Accutane was a brand name for an oral, anti-acne medication that is no longer being prescribed, but the active ingredient in it (isotretinoin) is now available as a generic. Accutane/isotretinoin has the potential to cure acne or at the very least make it go away for awhile. Once a round of isotretinoin is done, the acne may still return; however, if it does, it is rarely as bad as before.

Regrettably, isotretinoin is a difficult drug. There are lots of serious side effects such as elevated cholesterol, liver problems, loss of hair, unbelievably dry skin, birth defects if you get pregnant while taking it, depression (though that side effect is controversial), headaches, bloody nose, and on and on. But for me, my acne was even more difficult than all of those health risks, which is why, once I was fully informed about the risks, I still opted to take this medicine to help my acne.

Prior to Accutane, every morning for me was a living nightmare of having to look in the mirror to see what had happened to it overnight. It was agonizing and it was rarely good news. And then during the day I could feel eruptions developing as I touched my face or felt the small throbs where swollen bumps were growing. I even hated the word “pimple.” I found it embarrassing and insulting. I am sure anyone struggling with acne knows just how I felt, and how strong the desire for clear skin becomes.

When I finally decided to try Accutane it was with utter abandon. I would do anything to not have this struggle of seeing red, inflamed, white dotted lesions on my face.

When I started my prescription I noticed a difference within the first week. I’ll never forget the moment when I touched my face and felt nothing that I was so used to feeling. All I could feel was smooth skin! Much to my continued surprise, it remained that way for weeks. I had some of the side effects I was told about, including bloody nose, dry lips, and headaches. No one tested for liver function and cholesterol levels in those days and I was beyond getting pregnant so there is much I don’t know for what did or didn’t go wrong for me internally. What I do know is that it was the first time in my life since the age of 11 that I liked looking at myself in the mirror.

At the three month point I started experiencing hair loss and that freaked me out. As a result, I stopped taking the drug and, as expected, the hair loss stopped. The trade-off for stopping too soon to save my hair was my acne came back about two months later. I did a great deal of research and found that the dosage and timing was a big deal. A lower dose taken over a longer period of time seemed to be far better. I discussed this with a new physician and started another cycle of Accutane. Thankfully, it went much better the second time around.

Today, almost 17 years later, I still struggle with breakouts but nothing like I did before Accutane. I sometimes think I should have taken another treatment cycle but never did, not because of the risks, it was just that I never got around to it and I was happy enough with the results two rounds of Accutane provided.

Given everything known about isotretinoin/Accutane my only personal regret is that I waited so long to take it. I can only guess what my mornings would have been like in my 20s and early 30s had I taken the drug back then, and not wasted so much time and money on irritant-laden products that made matters worse not better. Like many of you, I just didn’t know any better and just kept buying product after product hoping something would work.

Everyone has to weigh the pros and cons of many things they do in life; for me, Accutane was a no-brainer. Whether you feel the same way is a decision only you can make, but if you decide to take isotretinoin, be certain you’re fully informed of the risks, particularly if you’re a woman of childbearing age.

There are many things I love about owning a cosmetic company. I love that I can provide the real information consumers need to make intelligent, rational decisions about their skin care. Presenting the facts doesn’t always make me money; obviously, it would be easier to promise women miracle ingredients that replace cosmetic surgery rather than tell the truth about exactly what my products can and can’t do. Mostly I love formulating new products—that’s the best! Taking research about new ingredients and new understanding of how skin works and then putting that knowledge together in a new formula is thrilling. It is challenging, stimulating, endlessly creative and always rewarding, especially when my customers love the results.

What is often difficult is helping customers understand how to put a skin-care routine together or how one formula differs from another. For example, often one formula is different from another only because the base formula’s chemistry affects the rate of efficacy or a different base is needed to support the product’s claims. How do you explain such technicalities to thousands of people?

Here is where I need your help: The two toners I created for my CLEAR anti-acne line are confusing customers. One is Regular Strength and the other Extra Strength, BUT they both contain 2% salicylic acid. Therein lies the problem! The difference between the two is the base ingredients which don’t seem significant—but they are. Both formulas are liquids but one allows the salicylic acid to penetrate better (that’s the Extra Strength), and the other allows the 2% salicylic acid to be effective but less penetrating so it is essentially a more gentle formula. See what I mean? It’s not so easy to explain when the amount of active ingredient is the same for both products. Based on customer feedback, the names and descriptions we have aren’t helping.

So we are considering renaming both CLEAR toners. Here’s what my team and I have come up with:

The Regular Strength could be named: Soothing Acne Relief Toner with Salicylic Acid
The Extra Strength could be named: Extra Strength Deep Targeted Acne Relief Toner with Salicylic Acid

On the back of the container the percentage of salicylic acid would still be there with the appropriate description.

The Soothing Acne Relief Toner would state:

This toner contains 2% salicylic acid in a gentle formula that allows for effective exfoliation on skin’s surface and inside the pore lining. It is best for sensitive skin or for those with mild acne.

The Extra Strength Deep Targeted Acne Relief Toner would state:

This toner contains 2% salicylic in a penetrating formula that allows for maximum exfoliation on the surface of skin and in the pore, making it more effective for those with moderate or stubborn acne.

So tell me what you think. If this was your cosmetic line, with anti-acne products you knew were some of the most effective available, but there were formula nuances the consumer needed to understand to determine which one to use, what would you change on the label (keeping in mind there isn’t much room)? I would sincerely appreciate your input!

I received this letter from a reader:

Hi from Spain. I am independent journalist in nutrition and cosmetics and I have been reading your new book The Original Beauty Bible (its great) and I noted you talk about anti-inflammatory diet. First of all I believe you are so influenced in nutrition by Dr Weil, but the original creator of anti-inflamatory nutrition is Dr Barry Sears (read for example THE ANTI-INFLAMMATION ZONE). Second, it’s so odd for me that you recommend anti-inflammatory diet and then you say diet is not linked with acne and there aren’t studies about this. Really there are many important clinical and published studies about how a high glycemic diet and a low Omega 3 diet worsen acne. You can read chapter 8 of “Cosmetic Dermatology” (2009) by Leslie Baumann MD or all literature of Loren Cordain (in “The Dietary Cure for Acne” explains based on studies how diet affects acne, for me the very best book about this topic). And really all my readers have improved their acne condition following an Omega3 anti-inflammatory diet.

Here are my comments:

While I apprecaited the feedback and the great compliment there were a few things wrong with the assessment. First, in terms of influence, I actually rarely use Dr. Weil, rather I use a vast number of research journals that I have online access to. In terms of Cosmetic Dermatology, I know that publication well and have a subscription to it, though it is a bit suspect because so much of the research published is paid for by manufacturers of skin care products (both prescription and non-prescription brands) and some of the doctors who write the articles are on the payroll of cosmetic companies.

Yes, nutrition is important to skin care, after all if we don’t eat we die and then we don’t look so good, but the research about a specific diet and skin care is lacking, especially for acne (research about diet and wrinkles is also sparse but growing).

In terms of diet and acne I have seen the research about the glycemic index association but that is hardly conclusive and is more theory at this point then anything else.

Here is some information you may find interesting from the American Academy of Dermatology:

The American Academy of Dermatology (Academy) still says that diet does not cause acne. After all, haven’t research studies found that certain foods cause acne? If you have acne, you may even have noticed that when you eat certain foods you break out. With all this evidence, why does the Academy still say that food does not cause acne?

What the Research Really Shows
While studies have been conducted, more research is needed to conclude that what we eat can cause or prevent acne. What these studies have found suggests that diet may play a role in acne. Here is what the research has shown so far.

Milk and acne. Could drinking milk cause acne? One researcher reports that between 75% and 90% of the milk and milk products consumed in the United States come from pregnant cows. Could acne develop because drinking milk exposes us to the hormones that cows produce when they are pregnant? We know that hormones clearly play a role in acne.

To answer these questions, researchers began by asking people to recall what they ate. One such study asked 47,355 women to remember what they ate in high school 9 years prior. Another study asked teenage boys to recall what they ate and to determine the severity of their acne.

After analyzing the foods eaten, researchers concluded that there was one association. Sodas, chocolate, and even potato chips were not associated with acne. Only drinking milk was.

These studies had limitations. Trying to accurately recall what you ate years ago — or even days ago — can be difficult, so the collected data cannot be considered entirely reliable. What the data does show is that there maybe an association between drinking milk and acne. An association means that more research is needed to prove whether this is just an association or a cause.

It is possible that other causes were at work. These studies did not account for known causes of acne, such as heredity. Acne is known to run in families, and some of the women and teenage boys may have had acne because they inherited genes for acne. The researchers acknowledge the limitations of these studies and conclude that more research is needed.

Western diet and acne. Some researchers hypothesize (explanation that needs to be proven) that more than milk could be causing acne. It could be our Western diet, a diet rich in refined carbohydrates. A few studies have looked at this possibility. One study observed that people in 2 non-westernized societies — Kitavan Islanders (remote islands off the coast of Papua New Guinea) and the Aché hunter-gathers of Paraguay — did not have acne. The researchers attributed this to the people’s low-glycemic diet. A low-glycemic diet consists of fresh fruits, vegetables, and lean proteins.

When people eat a low-glycemic diet, the body works more efficiently. The body needs only produce relatively small amounts of insulin to keep blood glucose levels (glucose gives us energy) within the normal range. When the body works this way, the person is said to be insulin sensitive. This means the body requires relatively small amounts of insulin.

A high-glycemic diet can lead to insulin resistance, which means the body needs to produce a lot more insulin to maintain glucose levels. Insulin resistance can cause numerous health problems including high blood pressure, heart disease, and diabetes.

The researchers concluded that a Western diet, which often causes insulin resistance, might also be fueling known causes of acne such as the production of excess sebum (oily substance) and inflammation. More research is needed to find out if a low-glycemic diet can prevent acne and lead to clearer skin.

To find out, small studies have been conducted to look at the effect of a low-glycemic diet on acne. These studies suggest that a low-glycemic diet maybe helpful, but further research is needed to explain the role that diet plays.

There are still many unanswered questions. One question researchers must answer is why every obese person does not have long-term acne. Individuals who are obese generally have had insulin resistance for years. If insulin resistance leads to acne, then everyone living with diabetes would be expected to have acne. Why is this not the case?

The diet-recall studies also did not show an association between eating high-glycemic foods such as soda and chocolate and acne. Why is this?

More Research Needed
While the research shows that there may be an association between diet and acne, the researchers conclude that more evidence is needed to prove this association. Until research proves that diet causes acne, this site will continue to state what the research shows. To date, the research does not prove that diet causes acne.

References:
Adebamowo CA, Spiegelman D, Berkey CS et al. Milk consumption and acne in teenaged boys. J Am Acad Dermatol 2008; 58: 787-93.

Adebamowo CA, Spiegelman D, Danby FW et al. High school dietary dairy intake and teenage acne. J Am Acad Dermatol 2005; 52: 207-14.

Arbesman H. Dairy and acne–the iodine connection. J Am Acad Dermatol 2005; 53: 1102.
Bershad SV. Diet and acne–slim evidence, again. J Am Acad Dermatol 2005; 53: 1102; author reply 3.

Cordain L, Lindeberg S, Hurtado M et al. Acne vulgaris: a disease of Western civilization. Arch Dermatol 2002; 138: 1584-90.

Danby FW. Acne and milk, the diet myth, and beyond. J Am Acad Dermatol 2005; 52: 360-2.

Smith RN, Braue A, Varigos GA et al. The effect of a low glycemic load diet on acne vulgaris and the fatty acid composition of skin surface triglycerides. J Dermatol Sci 2008; 50: 41-52.

Smith RN, Mann NJ, Braue A et al. A low-glycemic-load diet improves symptoms in acne vulgaris patients: a randomized controlled trial. Am J Clin Nutr 2007; 86: 107-15.

Smith RN, Mann NJ, Braue A et al. The effect of a high-protein, low glycemic-load diet versus a conventional, high glycemic-load diet on biochemical parameters associated with acne vulgaris: a randomized, investigator-masked, controlled trial. J Am Acad Dermatol 2007; 57: 247-56.

Thiboutot DM, Strauss JS. Diet and acne revisited. Arch Dermatol 2002; 138: 1591-2.

Treloar V, Logan AC, Danby FW et al. Comment on acne and glycemic index. J Am Acad Dermatol 2008; 58: 175-7.

Webster GF. Commentary: Diet and acne. J Am Acad Dermatol 2008; 58: 794-5.

However, what is 100% certain is that anecdotal feedback about what helps acne makes for good reading. Yet anecdotal information isn’t solid research. Someone’s individual success, and I’ve seen it all, includes things that could not possibly help and if anything can hurt skin. For example, you can start a diet at the same time your hormones are changing (such as associated with stress or someone’s menstrual cycle) and you would mistakenly associate that with your diet. When the acne returns you may not be the one to hear about it (that’s the nature of anecdotal information). I do suggest experimenting with diet and I mention the relation to certain foods to see what may work for you, including specific allergies to nuts or milk, but that is still not fact, just theory and personal experience.

I know “mineral” makeup remains a popular choice for many women. There are some great mineral makeup options available for those who are fans of this type of product. But without question this is one cosmetic product where the claims has spiraled out of control and taken on a fairytale life of their own (and I don’t mean Aesop’s Fables, because at least those have a good homily at the end, the story behind mineral makeup is all lies and puffery to the max!).

I read an article about mineral makeup in the April issue of Day Spa magazine. This is a publication that is tailored for estheticians and other spa professionals (the ones that are going to be selling you the myth). There were so much false, ridiculous information I lost count. In fact, I couldn’t even finish the article; it was that bogus. Here are a few of the big lies the article intended to position as key selling points and benefits of using mineral makeup, followed by my response.

• Cleopatra started the mineral makeup trend centuries ago, so once again modern-day women can learn from the ancient wisdom of this Egyptian ruler.
  Does anyone still believe that Cleopatra had such forward-thinking knowledge of beauty? The woman lived at a time when products resembling what we refer to as mineral makeup were impossible to make. And if they dug up iron oxides, titanium, and other earth minerals they had no idea these were contaminated with toxic minerals such as lead, mercury, and cadmium. Cosmetic-grade ingredients are what are allowed today, and they’re purified to remove contaminants. And ancient wisdom? The Egyptians sacrificed human beings to their gods, buried family members alive with the king, and had hordes of slaves. Clearly an advance civilization we should learn from! Puhlease!!!
• The spa industry likes mineral makeup as something that sets them apart from the cosmetics industry at large.
  Perhaps that was true several years ago, when the only place to find mineral makeup was in small salons and spas carrying such lines as Youngblood or Jane Iredale. That’s definitely not the case anymore—mineral makeup is everywhere, from small cosmetic lines sold at Ulta to brands known worldwide such as Estee Lauder and Lancôme and Neutrogena and Maybelline. If anything, these non-spa cosmetic lines have improved mineral makeup considerably while many spa brands seem to be resting on their laurels and have not kept up with new technology.
• “Mineral makeup is all-natural and there are no by-products created during their production.”
  This one is patently false. Although the minerals in mineral makeup may have begun as a natural source, the process that turns titanium into titanium dioxide or bismuth into bismuth oxychloride is anything but natural—and it certainly produces by-products as they are chemically manipulated and manufactured to be suitable as cosmetic pigments and binding agents. Remember, in most cases these naturally-occurring minerals must be purified to remove harmful elements that, while also natural, aren’t what you’d ever want to put on your face.
• Mineral makeup is a green alternative to chemical-based cosmetics.
  This is a big selling point used by many lines selling mineral makeup exclusively. They attempt to scare consumers into believing that mineral makeup is the only safe, pure option and everything else is laden with “chemicals”. The word “chemicals” is used to inspire fear (and it works remarkably well, at least based on the emails we get) even though the basic truth is…..EVERYTHING is made up of chemicals! Yes, even natural ingredients are composed of chemicals (so many, in fact, that in some instances a synthetic version of a natural ingredient is actually safer and more beneficial because the potentially harmful chemicals are not included). Please don’t fall for the “chemical-free” claim many mineral makeup brands promote. It’s a lie, and the consumer is being duped big time.
• Bismuth oxychloride is “one of the best ingredients because it helps clear bacteria and heal skin”.
  The quote above is from the owner of a small mineral makeup company, and she is soooo wrong! Bismuth oxychloride is a synthetic ingredient that has no substantiated research anywhere proving it has antibacterial properties or has any healing effect on skin. It is used in mineral makeup due to its opacity and pearlescent finish, plus it adheres well to skin. In contrast, zinc oxide (another ingredient in some mineral makeups) has healing properties for wounds and there is documented evidence to support this (Sources: Wound Repair and Regeneration, January-February 2007, pages 2-16; and September-October 2006, pages 526-535) but lots of cosmetic companies use zinc oxide, this is hardly unique to mineral makeup!
• Mineral makeup helps keep skin hydrated.
  Anyone with dry skin who has tried mineral makeup without the benefit of a moisturizer underneath knows what a bunch of bunk that statement is! Traditional loose powder mineral makeup is composed of absorbent materials that are incapable of hydrating skin. Some of the ingredients may have natural water content, but their absorbent nature won’t transfer that water to your thirsty skin. Even it did, skin needs more than water to rebuild its barrier and reduce dryness. Believing that mineral makeup is the least bit hydrating is akin to thinking you can scrub away acne and blackheads. In both cases, it just isn’t going to happen.

There’s more, but I am sure by now you’re getting what a puff piece of reporting this story is—and this is the type of garbage well-meaning estheticians read, believe, and then pass on to their clients. Misinformation begetting misinformation, but hey, it’s selling product so why not? I’m not out to bad-mouth any esthetician. Even with their skills and experience, they can be just as prone to hyperbole as the rest of us. But if you are an esthetician and you read this blog, please think twice before jumping on the mineral makeup bandwagon for the reasons listed above. Mineral makeup has its place and certainly its proponents, but it doesn’t deserve its prefabricated status as the safe and natural.

One more thing about my trip to Los Angeles to meet with some of the labs that help us formulate our products, almost without exception the most common comment I get is how different it is when my team and I meet with them. Why different? Because we talk ingredients, we ask for studies, we want products with no fragrance and no coloring agents, we provide air tight containers, we ask for plant extracts and vitamins with proven benefits, we only want “natural” or “organic” ingredients that can make a difference for skin, we want effective exfoliants, effective anti-bacterial agents for acne, effective antioxidants, cell communicating ingredients, and skin identical ingredients, and we want an honest discussion about how to make a product stable. Primarily what we don’t want is the hype. It usually takes awhile to wade through all but eventually we do get to the other side.

Eternally perplexing to the cosmetic chemists we work with is the need to see in an ingredients deck (the proposed formula as it would appear on the ingredient label) before we see the product. I’ve been formulating products for more then 15 years and it is the rare lab that does this. Their system is to send the product because no one is all that curious about what the product contains (they only want the “special” ingredient they can showcase to the consumer); they want to know how it feels and smell. Feel and smell is important but if the ingredients aren’t healthy for skin why bother. From my perspective it is a waste of time and money, show me the ingredients.

At some point I’m always expecting this to change, that at some point there will be a learning curve and our account representative and chemist will cut back on the salespitch but that has yet to happen. They see dozens of companies a month and we appear to be the only one asking for formulation details. I shouldn’t be that shocked, that’s my learning curve, I never get used to the way my industry works.

I hate watching infomercials or any cosmetic advertising for that matter. I can barely tolerate listening to what the salespeople behind cosmetics counters have to say; it just makes me cringe and my skin crawl. The utter nonsense that is spewed to unsuspecting women is beyond my tolerance level. I just get so frustrated, my blood boils, I start grousing, and that can eventually turn into a rant, and well, that just isn’t pretty.

Such was the case last night when I was watching the latest spate of infomercials from Dr. Murad. He was explaining why his acne line doesn’t include benzoyl peroxide. Is he serious that there is a rationale for ignoring a basic skin care protocol for acne? Did he miss the research published in the Lancet, December 2004, pages 2188-2195, stating that benzoyl peroxide is the most effective treatment for acne, especially in comparison to oral antibiotics (such as tetracycline), topical antibiotics (such as erythromycin), or combination treatments? Another nice benefit over and above a significant reduction in breakouts: the study noted that benzoyl peroxide was also the most cost-effective treatment.

Dr. Murad’s explanation for not using benzoyl peroxide was that it can be drying and irritating. Well, so can watching infomercials for some people, but not for everyone. As a matter of fact, you would be far more able to easily tolerate benzoyl peroxide if the product didn’t contain irritating ingredients such as alcohol or menthol, lime, lemon, or peppermint, or you used gentle cleansers along with it. While Murad is worrying about benzoyl peroxide (at the very least he should offer it as an alternative, something most any reputable doctor would do) he isn’t worried about the irritating ingredients he does use in his acne products including menthol, citrus extracts, alcohol, and lavender.

I won’t even get into the pandering he does with his anti-wrinkle products categorized by hormonal, environmental, and genetic aging. Or maybe I’ll get into that the next time I’m in a blogging mood…