I'm Charlotte, Co-founder of Cleyra, an Isotretinoin (Accutane) tracking app. I'm currently starting my last month (month 6) of treatment. For the first time in my life, I'm experiencing wanting to show off my skin because it looks so nice, but getting here was hard. The treatment journey is full of misinformation, manageable, yet uncomfortable physical symptoms and an unexpected mental load.
Everything I Tried Before Isotretinoin (Spironolactone, Tretinoin, Winlevi, and More)
I started Isotretinoin ("Accutane") this March after 15 years of struggling with persistent, treatment-resistant hormonal acne. I'd tried everything from the highest dose of Spironolactone (an oral androgen blocker) to Tretinoin (a retinol) to Clindamycin (an antibiotic) to Winlevi (a topical androgen blocker) to monthly facials (a huge expense). I've seen a derm since I was 13 and until I hit 30, had naively assumed things would get better on their own someday in the not-so-distant future.
Why I Was Scared of Isotretinoin's (Accutane's) Side Effects
In high school, unlike my braver friends, I chose not to take Accutane, scared off by (questionably accurate) horror stories of brain swelling, treacherous sunburns, and suicidal ideation. I spent 18 years avoiding the most effective long-term treatment for severe acne, struggling with a painful condition riddling my largest organ that wrecked my self confidence, made me physically uncomfortable, and made me fear being perceived, an insecurity anyone who knows me would struggle to believe.
What Isotretinoin (Accutane) Treatment Is Really Like: Side Effects and Logistics
Turns out while treatment does have some very real (and manageable) side effects, the hardest part of the journey for me has been tracking progress, being patient, and making sure treatment doesn't take up more space in my brain than it deserves to. Managing logistics (monthly bloodwork, pregnancy tests, derm appointments) and progress that isn't linear and seems to backtrack every time a dose increases is really hard. Tracking subtle patterns in breakouts, mood, and dryness to share with my doctor is really hard. Non-stop calls to pharmacies to see who can fill my prescription locally during my "7-day refill window" and regular FDA-required iPLEDGE quizzes on the risks of pregnancy while on treatment (as a gay woman) are hard. All that being said, I'm on my last few weeks of a 6 month-long course and I can say from experience that Isotretinoin worked for me. It's changed my life.
How I Found Cleyra While Tracking My Isotretinoin (Accutane) Progress
On a bittersweet June trip to the east coast to help my best friend move from LA back home, I realized how all consuming my blemishes and treatment had become. I couldn't stay present enough to appreciate some of the last few moments I had with her, pre-occupied with my pulsing skin and lack of control, so I started looking into tracking apps and found Cleyra. I came to Cleyra as a user tired of tracking my progress on iPhone notes, moving selfies of breakouts to my hidden folder daily, and getting kicked off YouTube and Instagram and Reddit by my social media blocker app after hours spent watching YouTube "Accutane journeys" and scrolling r/Accutane Reddit in an attempt to soothe my treatment anxiety. My only source of hope was in the proud makeup-free selfies that those who had come before me posted.
How Cleyra Helped Me Track Progress Without the Anxiety
Cleyra is an app that helps people on Isotretinoin track breakouts, side effects, mood, and appointments in one private place. With Cleyra, for the first time in months, I was proud of how far I'd come and how much closer I was getting each day to my cumulative dose. I stopped taking pictures before bed and started noticing the incremental progress my skin was making. I had a designated space for acne stress and a system for setting reminders for all my appointments. I was able to track hydration and mood and mental health and see real progress before I saw it in the mirror, and I was comfortable doing all of this because I knew my (sensitive and deeply personal and embarrassing) data was safely stored on my phone.
What I Wish I'd Known Before Starting Isotretinoin (Accutane)
1. Book your monthly doctor appointments in advance at the start of your treatment journey.
2. If you can get pregnant and have to do iPLEDGE, order all the pregnancy tests you'll need at the start of your treatment journey. Get crystal clear on how your doctor needs them submitted.
3. After your monthly derm check-in and submission of a pregnancy test, call your pharmacy to make sure it has Isotretinoin in stock. If not, ask them to help you find other pharmacies for them to forward your prescription to.
4. Periodic purges when you go up on dosage are tough. Give yourself permission to cancel plans.
5. My nails changed a lot. My cuticles stopped growing and my nails got thinner and drier. They always looked manicured, but polish stopped sticking well.
6. You will learn what the phrase thin-skinned means. Your skin becomes very delicate and pimple patches will help you not only heal, but protect yourself from picking. I recommend ordering a roll of professional hydrocolloid bandages and cutting them out yourself. You will use so many and the fancy stuff will get expensive.
7. If you wear makeup, find a foundation with SPF in it. Make sure that SPF is also a moisturizer.
8. You'll get breakouts in the same spots over the first few months. This is normal.
9. Some of your friends might say your skin is looking better when you know it's not. They mean well!
10. Have a chapstick for each bag and maybe even each room. Make sure to have a chapstick with SPF.
11. Invest in a good wide brimmed hat if you'll be doing your treatment in the summer.
Frequently Asked Questions
What was the hardest part of isotretinoin (Accutane) treatment?
For Char, it wasn't the physical side effects. The harder parts were the logistics and the mental load: monthly bloodwork, pregnancy tests and derm appointments, calling around to find a pharmacy that could fill the prescription inside the 7-day refill window, and progress that wasn't linear. Other people find different parts hardest — this is one patient's account, not a general rule.
Do breakouts come back when the dosage goes up?
Char describes periodic purges after her dosage went up, and progress that seemed to backtrack each time. Isotretinoin's prescribing information notes that a transient worsening (flare) of acne has been observed, generally during the initial period of treatment. Whether this happens, and when, varies from person to person — bring any flare to your dermatologist rather than reading it as a sign the medication isn't working.
Does everyone taking isotretinoin have to do iPLEDGE pregnancy testing?
iPLEDGE is the FDA-required risk management program that every isotretinoin patient, prescriber, and pharmacy in the US must be enrolled in. The monthly pregnancy tests and the comprehension questions about pregnancy risk that Char describes apply to patients who can become pregnant. Your prescriber and pharmacy are the ones who confirm what the program requires in your case.
How long does a course of isotretinoin last?
Char's course ran about six months, and she was in her last month when she wrote this. For context, the prescribing information describes a recommended course of 15–20 weeks, and the American Academy of Dermatology says a course typically takes about four to five months. The actual length of any individual course is set by the prescribing dermatologist.