I suffered from acne for 25 years. In my teens it was horrible. I had a pizza face in glorious technicolour. It certainly didn’t do my self-esteem any good, and in those days doctors just told you that you would “grow out of it”. So I tried all the over-the-counter preparations that existed, to conclude that they were marginally effective at best, but mostly useless. In my twenties my acne settled down to being “mild”. Yep, the medical profession has a scale of how bad it is, going from mild to severe. I have one too, from “disgusting but tolerable” to “omigod it’s a breakout”. For many years doctors did not take it seriously. And I think acne sufferers colluded in this by suffering in silence. I know I did. I kept telling myself that it wasn’t life-threatening; that it was hardly noticeable, that other people had it much worse than me....but I was deluding myself, as it was causing continuous, if low level, psychological pain.

I then went on to antibiotics for about 5 years. These definitely were an improvement, but if I stopped taking them, the acne returned, and I reasoned that they were just suppressing the symptoms, not treating the cause. I kept up with the medical reports, and there was talk of the new drug isotretinoin (Accutane/Roaccutane) which finished off acne completely, but had terrible side effects.

The Porsche test

I have a test, the Porsche test... I have now talked to quite a number of acne sufferers, from the very mildly afflicted to the poor sods with severe acne, and I ask them which they would rather have, a brand new Porsche or clear skin. Their answer is always the same as mine: clear skin. Not one would go for the Porsche.

In this book I am going to tell you about all the possible acne treatments, and as I’ve had most of them, the view from the horse’s mouth. Or the view of the horse’s skin, all right, I’ll shut up and give you my recommendation, first and foremost, is to get (Ro) Accutane now! I’d say it is the treatment of first resort, not last, ‘cos it works. Given that the medical profession moves in mysterious ways, I enclose details of methods to pressure your doctor into getting you it. Forget the scare stories: you are trading long-term psychological pain for short-term mild discomfort - I reckon that’s a good bargain, and the knowledge in this book will help you minimise the side-effects and help you through the difficult six months of the course.

You must keep a sense of perspective about Accutane/Roaccutane, rather than listen to the exaggerations about this drug put about by a few individuals and groups who seem to want to scare people. Yes it certainly is powerful, and has the weirdest set of side effects of any chemical I’ve ever come across. Including recreational drugs. But most of the effects are tolerable. About 80-90% of people who take it find that their acne gets better, sometimes it’s gone forever, sometimes it goes for a while then relapses, though the relapse is rarely as bad as the first occurrence. About 5% of people give up the drug….the med term is non-compliance, because they find it a hassle, and around 5% get adverse side effects which are sufficient for them to stop using it. A few people seem to have had long-term effects that were quite painful or suffered from some form of depression that may be associated with the drug. The connection between Roaccutane and suicide is, in my view, not proven; in any case Acne causes horrible depression. One of my correspondents wrote: “It may be useful for the same anti-Roaccutane group to perhaps consider the number of suicides where depression, caused by acne, has been a key factor. I have found that Roaccutane has helped me enormously. “

Over the past few years I have received a great many letters from people who were very depressed by having acne. This has reinforced my own belief that it causes a lot of problems in later life because of the stowed-up lack of self-esteem. I speak from experience.

Three or four years after having Roaccutane, I started suffering the “creeping relapse” – gradually the spots and black/whiteheads started to return on my nose, chin and chest. They were “ultra-mild” (sounds like a brand of ciggies) but you can understand that I became paranoid that the acne would return full-strength (hey, what’s with the smoking similes? ;-). After a while I heard the buzz about Vitamin B5 and other natural substances such as MSM and Essential Fatty Acids (Fish Oil/Flax Seed Oil). I am currently using them, together with Retin A and Ketsugo Isolutrol. You can read about my vitamin/supplement regime here.

This regime has finished off the acne completely. My skin is totally, unbelievably clear.

I’ve been gradually resurfacing my skin using home-made exfoliators, which cost virtually zilch. There has been a good improvement. I still have scarring, and I guess I’ll take it to my grave, but I can live with that.

So my view is that the best route to an acne cure is a course of Accutane/Roaccutane first, followed by a second phase of natural remedies and finally when your skin has recovered enough from the Accutane, some gentle exfoliation/peeling.

How to use this eBook Version 2

You can go through this book in chronological order, or jump straight to section about Accutane/Roaccutane. All the advice in here is either my own or from other sufferers like ourselves. Since the first version was published I’ve had a tremendous amount of correspondence from sufferers: I thank all of them. Many people have told me about what helped them and this material has been included where I felt it would be beneficial. But it is not a substitute for talking to your own doctor. So please consult him or her about your condition.

1. Acne Basics

Acne is caused by hormones making the normal sebaceous glands which lubricate the skin go wild. They produce great amounts of oil, which clogs up the tunnel leading to the surface - the pore - and you get white or black-heads. This allows the completely normal P. acnes bacteria which live on your skin to multiply in the blocked pore and you get zits and cysts. Blackheads are not dirt, they’re pores blocked with dried oil (sebum) and dead skin cells, that’s why washing doesn’t get rid of them. There’s a genetic factor involved. If someone in your family has acne, then you’re likely to get it. Your younger brothers and sisters may be acne-free now, but if you have it, then they will get it when they become teenagers.

It’s horrible. Usually - but not always - it starts in adolescence, and should die away by the time you’re about 22. Or so the medical statistics have it. Nonetheless that doesn’t mean that you have to suffer it as a teenager, you still should go for treatment, though a relapse on Accutane/Roaccutane is more likely the younger you are. If you’ve reached 22 + and it isn’t going away you’ve got clinical acne, a recognised disease, and need proper medical treatment.

But a number of people have acne that is severe, doesn’t go away (or bursts out again at the menopause or pregnancy). Some women get horrible flare-ups at period time, or it breaks out for no reason when they are in their 20’s or 30’s. About 30% of people who get the disease, according to British acne expert Dr. Tony Chu, have continuing acne that doesn’t “go away”. Some people even continue to have zits into their sixties and seventies. I suffered it for years; and it was only “mild” by clinical standards. I reckon anyone with it worse than that (the scale goes from “mild” through “moderate” to “severe”) should go straight to the dermatologist, do not pass Go, and get treated. I base this on my own experiences and those of other sufferers. You don’t want to look like crap all the time.

Remember doctors don’t know what you’re feeling. Many of them are not attuned to the grief that acne causes, though this attitude has improved in recent years. I am looking at a medical publication to help (!) acne patients right now, and it has splendid pictures of how you define “moderate” and “severe” acne. It’s painful to look at them. Their idea of moderate (which I looked like at 17), is my idea of never mind the topical antibiotics, start them on oral isotretinoin now!

This guide to acne (written in 1995, and trying hard to be helpful), talks about managing clinical acne. If your acne doesn’t go away and you see the doctor, you do not want your acne managed, you want it effing cured.

There’s only one treatment that actually cures acne that hasn’t gone away by itself and that is Isotretinoin (Accutane/Roaccutane). I do talk about natural remedies in Section 6 but I think they are a second stage. Nevertheless, if you are worried by the idea of Isotretinoin, please do try them or antibiotics first.

In my twenties and thirties I had mild acne; Roacc was only given to “severe” patients, and I was too ashamed to go to see the doctor - I used all the over the counter medications I could find and they’re crap. On the basis of this, I recommend anyone reading this, and by my reckoning you are suffering psychological distress, or you wouldn’t have bought it, should go to the doctor, armed with my arguments below. It’s the most sensible thing to do. Don’t suffer in silence like me. If you don’t feel assertive, or think your doctor will not be responsive, take a sympathetic friend and ask them to be an advocate on your behalf. Dermatology specialists, generally, are much more aware of the problem than your ordinary doctor and so once you get to see them, you should be all right.

Psychological problems

If you don’t want to go out in daylight, avoid going swimming, can’t face looking at yourself in the mirror, suffer from depression, you are not alone:

“low self-esteem, picking spots with a kind of masochistic satisfaction, and depression are experienced (in all degrees) by acne sufferers in general”(Acne Support Group Newsletter).

In a questionnaire the A.S.G. found that 84% of the 645 respondents felt that their socialising had suffered because of their acne, and 72% felt that their relationships had been affected by the disease. 50% avoided sports, 46% avoided leisure activities, 28% avoided work and 1% avoided “everything”. I also know female sufferers who are obsessive about makeup and will not be seen without it to cover up. You are suffering from a serious problem, not something trivial.

But this is not primarily a psychological problem. It all stems from the physical: if that is cured then the other problems will diminish or vanish. if they don’t after you have had proper medical treatment, then is the time to seek counselling or therapy.

4 years post-Roaccutane, and having had a mild relapse which seems to have been cured by a combination of MSM, Vitamin B5 and some other therapies (see chapter N). I like my face (its an acquired taste, you understand!) I can go for weeks without having a single zit. I still have a few blackheads on my nose and chest but they are under control and don’t bother me very much. My skin seems “normal” in its oiliness for the first time since puberty. I have open pores and ice-pick scars but they’re not too bad – much reduced since the bad old days. My complexion is pink and healthy. I have had compliments on it. I nearly hyperventilated when that first happened: I couldn’t have been more surprised if Manchester United had offered me a place in their First Eleven. This has affected my confidence in social and work situations: though I’d surmounted these problems mostly by willpower, there were “moments of doubt and pain” (Rolling Stones – an age giveaway if ever there was one).

I do feel better about myself.

Now we know enough to have a good idea what will work for most people. You don’t have to suffer like I did.

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