A pimple can easily feel like the end of the world, especially if it’s large, painful, red, and… you get the picture. For those of us with the unfortunate but occasional breakouts or acute smatterings of blemishes across our face and body, topical creams and medicated cleansers (or, in some cases, antibiotics) usually do the trick. But for those with an excessive amount of pimples, visible redness, and deep-rooted cystic acne, these topicals and low-grade prescription medications aren’t aggressive enough; you’re still left with marks that physically affect your skin and, in turn, tarnish your self-confidence.

In these cases, when patients can’t achieve a clear complexion with OTC treatments or antibiotics (or, in some instances, birth control), a dermatologist may suggest Accutane.

The name alone may scare people away. After all, it carries a stigma: Harmful internal maladies and depression are widely known side effects that paint it as a taboo and potentially dangerous kind of drug. Despite its setbacks, however, Accutane can actually be a “cure” of sorts, for those with chronic acne, a sentiment Dr. Hadley King, a dermatologist, agreed with when we spoke with her last month. “Accutane can be a life-changing medication for people who suffer from severe acne,” King says. “For severe recalcitrant acne, isotretinoin [the medical term] is an excellent option.”

Meet the Expert Dr. Hadley King is a board-certified dermatologist who specializes in cosmetic and medical dermatology. Her sought after private practice has landed her in publications such as Elle, Glamour, and Self Magazine.

So how does Accutane work? According to Dr. Elizabeth Tanzi, founder and director of Capital Laser & Skin Care, “One of the main effects acne has on the body is in the sebaceous glands of the skin. [Accutane] reduces sebum production and makes the pores less ‘sticky’ so they don’t get clogged and cause acne.”

Meet the Expert Dr. Elizabeth Tanzi is a board-certified dermatologist and founder of Capital Laser & Skin Care in Washington D.C. She has written numerous academic articles and lectured on cosmetic dermatology.

For a visual guide to Accutane's potential effects, see the graphic below.

Original Illustration by Ellie Benuska

As you can see, along with the fact that it prevents new acne from forming while healing current blemishes, there are quite a few potential side effects of Accutane—but the operative word here is potential. Yes, dry skin and chapped lips are almost a given, as oil production is practically halted while on the drug, but joint pain, rash, intestinal symptoms, and depression were reported 15% or less of the time while users were on the drug, so as with most medications, not all side effects are guaranteed. However, meeting with your physician regularly and being attuned to your body is paramount.

Something women may not know prior to taking Accutane is that they will need to enroll in a risk management program designed to prevent fetal exposure to isotretinoin called iPledge. This requires that she must use two forms of contraception and submit a negative pregnancy test to her physician each month over the course of taking the medication, as Accutane can cause severe birth defects. In other words, physicians do not take the potential side effects of the drug lightly, and neither should users.

While the medication has its negatives, we know that it certainly has a bevy of positive attributes. The American Osteopathic College of Medicine argues that “there is nothing else in the world that comes close to being this effective for severe acne.” The pill, which is a derivative of vitamin A, was found to essentially “cure” about half of those who take it, meaning they’ll never have to treat acne again. Pretty amazing, right?

We asked a recent Accutane user, Taylor Kelly, about his experience on the pill, and while he found it to be very effective, it surely wasn’t without its faults.

Says Kelly, “The monthly doctor appointments and blood collection were tedious, but my skin cleared up very rapidly. During the six months I was on it, I was not allowed to be in any sunlight and was advised against drinking heavily. My lips shed about three times a day. Layers of skin would literally just wipe off.” He jokes, “It would leave me with a pretty sexy, smooth and colorful lip, however.”

“Honestly,” Kelly continues, “there were periods of time while I was on Accutane that I would get very emotional for no reason and couldn’t explain why. One of the listed side effects is that the medicine can make you sad, but whenever the doctor asked me those monthly questions [regarding my emotional behavior], I would say nothing is unusual. I was sure that if I said yes to any of their questions, they would stop the medicine immediately, and I would not be able to see the full effect. It has been months since I have met the full dosage and stopped taking Accutane, and so far, I do not break out as much as I used to, and when I do, the pimples are not deep or cystic like they used to be.”

Kelly’s experience brings up an important point: Even though he endured the emotional side effects in his quest for clear skin, it’s important to be honest and open with your doctor each time you meet for a check-up. Let the professional work with you to decide how to adjust your prescription if you’re noticing negative repercussions, whether physical or emotional. As effective as Accutane can be, it’s not worth jeopardizing your health.