn’t been so brutal.

• My skin is dry, especially on my chin, but slugging with Aquaphor has helped a lot.

• However my eyes are killing me. They’re so dry I have to use Systane eye drops frequently. It’s driving me nuts and I absolutely hate it.

• Lanolin Nipple Cream is THE BEST lip balm!

• My skincare routine is extremely boring now, but it’s working very well. In the evenings, I wash my face with Vanicream Gentle Wash and moisturize with the Prequel Barrier Therapy Moisturizer.

• Your skin is so much more fragile while on Accutane and heals a lot slower. I picked one pimple and created an absolute disaster, the likes of which I’d never seen before. I guess as a picker, I had to learn the hard way, but jeez I’m never doing that again.

• I have to wear giant sun hats and lots of sunscreen (the new Sofie Pavitt SPF is so hydrating and glorious) because I’m super duper sensitive to the sun now. This was hard for me because I’m a hiker.

• My joints were sore all the time and it made me feel like an old lady, but once I started taking high quality fish oil supplements it wasn’t so bad. These are expensive but I swear they are the best.

My skin progress…. it’s still loading but the improvement is already wild.

I will continue to keep you guys posted on my Accutane journey as it progresses. Please feel free to drop any questions below that you may have!