I first took Accutane my freshman year in college. The pills were big, red, egg-shaped, and they came in a grid of firmly-wrapped blisterpacks. For my daily dose I had to tear through a creepy drawing of a pregnant woman with that Ghostbusters “don’t” circle and and diagonal line printed over it: I should not take this powerful drug if I were to be pregnant. That wasn’t a risk, but I felt like I was about to deform myself.
I am a person with “active” skin. This is the milder way of saying that I am well traveled in Acne Land. My skin was extremely troublesome from age 16 on up till my early 20s. This was not the “I’m Jessica Simpson and I have a pimple!” kind of problem skin. This was the painful, often cystic, big, red, breakout bad kind of skin that hurt and couldn’t be covered up even if I was brave enough to be a guy who wore foundation. And, lucky me, my active skin was most active during those formative years when I was just getting to know myself and come to terms with my sexuality.
As a young latent gay kid, my skin didn’t make self-acceptance any easier. I remember passing by mirrors or car windows or any kind of reflective surface not wanting to look at myself. I remember waking up in the morning hoping that an inflamed area on my face had gone down or changed or stopped being painful and it was just worse. I remember the first time I got a cystic kind of pimple and I thought to myself: “Oh no. I have to deal with this, too?”
My teen years were spent using tubes and vials of topical creams and astringents that never seemed to do anything. I took a series of antibiotics: Minocin, Tetracycline, pill after pill, day after day, until sometimes I would feel vomitious. It’s a wonder I still have intestinal walls.
My dermatologist, an avuncular, kind-voiced man who had absolutely no reservations when it came to giving me medication, finally prescribed Accutane right before I was off to college.
After a week or so into my Accutane course, while living in the freshman dorms of my university, my spine started aching, my lips became chapped, and I got facial twitches that fluttered under my skin for days. I was tired and sluggish. I spent that first winter of college taking English and Astronomy 101 classes like this, watching my skin break out worse than before and then dry up, like it was going through a radical molting process. Meanwhile I was trying to become who I really was, to reveal my gay heart, but I was afraid to show it “too much” for fear of being ridiculed or drawing attention to myself. And I didn’t like the way I looked. It was all knotted together like a tangled necklace.
My whole youth could be defined by this strange double helix of identity: my sexuality and my skin, seemingly intertwined. Their relationship, real or psychogenic, seemed bound up in each other.
Both my sexuality and this mysterious bad skin seemed like they came from somewhere deeper inside of myself, some part of me I didn’t understand. It was a cruel but appropriate metaphor: my skin was a public billboard that displayed what I was hiding about myself. I blamed the body that was doing this to me: mine. Thinking that made me feel more shame. Then the suffering kept repeating, over and over, in a spiral.
Most medical professionals try to be, of course, more clinical. Acne is caused by the overproduction of sebum that blocks the pore. Some say high testosterone levels can lead to this. Sure, there could be simple reasons like this, but when you are a teenager and can’t stand to look at yourself, you can’t help but think: why me? Why is my body doing this?
That’s one aspect of acne I’ve always wondered about. How related to our state of mind could it be? Just type in “stress acne” and you can call up hundreds of pages on the subject—about how stress puts your immune system into overdrive and can cause overproduction of oil, leading to breakouts. Maybe stress factors are even deeper in me than I’d like to imagine. Like, having to repress my sexuality in a semi-hostile environment put my body into fight/flight overdrive, producing high levels of testosterone or whatever else clogs sebaceous glands.
Years later, when it was posited that Accutane can lead to depression, the link between mind and body became even more puzzling to me. Several recent studies have shown a link between isotretinoin (the drug’s generic name) and clinical depression. Between 1982 and May 2001, 431 cases of patients treated with isotretinoin with depression and suicidal tendencies were reported to the FDA Adverse Events Reporting System. 37 patients had killed themselves. In 2009, it was taken off the U.S. market because of this, and also after it was found to lead to inflammatory bowel disease among other intestinal disorders.
When my mom found out about the recall, she called me and asked if I had felt depressed during my courses of Accutane. Was I depressed? It’s difficult to say. I was confused and in college: isn’t everyone depressed then? Which comes first: having bad skin or the stress that leads to it? And, if my breakouts were caused by “stress” or psychological reasons, why was a toxic pill which may cause depression or suicidal feelings the one thing that cleared it up?
Regardless, Accutane worked. By spring of Freshman year, my skin was much clearer, and, weirdly timed, I found a group of friends (mostly gay, lesbian or otherwise artsy) to hang out with. (I took two more courses of the drug later in life, but that is a longer story.)
10,000 Clearasil tubes, yoga classes and aloe vera juice smoothies later, I don’t break out as much. But as a lifelong “active” skin person, I am no stranger to breakouts, believe me. These days, when I do get one of those unavoidable doozies, I am not as psychologically crippled as I was back then.
Mostly because I like myself and think I’m doing a pretty good job: I’m not addicted to meth, I don’t have awful plastic surgery, and I’m not on a reality show (or all three at once). In a way, I can’t imagine who I would be without having had bad skin. My “active” skin made me hate myself, then truly see myself, then accept myself. It was a lesson in layers which us “active” skin people know all too well. When we were at our lowest, we pushed past our appearance to reach deeper into ourselves. Instead of self loathing, we chose self-compassion to survive. We learned how to be kind to ourselves, and that’s one of the biggest achievements of all.
I wish I could say I was blemish-free and perfect, but I’m not. I may know myself better, but my skin still confounds me. Breakouts still happen and they make no sense to me. For instance just last month I was at the beach for a week and had a doozy of a pimple and I couldn’t have been more relaxed and stress free. I still want to know more. Acne, you are a mystery.