Post-Accutane skincare for your dry, desiccated husk of a face

Wikipedia | Cassandra, Doctor Who

I regularly feel like Cassandra from Doctor Who. I sort of talk like her, too. Actually, that’s a lie, but you should pretend I do.

As soon as puberty hit, I got greasy. Hair, skin, you name it — and, of course, the acne followed. It didn’t help that because of PCOS, my body was producing all manner of androgens that gave me Super Acne, with the power to leap tall buildings in a single menstrual cycle.

So I nuked my acne with Accutane. I still don’t know if that was the right decision, but for now, I don’t regret it. Well, for the most part.

You see, it is winter here in New Jersey, which this year may as well be New Siberia, and I have Chronic Dry Everything (skin, mouth, eyes) due to Accutane. The air is dry, and to make matters worse, our humidifier is broken. The fiance and I have been flaking all over the place and sort of wishing we had those moisture-recycling suits from Dune, so I’ve been learning to adjust.

So here you go: skincare for dry or dehydrated skin.

What’s the difference between dry and dehydrated skin? Well, dry skin is skin that doesn’t produce enough oil. If you took Accutane, you likely have dry skin. Dehydrated skin is skin that lacks water. Even if you have oily skin, you might wake up after a night of X-TREEM binge drinking with dehydrated skin.

If your skin is dehydrated, drink water like it’s going out of style. Stop reading this blog post and go knock back a glass of water. Do it! (This comes naturally for me because I have dry mouth, so I’m never not thirsty. Silver linings, I guess.)

  1. Cleanse with something other than soap, and use lukewarm or cold water. Everyone’s gotta cleanse their skin — you don’t want all that dirt and bacteria to chill there, forever. And if you think you can’t get acne with dry skin, you’re wrong — all the skin irritation only makes it easier for infections to happen. My recommendation? Good old fashioned cold cream. This cleanses the skin while putting oil — in this case, mineral oil — back into it. At the end of the day, rub the cold cream into your face, rinse it off in the shower, and then apply it again after your shower, before applying your moisturizing cream. Your skin will look balmy come morning — probably.
  2. Moisturize twice daily. I use CeraVe Moisturizing Cream because my dermatologist recommended it. It’s pretty okay! In the morning, I splash my face with warm water, then rub this stuff into my face like I’m trying to penetrate my brain with it. At night, I put it on after my post-shower cold cream application. Yup, I put it on top of my cold cream, because I’m serious about moisture. And here’s where it gets good: I then smear a thin layer of Aquaphor on top. MAXIMUM MOISTURE.
  3. Wear sunblock. Even if it’s winter. Even if you’re tan as hell. Even if you work indoors in the dark. Legit, the sun is your enemy. Okay, it also gives you life, but feel free to show a complete lack of appreciation by blocking its loving rays from your face like they’re trying to kill you. Because they are trying to kill you, and age you in the process. You might be saying, “Well, Natty, you’re so pale you burn looking at postcards,” and it’s true — I can’t speak from experience that your beautiful bronze skin needs sunblock — but I’ve totally read that it does on the Internet, so you can probably trust me here. After I moisturize in the morning, I’ll just plop on a decently thick layer of my SPF 30 BB cream, and feel like I’m doing the responsible thing for my skin.

There you go! Follow these three steps and your face won’t feel like it will split every time you smile… probably. Do you have any great moisturizing tips for dry skin? Please enlighten me in the comments!


Skin Problems Hurt, Part 1: Acne

Overly photoshopped acne girl

A picture from when I had bad acne. Know how you can tell? The shitty Photoshop job on my skin. Even my eyebrows are a little blurry.

Acne hurts.

I didn’t expect to well up a little typing that sentence. It’s been years since I got rid of my acne, but for a few years of my life, it was such a source of pain. Not just emotional, but physical — my inflamed skin, oozing and bleeding in parts, hurt. The harsh chemicals I put on my skin, that burned in the open parts, already dried out, a cracked, dehydrated topography of eruptions, hurt.

But my god, the emotional pain — the hit to my self esteem, the fear that it would never get better, that it would scar, that fresh pimples would bubble up atop the scars, that my skin would never look acceptable — that pain followed me everywhere for a few years.

It followed me everywhere because you cannot hide your face. You can “dress down” your weight, and even then, there are always people out there who glorify the curvy body, who will be your ally. I never hated being fat as much as I hated having acne, even through my years of disordered eating. After all, I’d never met someone who said, “I think zits are hot.”

I know now that my acne was one of the first signs that I had PCOS. It was late-onset, after all. Throughout highschool, I had your normal pimple-prone teenage skin. Nothing a little bit of salicylic acid and concealer couldn’t take care of. Manageable.

But when I turned seventeen, around the same time my symptomless, clockwork periods became erratic, painful little assholes, my skin went rogue. Nothing I did — not the salicylic acid, not the benzoyl peroxide, not the tea tree oil, not the lavender oil, not the Proactiv, nothing — could curb the spread of eruptions. It only got worse.

“Severe cystic and nodular acne,” my dermatologist would eventually write.

Everyone had a remedy for me to try. “Put toothpaste on it; it’ll dry it out.” “Sit in the sun for a while, your skin is just oily.” “Proactiv worked perfectly for me!” Everything they named, I’d tried. I scowled at every Proactiv commercial I saw. Bullshit, Jessica Simpson, I’d say, we all know that if anything were wrong with your skin, you’d have the industry’s top dermatologists at your beck and call.

My senior band banquet arrived. There was a strapless dress I adored; I’d planned on wearing it for months. The skirt was asymmetrical, with a bold tropical flower print.

It was strapless.

My shoulders were massacred by my acne. I tried switching my shampoos and conditioners, but nothing helped. I dreaded combing my hair, as merely brushing against my upper back could cause one or more of the zits to pop.

The solution? I decided not to go at all. I couldn’t show my skin in public. In my teenage mind, there was no point attempting to get dressed up and look pretty when I was a walking aggregation of infection.

My friends would silently point out to me when my face was bleeding. I appreciated this, as spontaneous popping was so common as to be unnoticeable to me, and I at least wanted the chance to wash off in the restroom.

A friend’s mother, a substitute teacher I loved dearly, ran into me at a school event. I hadn’t seen her in years. Genuinely happy to see me, she grabbed me by the face in one of those loving aunt ways.

One of my zits burst into her hand. Mortified, I pretended I didn’t notice, and she followed suit.

College arrived. I had new people to be pretty for — thousands of new people who could potentially judge me. I packed enough OTC acne treatments to last months. They filled up my dorm shower, falling on me every time I stepped in. Exfoliants. Cleansers. Moisturizers. Toners. Oils. Wipes.

I didn’t leave my dorm room without a few layers of makeup. I’ve written about the fact that I wish there were more photos from when I was fat; I started using Photoshop around the same time that my acne descended. Virtually every picture of me from that time period is so amateurly digitally altered that my skin doesn’t even look like skin, so much as a flat swatch stretched haphazardly across some facial features, blurring everything in its wake.

Finally, my dermatologist offered me the Holy Grail of acne treatment. I had tried clindamycin, all sorts of prescription-strength ointments, antibiotics, to no avail. (Had I known I had PCOS at the time, I would have asked for something anti-androgenic — but no one was the wiser, and I didn’t think that the thing that was stopping my periods was also wrecking my skin.)

She wrote me a prescription for Accutane.

She assured me it was safe. “I’d give it to my own kids,” she said. I honestly didn’t give a shit. I didn’t know about Crohn’s or ulcerative colitis at the time, and I didn’t know that those were possible side effects. I didn’t know that I would get chronic dry eye and dry mouth from the Accutane, but that wouldn’t have stopped me, either. Even the painful eczema that blistered my hands a year later wouldn’t have stopped me.

Accutane is so teratogenic that every single pill in the blister pack was accompanied by an image of a pregnant woman with an X through her; I had to pass a quiz on contraception every month just to fill the prescription.

And sure enough, my skin got better. It flaked; it peeled; it cracked. I woke up every morning with mysterious scratches all over my arm, as though a cat had clawed me in my sleep. I didn’t give a shit. My acne was going away.

And it’s stayed away for years.

I sometimes wonder if I’d do it again — risk my digestive track, my sight, my reproductive organs just to have clearer skin. Now that I’m in love with someone with Crohn’s, how could I risk inflicting that upon myself?

But knowing what I know now, I know what that answer would be. I know that if I confronted my eighteen-year-old self with this knowledge — that beautiful young woman with the long black hair, big green eyes, and broken skin — her answer would be the same.

Damn straight I’ll risk it, she’d say. Because acne fucking hurts.