Skin Journey

1 December 2024


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From the age of around fifteen, painful inflamed lesions were not uncommon on my skin, however, they were manageable and only exacerbated due to dermatillomanic interference. However, as I neared high school graduation, my skin grew inflamed and acneic to the point it caused daily distress.

It is probably no coincidence that this around was the time I began to do "skincare" in the common sense, which unfortunately had dramatically negative effects. Looking back, a seven-step routine complete with several actives including chemical exfoliants is an almost comical idea for eighteen-year-old skin, but at the time it seemed the only logical solution: more money spent could only mean better skin.

As my skin barrier continued to be destroyed by my own undertakings, other factors too played a harmful effect: stress from my environment, working mostly in classrooms (I am a firm believer in "school air"), and not being physically active enough took a significant toll on the invisible parts of the body, inevitably leading to visible symptoms.


And as my total lesion count continued to increase, my tendency for skin excoriation only grew stronger. While occasional lesion extraction is sometimes necessary, I affirm in complete confidence that the mirror-facing, obsessive-compulsive, and repetitive extreme of it is harmful and indeed only creates more of the problem you are trying to avoid in the first place.


So, in May of 2024, I began adapalene gel 0.1%. This topical retinoid is available over the counter and is used as a first line of defense against mild to moderate acne. While no one can deny the accessibility and scientifically proven efficacy of adapelene, it failed to make an effect other than dryness on my skin for the four months I used it.

At this point, I was growing desperate for a solution and willing to face the intimidating pharmaceutical world as a fresh adult, albeit in a shy way. An online visit with an effectively random doctor enabled me to obtain a prescription for tretinoin.

Tretinoin is another retinoid (in this case, all-trans retinoic acid) also applied topically in the form of a cream or gel, and in my opinion remains the single most incredible active skincare product. While dryness and sensitivity is common, tretinoin worked wonders for me when nothing else did: in three months, my skin noticeably began to heal

Tretinoin is a dermatological miracle drug, and while it reduced apparent inflammation and total lesion count it did not fully treat my acne. After months of waiting I finally was able to get an appointment at a dermatology office, where I almost immediately requested Accutane.


This wasn't a spur-of-the-moment decision; in fact, I had considered it for months and even prepared exactly what to say before my appointment. Accutane (more properly, isotretinoin or 13-cis-retinoic acid) is an oral medication used for the treatment of acne—and other dermatological conditions—that have not responded to other treatments. Though uncomparably effective, its use is associated with dozens of potential side effects: dry skin, lips, eyes, nose, scalp, and other bits are expected, hair shedding and joint pain are common, and serious side effects such as psychiatric disorders are extremely rare but possible. Most importantly, the teratogenic nature of Accutane puts it under extremely strict governmental control. Accutane is the last resort, the nuclear option. To my surprise I was prescribed it readily, given the rundown, and sent on my way. (I have no doubt that being a person who cannot get pregnant helped my case, and I had specifically requested to avoid oral antibiotics.)

As of the beginning of December 2024 I'm on my second month of Accutane and I am pleased to report that (a) it's working and (b) side effects insofar are highly manageable. With four months to go I am excited to continue seeing improvements. On December 1, I went out in public without any makeup, even a drop of concealer. This was immensely liberating; for the first time in years I felt unashamed of my skin and even a bit excited to show it off. (Of course, this only really applied to myself, as truly no other person thinks twice about how your skin looks.) I have never been a makeup "artist", but for years I had felt reliant on it just to feel normal. (As one might guess, this is a massive suck of time, energy, and money for an eighteen year old male).

Skincare Routine
For a long time I've said that my dream skincare routine is simply splashing water on my face, and this remains the truth, but in reality I find myself reliant on various products. Over the past years my routine has changed dramatically, sometimes as often as month to month, which naturally fails to meet the skin's standard and desire for consistency.


The number of products I have tried probably approaches the low hundreds, and while many probably have merit if used consistently they failed to be suitable for me. Currently, I have dry, retinoid-affected skin, so I use only one weak active and focus on hydration and protection. My current routine is as follows:

That's it ☺ Long gone are the days of four or more steps, which not only probably ruined my skin due to misuse (see above), but was an enormous waste of time and money. Granted, the most impactful "skincare" I currently use is Accutane, so these steps arguably act more in supplemental roles.

This page discusses my personal journey. For opinion