“The Miracle Drug?”-A Guide for Vegans on Accutane

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Roaccutane/ accutane/isotetrinonin is a powerful drug prescribed to treat moderate to severe acne that has failed to respond to all other treatments. It has been described as both magical and controversial by its critics, the latter claim stemming from the aversive side effects endured by some of its users. These include severe muscle soreness, mood swings and extremely dehydrated skin and lips, liver failure, and fatal fetal abnormalities in cases of pregnancy during accutane treatment. This article will provide an insight into my experience of acne-my story if you will, and will follow up with a “roaccutane guide,” or tool kit listing some cruelty free, vegan product recommendations as well as some general lifestyle tips for during those potentially challenging months constituting your roaccutane treatment.

One of the primary reasons I felt motivated to compose this article was to compensate for the gaping deficit in cruelty-free, vegan product guides available on the net for vegans on accutane. I therefore see it as imperative to underscore the importance of choosing cruelty-free, vegan skin products when on this drug. The fact that roaccutane is no way cruelty free or vegan does not mean that one can let their guard down when it comes to additional product choices, which unlike roaccutane can be just as effective if not more effective than the animal-tested alternatives.

My Story…

Any individual who has struggled with acne over a sustained period will tell of the toll such a condition can take on one’s self esteem, a circumstance which will propel many into a state of social avoidance and despair. In my situation I, like many became obsessive about my skin care regime, trying every product on the market, every so called “magic” cure, the deceptive promises of sales people striving to make a buck invariably instilling in me a constant sense of false hope, followed by a bitter sense of disheartenment; a wave of brief, hopeful highs followed by a series of devastating lows. What I failed to realize was that topical treatments are not always the answer, especially in the case of products filled with skin irritating sulfates, and harsh chemicals which merely deplete your skin of all its natural oils, thus exciting an increased production of that nasty commodore producing sebum. In this manner I relied on various over the counter topical products for a couple of years.

By the age of 20 my skin had begun to flare up once again following a period of manageable minor acne and I felt compelled to try something different. I began working in a health food store at the time and diet-wise I had been vegan for about two years, (vegetarian since the age of 11),  consuming a diet nearly free of processed carbohydrates and refined sugars. At that stage my skin was the worst it had been in years. I began taking clear skin complexes, probiotics, algae-sourced EPA and DHA, and wearing only natural mineral foundations. My skin regime was also completely natural, consisting of oil cleansers, gentle exfoliants, AHA and BHA  based cleansers and homemade toners containing apple cider vinegar, rose water, and lavender oil. I washed my make-up brushes at least 3 times a week and changed my pillow sheet daily to ensure my face would not be in contact with excessive amounts of bacteria.

Nonetheless, my skin stubbornly persisted in its inflamed state. This inevitably led to a sense of deep frustration on my behalf. I found (and still find) it difficult to look people in the eye at times and am constantly checking my face in mirrors to ensure that I haven’t managed to transform into a leper in the past 10 minutes from the ominous gusts of air conditioning pouring from the ceiling at work, one of a myriad of perceived  threats to the clarity of my make-up covered complexion. As a teen I would invariably avoid looking in mirrors and recall completely avoiding all such glasses and reflections in this manner for at least a year, any accidental confrontation with my imperfect, inflamed complexion leading to a near state of near-hysteria. Hairdresser appointments were thus a constant worry as sitting face to face with myself, seeing what everyone else could see would lead to nights of clawing at my skin whilst weeping silently in the darkness of my bedroom.  I still have a tendency of leaning slightly to one side when in the front seat of my car, in an effort to avoid catching a glimpse of myself in the side view mirror. Darkly lit rooms form a brief respite from my constant self-consciousness, a shelter from the storms of negative self talk and discomfort, from the belief that I am somehow unworthy, ugly or repulsive. I know that such a mentality is logically incorrect and that I may appear shallow or superficial in my placing so much value on my appearance, but when it comes to acne or skin conditions one’s mentality or outlook so often becomes locked to this single flaw literally staring them in the face every day; becoming overly fixated on that which renders them different, physically unconventional, a foil to what society defines as aesthetically beautiful.

Might the Drugs Work?

I attended my GP about six months ago and he prescribed me dianette, a form of the contraceptive pill that is administered primarily to those suffering from skin conditions such as mild acne. It acts as a mild anti androgen, thus reducing the body’s production of sebum, and can help many but rarely guarantees that the condition won’t return. After being on this medication for a few months and unhappy with my progress I decided to try attending another GP with a  diploma in dermatology. She diagnosed me with moderate to severe acne, and taking my problem with the due seriousness it deserved immediately sent an urgent email to a dermatologist in the Galway Clinic stating my case in a convincing manner with the intent of accelerating my waiting time to attend the clinic. She prescribed me tricyclcone, an anti-biotic, contesting that for me to get prescribed roaccutane I would have to show evidence that I tried all the alternatives at my disposal. Thus, although reluctant to take a 6 week course of antibiotics for the reason that they are largely ineffective in permanently eliminating acne and often trigger an exacerbation of the problem once the course is completed, I nonetheless consented to take the bullet for the aforementioned reason, namely that their ineffectiveness would serve as a justification for the subsequent administration of roaccutane, a drug, which albeit its bad reputation is nonetheless a wonder cure in many instances, or at least the best option out of a bad lot.

Although many vegans and non-vegans alike may harbor reservations about the necessity of such a drug, due to it being neither cruelty-free nor vegan,  as well as the potentially challenging side effects, I felt it necessary in my circumstance to take the plunge nonetheless. My view is that the use of prescription medication is justified only when all other options have been exhausted and in cases of severe ill health. Gary Francione, the founder of the abolitionist approach to veganism contends that we should strive to reject the use of animals for reasons of pleasure, habit or convenience. Whether prescription medication comes under this definition is, I contend, determined by the necessity of the medication in relation to the health of its user and whether the alternative, cruelty free, vegan options are sufficient to alleviate the issue. In the context of my situation I have been struggling with skin issues since the age of 10, and have come to develop quite significant scarring as a result . Acne has had a severe impact on my mental health, leaving me with quite serious self esteem issues, as well as a gravitation towards low mood. I have exercised what I assume to be the majority of the natural, cruelty free alternatives but in my my case these did not have any effect. I do not wish to imply that such options won’t work for others, in turn discouraging individuals from testing all the options at their disposal before resorting to roaccutane but rather to assert that one should accept that in some cases, the drugs might be the only viable option and that one should not feel guilty or ashamed on reaching such a conclusion.

I am at present on my fourth month of roaccutane treatment and have noticed a huge transformation in my skin condition since commencing. All that remains on my face at present is a fair degree of post inflammatory hyper-pigmentation; these are the red marks that remain after a spot heals and will, according to my dermatologist (and google) most likely fade over the next couple of months, although for some it may take longer. Nonetheless, I am relieved by virtue of the fact that the acne itself is almost gone, and that my side effects were nothing compared to the nightmare I had envisaged. Yes, the dry lips and peeling skin were quite bad, but improved after about month two of treatment; and I do experience some muscle soreness, especially after exercise such as yoga and hiit training so have toned down the intensity a little.  I also experienced some fairly severe fatigue for a period but that has improved also in recent weeks. I think the key take home message is, as I will reiterate below,  to start your treatment with an open mind, but to recognize your limits, both physical and mental, alerting your GP or dermatologist of any concerning side effects or changes you experience throughout the course of treatment.

 

           My Roaccutane Guide

 

Some General Pointers

1. Everyone will react differently to roaccutane, these variations being dependent on the dosage strength, alongside a whole myriad of biological, environmental, and hormonal factors (although dry lips and sensitivity to sunlight are kind of a given).

As a result it is important to avoid over-analyzing other people’s roaccutane experiences, especially their side effects. If you are anything like me you will feel tempted to over-research every aspect of the drug and its user experiences, but you will soon discover that every person will encounter their own set of side effects and symptoms, whilst the severity of those symptoms will vary greatly from person to person. Thus, it is a futile battle to try and prepare for every possible outcome.

The best you can do is adjust your behavior and product choices on the basis of your own experiences; to have a general understanding of the potential side effects, but without resigning yourself to the certainty of 6 months of torture or assuming the worst possible outcome. I for instance did not expect tiredness to be such a problem, anticipating all the most notorious side effects associated with the drug, from mood swings to depression and anxiety (which come under “rare” side effects might I add). I have thus learned not to listen to the scaremongers and talkers, with a mere vague knowledge of the complexities of the drug. Thus to my second point.

2. Avoid the scaremongers and the Talkers

I have been subjected time and time again to the ill judgment and criticism of others because of my decision to take roaccutane. Such criticisms are so counterproductive and merely run the risk of a sort of self-fulfilling prophesy-type situation whence your anticipation of certain side effects contributes to the development of such side effects.

3. Be kind to yourself

Using this experience as an opportunity to take care of yourself is useful irrespective of the severity of your side effects. It is never wasteful to give yourself a little tlc, whatever that means to you, whether that is taking the time to do 15 minutes of yoga everyday or re-reading your favorite novel

3. Aim For “Gentle” “Hydrating” everything.

Roaccutane works by reducing the skin’s production of sebum (the skin’s natural oil) so will inevitably result in at least some degree of dehydration. The skin also becomes quite sensitive to harsh chemicals I try to keep my beauty regime as natural as possible. 

4. Attune to your own skin’s demands.

Everyone’s skin will react differently to the drug so it is important to bear in mind that what works for one person may not suit another.

 

Moreover, the following guide outlines what works for me, in accordance with my symptoms. It is thus in no way a one-shoe-fits-all sort of list that will apply to every person taking the drug.

 

My Product Choices

Lips

Dry lips are kind of a given in the lives of many accutane users. My Herbal Earth calendula lip balm has thus become my new best friend over the past three months. If I momentarily misplace it or forget it on leaving the house I am subsequently subjected to intense discomfort, as I can almost instantly feel the skin of my lips tighten and cease,  to the point where taking becomes slightly painful! When my balm and I are reunited all is well, that is once I have managed scrub the accumulated layers of dead skin from my distressed lips, my point being just don’t forget the balm.

  • Dr Hauschka lip Balm
  • Herbal Earth Lip Balm Range 
  • Shea Moisture Vegan Lip balms
  • Exfoliate: I use a gentle brown sugar exfoliant or a soft bristled toothbrush if I experience a build up of dead skin.
    The following lip scrub recipes might be useful (n.b. not all these recipes are vegan, usually because of their use of honey so swap it with agave syrup!)
  •  Avoid vaseline
    This is one point on which I disagreed with my dermatologist by virtue of the fact that vaseline or any lip balm containing petroleum merely acts as a seal, retaining any moisture already present in the lips but not helping with the production of more moisture. Thus, in the case of those whose lips are deprived of nearly all their moisture, petroleum-based balms may bring immediate relief but are really counterproductive in the long term.

Face

Moisturizer

Cleanser

Serum

Any ultra hydrating serum you can get your hands on
I alternate between

Exfoliator

I use Dr Hauschka Cream cleanser (a granule textured exfoliant) on the flaky areas to remove any excess skin (don’t rub, press!)

Toner

  • Homemade balancing Toner:
    1 part rosewater: 1 part apple cider vinegar: 2 parts water and add some soothing essential oils (lavender, tea tree, jojoba etc)
    Rosewater on its own is also quite effective for hydration if the cider vinegar irritates or burns the skin. I find it calming to spritz some pure rosewater on the skin if it ever feels tight or irritated.
  •  Trilogy hydrating mist toner
  • Dr Hauschka facial toner

Primers


Foundations

This will be highly individual as some will experience more dryness, dehydration and peeling than others. Thus, it can be a case trial and error for many when figuring out what works best for them. Also, I noticed that the texture and condition of my skin took a while to settle, so I had to alter my foundation choices accordingly (sometimes successfully and sometimes not so much so); for instance, I experienced a lot of dry, peeling skin around my mouth and chin in the first month, as well as really bad texture around my nose and chin, but these cleared up in a matter of weeks, paving the way for a case of overall dehydrated skin.

 

Hands

Mine broke out in a sort of temporary dry peeling rash so they have been hyper sensitive, and sting if I apply any products containing substantial levels of alcohol or chemical irritants


Hair

  • Pureology– the purple hydrating one. This may seem like a bit of an investment but it worked wonders for me as the roaccutane really dries out my hair. It lasts ages as you need only apply a coin sized amount of product to the hair. The conditioner is a real treat if you enjoy minty smells that make your scalp tingle
  • Coconut oil or pure argan oil as an overnight treatment
  • You could also invest in a natural hair mask  if you are concerned about excessive dryness
  • Avoid too much heat (straighteners and curlers) as hair can become very dry and dehydrated

SPF Products

Always apply a product (serum, moisturizer, foundation…) containing at least spf15 as accutane makes the skin more sensitive to ultraviolet light, meaning that one can easily get sunburned, even on overcast days.

  • See the following list of cruelty free and vegan SPF products compiled by Logical Harmony, a wonderful blog space which provides access to hundreds of cruelty free brand lists and their vegan product options.

For dry eyes

  • Make sure you take an omega 3 supplement and perhaps omega 7 on top of that (Sea buckthorn oil) 
  • Drink loads of water
  • Eye drops if necessary (I haven’t needed to use them much). 
  • Avoid hot dry indoor spaces where possible 

For Dry nose

  • Coconut oil.  when my nose is dry or if there is a build up of crusty mucous in my nostrils, I lubricate my them with coconut oil in order to soften it, and then simply blow my nose to remove.

Supplements and Diet

Supplements

  • A good Omega 3 supplement is important for eye and skin health. It will help with any inflammation, dryness and enhance brain function, regulate your cholesterol levels etc) I am taking Opti3, an algae based formula
    • Dietary sources (not as absorbable but still good): I consume a tablespoon or two of flax seeds (milled or sprouted ideally) and chia seeds every day. Flax oil is another good option but do not heat it as that will destroy all the good fats. Macademia nuts and almonds have the highest level of omega 3 in the nut family but most other nuts contain a far greater quantity of omega 6 which if consumed in large amounts can have a pro-inflammatory effect which is not good!

  • I have not been very disciplined with this one but you might consider taking Milk Thistle as it helps to detox the liver, thus placing less stress on it during your roaccutane treatment (but check with your pharmacist first)

  • A Probiotic!!-This will protect your gut and thus pretty much everything else in your body (immune system, digestive system, neurotransmitter functioning…). I am taking the Terra Nova one but any natural, quality, vegan probiotic should do fine. 
  • Vitamin D is also so important for the immune system. I take a liquid form which is super handy. Make sure that the source is vegan however as many are derived from lanolin (ships wool)
  • Avoid Vitamin A or any supplements that contain vitamin A, such as some multi-vitamins. Roaccutane is a retinoid so consuming any additional levels of the nutrient could overstress the body

 

Diet

  • Take roaccutane with food (fat)
  • Drink loads of water (Aim for around two liters a day).
  • Try to eat as clean (and vegan!) as you can to ensure your lipid count remains normal. Aim to consume plenty of good quality, unprocessed plant-based ingredients such as pulses, grains, seeds, fruit and vegetables.

 

Additional Resources

What Does Accutane Do to the Skin? Livestrong

Diet and acne: a review of the evidence

Can You Take Prescription Medications and Still Call Yourself Vegan?

ROACCUTANE Patient Information Leaflet

 

 

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