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  • A 40-Year-Old's Guide to Being on Accutane

    January 25, 2018 3 min read

    When 40 greeted Danielle Pergament with her first-ever cystic breakouts, she learned a thing or two about isotretinoin (a.k.a. Accutane).

    I’m not saying I drink too much. What I’m saying is that if I did drink too much, a little heads up would have been nice.

    See, here’s what they don’t tell you right off the bat about isotretinoin: no drinking. The medicine stresses your liver. And alcohol stresses your liver. See where I’m going with this? Four, five, maybe six months to glowing skin also meant four, five, maybe six months of staring at my tequila collection with longing and nostalgia. My dining-room bar would become a study in unrequited love. (Maybe cutting back wouldn’t be the worst thing.)

    And yes, I have a dining-room bar. The thing is I’m not a teenager. I’m many years out of college. I’m a full-on grown-up, and after a lifetime of pretty damn good skin, I was dealing with near-constant cystic breakouts. The kind that led me to pull turtlenecks over my chin, seek out dark corners, and occasionally — and I’m not proud of this — even cancel plans. Makeup, you say? Not my thing. I can’t explain it beyond: Love eyeliner. Adore lip gloss. But foundation and concealer always feel like a lie. And worse, they’re a lie that I’ve never been very convincing at pulling off. What’s more uncomfortable to look at than a big red spot on someone’s face: a big red spot on someone’s face that’s been poorly covered in mismatched concealer. Nope, couldn’t do it. And yet I could no longer seek out the dark corners of life. It was time to ask my dermatologist for the hardest of the hard stuff.

    Here are the other things you don’t know about isotretinoin. (And if you do, it’s only because you’re a dermatologist, which doesn’t count.)

    First: You will have to take a test every month. A blood test — to assess, among other things, that liver situation — as well as a test test. You want blemish-free skin, you’re gonna have to multiple-choice your way there. The test is to prove that you know the hazards of getting pregnant while on the drug. Let me spoil the surprise for you. Those hazards are a cross between science fiction and straight-up horror. If you’re not totally sure of the answer to a question, pick the worst, most horrible option. I mean, this shit is bad. This is where Tobe Hooper must come for ideas.

    Also: As far as I know this is the only situation in which the government makes the patient swear — like a step above a pinkie promise — to use two kinds of birth control. And I’m going to throw in a third. Abstinence. Isotretinoin pills are individually wrapped with graphics of a pregnant lady with a red slash through her. Nothing has ever said “God help me, there’s no chance you’re getting laid tonight” quite as effectively.

    And of course: Aquaphor. Cases of it. Isotretinoin shrinks your oil glands, and while you’re on it your skin will be all kinds of dry. My lips and my eyes, by the way, feel like I’m on a redeye flight that never lands.

    And then finally: In four, five, maybe six months, sit the hell back and glow. I’m halfway to glowing as I write this and already pretty freaking radiant. In another month I’ll be done, and I plan to beam like Venus.

    Maybe I’ll have a dinner party to celebrate. You know, turn the lights way the hell up. I even have just the Patrón for the occasion.


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