This is part 2 of a 3-part series on how to get rid of acne. It covers:
- When you should ask your doctor about prescription acne medication
- Understanding the names of prescription drugs (drug nomenclature)
- The 3 topical (external) prescription acne medications I’ve used
- My experience with accutane/isotretinoin
- Accutane side effects
- Drinking alcohol on accutane
Here are Parts 1 and 3 of this series:
Disclaimer: I am not a doctor and this information is all based on my personal opinion and experience – it is not medical advice.
When should you go on prescription medication?
If your acne is classified as “moderate” “moderate-severe” or “severe”, it may warrant prescription medication. Here are those definitions explained:
Mild acne is classically defined as open (blackheads) and closed comedones (whiteheads) limited to the face with occasional inflammatory lesions. Acne may be considered to be of moderate severity when a higher number of inflammatory papules and pustules occur on the face compared to mild cases of acne and acne lesions also occur on the trunk of the body. Lastly, severe acne is said to occur when nodules and cysts are the characteristic facial lesions and involvement of the trunk is extensive.
You should see a doctor about prescription medication in one of two cases:
- You have tried a benzoyl peroxide based OTC medication and a salicylic acid based OTC medication (see Part 1) and neither of them worked
- Your acne is really bad and/or you are impatient and don’t mind going straight to ‘harder’ stuff
There is little harm in asking your doctor about your acne. Personally, I wish I had done it sooner as prescription medication was the only thing that really worked for me.
Understanding the names of prescription drugs (drug nomenclature)
A single drug can – and often is – referred to by multiple different names. This can be a bit confusing if you don’t know how the naming of drugs works.
There are three different names for the same drug:
- The chemical/scientific name
- The generic name
- The brand name
The chemical/scientific name of a drug refers to its molecular structure. This is something like “3-(2-methoxyphenoxy)propane-1,2-diol” – it looks like what you learned in chemistry class and is generally not used in common speech.
When a drug is approved by the FDA it is given a generic name. This is usually a shortened version of the chemical name. Common examples of generic names are “Paracetamol” “Tramadol” or “Tadalafil”.
When a pharmaceutical company sells a prescription drug, they give it a brand name. Examples of common brand names are “Viagra” “Lipitor” or “Prozac”. The same drug can have multiple brand names, because multiple companies are selling it.
So to put it all together, for the acne drug Accutane:
The chemical name is (2Z,4E,6E,8E)-3,7-dimethyl-9-(2,6,6-trimethylcyclohex-1-en-1-yl)nona-2,4,6,8-tetraenoic acid.
The generic name is Isotretinoin.
The brand name is Accutane (also sold as Roaccutane, Amnesteem, and several others by different drug companies).
Topical prescription acne medication
I have experience with three types of topical prescription acne medication – two benzoyl-peroxide based gels and topical tretinoin (brand name: Retin-A).
Benzac AC is a benzoyl peroxide based prescription medication that comes in three different strengths – 2.5%, 5% and 10%. I was prescribed this gel to use during the later parts of my accutane cycle and with continuing use after I finished accutane.
The main active ingredient in Benzac AC is benzoyl peroxide, while the “AC” stands for Acrylates Copolymer. These are small beads of liquid that soak up and absorb oil. The third main ingredient is glycerin, which hydrates and lubricates the skin.
I had generally good results from this medication (the 2.5% strength) and I would recommend it for use. It generally kept my acne under control after I went off accutane and had no real side effects.
Benzaclin is another topical prescription medication that combines benzoyl peroxide with clindamycin, which stops the growth of acne causing bacteria. I was also prescribed Benzaclin during my accutane cycle and had good results with it as well. Again I had no real side effects from this medication.
Retin-A is a topical cream and one of several brand names for tretinoin, which is basically Vitamin A. Vitamin A helps the skin regenerate – tretinoin is the topical form and isotretinoin/accutane is the oral form.
I was put on Retin-A for an 8 week cycle before I started using accutane. It was somewhat effective, but not enough. With Retin-A your acne can get worse for the first two weeks before it starts to get better, and this happened to me. Otherwise I had mildly dry skin but no other side effects.
What about accutane/isotretinoin? Should I take accutane?
Accutane is the strongest acne medication available and comes in oral form. It is usually reserved for “moderate-severe” or “severe” cases of acne, and was very effective in getting rid of mine.
I took accutane for one ~5 month cycle in 2010, when I was 17. This cycle covered a period of
- Some months in my final year of high school
- A backpacking trip in Europe
- Some months in my first year of university
While there are many possible side effects (discussed below), I would 100% recommend accutane to anyone who wants to get rid of their acne.
Accutane has the potential to permanently get rid of your acne, or at least to greatly reduce it. The side effects are worth it in the long run and – depending on the dosage and how you react – not as severe as many would have you believe.
Accutane side effects
Accutane potential side effects range from minor things like dry skin and lips to serious side effects like nausea, vomiting, blurred vision or even depression.
Here’s the thing though: for prescription medication, companies are required by law to list all of the potential side effects on the package – even if they occur extremely rarely. So while you will probably suffer some of the more minor side effects of accutane, the severe ones are much less likely.
Accutane and depression or suicide?
There has been controversy in the media about accutane causing depression in patients, and even leading to suicide.
However there are several different studies (also see here and here) demonstrating that there is litte/no causal connection between accutane and depression or suicide. In fact many studies found a decrease in depressive symptoms in patients because accutane improved their condition.
Obviously there are always outlier cases and suicide – in any instance – is a tragedy that should be avoided at all costs. At the same time, the media is a sensationalist drama-creating machine that will take a good story over the truth in a heartbeat. The fact is that the vast majority of people who take accutane do not suffer these kinds of side effects.
What’s more, when you take accutane you will have a blood test taken by your doctor once per month. If anything looks dangerous or out of the ordinary, they will take you off the treatment. These regular check ups, in my opinion, negate a lot of the risk.
The main accutane side effects I had were:
Worsening of acne for first 2-3 weeks
When you first start using accutane, your acne can actually get worse for the first 2-3 weeks of the treatment. This happened to me, and it can be very discouraging as it feels like the medication isn’t working. If this happens to you, I would encourage you to be patient, give it some time and know that it’s worth it in the end.
This is one of the most common and most minor side effects of accutane. It can be dealt with easily by having chapstick on hand at all times – I would highly recommend Burt’s Bees lip balm (Amazon). Burt’s Bees is made from beeswax, it’s flavourless, and it doesn’t make your lips shiny – I have used it for years and I still do.
While dry lips are a “minor” side effect, having extremely dry lips 100% of the time can take some getting used to. While on accutane I was applying chapstick probably 10+ times per day and would actually rub all the dead skin off my lips (gross I know) every morning in the shower. So be prepared for that.
A bloody nose (occasionally)
When on accutane I would sometimes get a random, sudden nose bleed. My nose would start bleeding out of nowhere – sometimes lightly and sometimes more heavily. This happened about 2-3 times per month.
This is another fairly common side effect of accutane, and it happens because the medication causes the inside of your nose to become very dry. This sounds like an inconvenience and it is – however it can be negated by using saline nasal spray (Amazon) – which basically means periodically shooting a moisturizing solution up your nose.
Overall though, this is not something to really worry about. At worst you will get a bit of blood on your shirt or something and have to excuse yourself for a few minutes. (I actually got a bloody nose once right in the middle of lunch with two cute girls in Paris – they were more concerned than anything and what I thought would be an “embarrassing” situation actually wasn’t at all)
Alcohol and accutane (Can I drink alcohol on accutane?)
According to the drug manufacturers, you are not meant to drink alcohol on accutane – not at all. This is because accutane is metabolized by the liver, and so is alcohol. The combination of the two can be too much for liver to handle and lead to problems.
However, my accutane cycle covered a backpacking trip and then my first few months of university… I was drinking a lot.
Particularly on the backpacking trip, I was drinking 4/5/6 nights per week and often pretty heavily. This didn’t slow down much when I started university.
But despite this heavy alcohol intake, I didn’t suffer any serious consequences. I had a blood test when I returned home from Europe, and the doctor simply took me off the medication for about a month.
I didn’t feel any adverse affects, and there was no long term damage. At university I went back on accutane and finished the cycle, while still drinking alcohol. Overall, I was fine.
Now, was this a good idea? Probably not. Would I recommend you do this? Definitely not.
But if you have a few beers one night while on the medication, it’s not going to kill you. It does depend on the dose you’re taking, and obviously on any other medical conditions you may have.
But in the same way that drug manufacturers must list every potential side effect of a drug, it is in their best interests to tell people never to drink on the medication as well, just to be safe. If my experience is anything to go by, the risks of drinking alcohol on accutane are overstated to say the least.
Accutane final thoughts
The bottom line is: if you want to get rid of your acne and the treatment is approved by your doctor, take accutane.
If you are on the fence I would highly recommend that you at least try it – it could make a world of difference for your skin and for your life. It did for mine.
And don’t let the possibility of side effects scare you off. Minor side effects can be dealt with quite easily, and if there are any serious side effects – external or internal – you will know due to regular check ups with your doctor, and you can stop taking the medication anytime you like.
This is the end of Part 2 – I hope I’ve shed some light on the topic of prescription acne medication for you.
To sum up:
- Ask your doctor about prescription medication if OTC treatment doesn’t work for you, if you have especially severe acne, or you are impatient about fixing the problem
- I had good results and no side effects with Benzac AC and Benzaclin, taken along with accutane
- I would highly recommend you try using accutane if your doctor will prescribe it
- Accutane side effects, in my experience, are well worth it
- It is not advisable to drink alcohol on accutane, but a couple drinks from time to time won’t kill you