Accutane or Acne: Which Is the Worse Evil?

I was 11 when the acne began. Normal at first, just your usual spotty teen. However, at 13, it took over my life. It covered my face like a medieval disease of sorts: oozing, embarrassing, and energy-sucking. And so, after many treatments, including every sort of cream, pill, and treatment, I was offered the be-all and end-all: Accutane. However, Accutane was not without its vices.

So, what is Accutane?

Accutane, or isotretinoin, is a medication derived from vitamin A. It reduces the amount of oil released by the oil glands in your skin and helps prevent pores from becoming clogged. It is generally prescribed for severe acne, particularly when other treatments have not worked, including topical treatments, certain medications (e.g., birth control pills), and antibiotics. So, before I get into the dangers of Accutane, I need to preface this with its benefits and why people choose to take it.

The positives of Accutane and the negatives of acne

Accutane is an effective treatment for severe, often cystic, acne. It targets several underlying causes of acne, and many patients experience long-term improvement after completing treatment. For so many people, this is truly a "lifesaver" because of the effects of acne. Acne has far deeper consequences than just the skin it covers. It can lead to depression and self-esteem issues that continue into the future. In severe cases, it can also cause physical pain when touching your face or simply lying down with back acne. These issues are difficult enough for adults, but for the large proportion of people affected by acne who are between 12 and 25 years old, they can be devastating. So, you can see the appeal of having all of this relieved.

Some benefits of the drug include never having greasy hair due to isotretinoin reducing oil production, including scalp oil, and, occasionally, a reduction in the appearance of the nose due to changes in oil production and inflammation. Most importantly, after a few months, many patients experience clearer skin.

Negatives of Accutane

But, of course, nothing is without a cost, and Accutane carries a large one. If I wanted to go through every side effect, this article would be more than two A4 pages long, which is roughly the size of the full pamphlet of warnings against Accutane. So, here's a brief roundup.

Less severe side effects can include joint pain, brain fog, irritated eyes, and nosebleeds. However, more serious potential side effects include increased cholesterol or blood sugar levels, changes in red and white blood cell counts, hearing or vision problems, and severe stomach issues. None of these are the biggest concerns, though.

Some of the most concerning potential effects involve mental health. These include depression, anxiety, changes in behaviour, and suicidal thoughts. Psychosis has also been reported. Another major concern, and one that patients are warned about repeatedly before starting the medication, is the risk of severe birth defects in babies exposed to isotretinoin during pregnancy.

People who can become pregnant must follow strict pregnancy-prevention requirements while taking isotretinoin. These typically include avoiding pregnancy for one month before treatment, throughout treatment, and for one month after stopping the medication. Depending on the applicable safety programme, patients may also be required to use two forms of contraception and undergo regular pregnancy testing. So, why are such strict measures necessary? When a baby is exposed to isotretinoin during pregnancy, it can cause severe birth defects, including facial abnormalities such as cleft palate, heart defects, brain and central nervous system abnormalities, and intellectual disabilities.

After hearing all of this, there may be questions such as: Should this drug even be sold on the market? Are there actual benefits? Are there no other options? So, I'll try to answer some of these questions.

First, the question of whether the drug should be available can spark debate, but personally, I believe it is an important resource, especially considering the benefits I listed earlier. Secondly, I do believe there are many benefits, particularly when considering the lasting effects acne can have on self-esteem and confidence. Yes, there are many other options, such as skincare products and antibiotics. However, I firmly believe Accutane should be considered only when appropriate alternatives have been tried and a dermatologist determines that it is the right treatment.

And finally, to answer the question I first proposed: Accutane or acne? Which is the worse evil? The honest truth is that the answer will vary for every person who has experienced Accutane or acne. But, as someone who has gone through the best and worst of both, I conclude that acne is the worse evil. Although Accutane carries serious risks and should be taken with caution, I would choose nine months of its potential side effects over possibly ten years of acne, poor confidence, and insecurity.