A former beauty queen has revealed the devastating toll cystic acne took on her confidence – and says the powerful medication she was prescribed has been a “double-edged sword” for her mental health.
In a matter of weeks, Zoe Morgan, 25, went from having “100% clear” skin to battling painful nodular cysts that erupted across her face.
The fintech worker, who once held the title of Miss Teenage Nova Scotia, said the shock transformation left her hiding behind face masks and dreading leaving the house.
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Desperate for a solution, Zoe turned to a powerful acne drug derived from vitamin A.
But her skin quickly got worse due to a “purging” phase of the medication, and her mental health took a major hit.
An Instagram video she posted about her experience on the @skinselflovestory account has gone viral with more than 21,800 likes and over 3,200 comments.
“At its worst, my entire nose was inflamed,” Zoe, from Montreal, Canada, told Need To Know.
“I had cysts the size of a grapes on my cheek and by the side of my mouth, and since the breakouts were causing actual physical pain, I could never not think about it – from the moment I woke up in the morning to the moment I went to sleep at night.
“My skin barrier was weak, sensitive, and compromised – I couldn’t hide my acne even when I put on a full face of foundation, so sometimes I would wear face masks when I went out.”
Zoe is currently taking a daily 10mg dose of Roaccutane – known in North America as Accutane – alongside trimethoprim antibiotics and prednisone steroids to reduce the severity of the “purge” phase.
But she has warned others like her to think very carefully before starting the medication.
Zoe said: “It is hard for me to know whether my mental health struggles have been from the Accutane or because of other things.
“I’ve only started Accutane two weeks ago so I’m definitely going to stick with the course, all while monitoring my symptoms and checking in frequently with my doctor.
“It’s a double-edged sword because I think a lot of people have low self-esteem because of their acne, and this can get even worse during the purging phase, which happens in the first four to eight weeks of taking it.
“However, once their acne clears up their confidence is back.
“Most people I know who have finished their entire course of medication rave about how happy they are with their transformation.
“I think it is important to have a mindset that it will get better in the future and it is completely OK to not feel at your best mentally during the healing process, but short-term sacrifice will lead to long-term benefits.”
On the UK’s National Health Service website, anxiety, changes in mood and depression are listed as some of the serious side effects patients might experience while taking Accutane.
Zoe said: “If you have a history of mental health concerns like depression, anxiety, or OCD, I would recommend bringing this up with your doctor and carefully considering all your options before starting Accutane.
“There are a lot of other ways to heal acne, including natural healing methods, so I would recommend trying those first and seeing if they work.
“Stress is very hard on the skin so if Accutane is really affecting your mental health then it might be a sign you should reconsider.
“I only take the lowest dose but I can’t imagine how hard the side effects might be for people taking higher doses.”
Negative feelings are not the only setback in Zoe’s acne battle, however.
She says the rules around taking Accutane have also limited her social life.
She said: “I used to love going to parties and festivals, but because I’m on this medication I can’t drink alcohol or else it will be too much stress on my liver.
“So I now have to find ways to assert my boundaries with friends and choose alternate activities like going for nature walks or exploring coffee shops or museums.”
Zoe experienced had experienced on-and-off acne since she was a teenager, but it was normally only a few breakouts here and there.
She explained: “In fact, there were many times of my life when my skin was 100% clear.
“In August 2025, my skin started breaking out uncontrollably – with painful nodular cysts popping up all over my face.
“I’d never had a breakout like this before and it was a very scary experience, especially when it was getting progressively worse.
“In Canada, it can take many months on the waitlist before someone is able to see a dermatologist, so I had to wait for a while with no idea what was going on with my skin or how to fix it.”
The sudden flare-up turned Zoe’s world upside down.
She said: “Going from completely clear skin to severe inflammatory acne within the span of only a couple months wreaked havoc on my identity.
“Growing up, I competed in national beauty pageants and held the title of Miss Teenage Nova Scotia.
“I was an extrovert who loved to meet people, go to parties, and travel the world.
“When my acne was at its worst, I didn’t go out much because I was living in a small town with my parents.
“But when I did meet people I felt like I always had to apologise or explain my skin condition, as kind of a protection mechanism to prevent them from bringing it up and making me feel worse about myself.
“I also felt like I had ‘failed’ in my healing journey, because I knew that acne can be triggered when there are imbalances in the body, and the skin can be a detox pathway if the liver or kidneys are stressed.
“I desperately wanted it to go away so I could get out into the world again and put my best foot forward in life.”
Zoe also believes her contraception played a role in the major skin breakout.
She said: “Something that has helped me so much is removing my Mirena IUD [intra-uterine device] and switching to oral contraceptive pills.
“Now I take Yaz, it is FDA-approved as a birth control method and to treat acne.
“I think that the impact of hormonal IUDs on skin health is something that is not discussed enough by doctors and gynaecologists.
“It is important for women to be aware of the potential side effects of IUDs on the skin so they can make informed decisions.”
Zoe started documenting her acne journey in mid-December and has been overwhelmed by support – despite cruel trolls calling her a “zombie”.
She added: “Of course, if you’re a content creator, hate comments will be an inevitable part of the journey.
“But after I posted a vulnerable video about how Accutane was affecting my mental health, I’ve had hundreds of people reach out to me to share their own acne journey, give skincare or lifestyle tips that worked for them, or provide support and encouragement.
“I’ve even had a psychologist reach out to me and offer free online counselling after hearing in my video that I could not afford therapy, which I am so grateful for.
“Acne is not only a physical battle – it is also emotional, and we all have had days where we want to just hide under the covers of our beds and not leave the house.
“However, I wholeheartedly believe that we shouldn’t have to wait until our skin clears up to feel happy, confident, and beautiful.”
Zoe is due to remain on the drug for a year and hopes that by sharing her raw reality and encouraging debate, others won’t suffer in silence.
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