Isotretinoin can clear severe acne when nothing else has worked, often for good. It is also a powerful medicine with strict rules, especially around pregnancy, and side effects that need careful monitoring.
Imagine years of painful cystic acne that leaves scars and makes you avoid photos and dates. Antibiotics and creams have failed. Your dermatologist suggests isotretinoin. You are excited but nervous about everything you have read online.
What isotretinoin is
Isotretinoin is a vitamin A-related medicine taken as capsules. It is known by brand names such as Roaccutane and Accutane. It shrinks the oil glands in the skin, reduces oil production, prevents blocked pores and reduces inflammation and acne bacteria.,It is usually prescribed by or under the supervision of a dermatologist for severe acne, acne that leaves scars, or moderate acne that has not responded to other treatments.
What a course looks like
A typical course lasts about four to six months, sometimes longer, depending on your weight, dose and response. Many people see their acne get slightly worse in the first month before it improves. By the end of the course, most people have much clearer skin, and many have long-lasting improvement.,Some people need a second course if acne returns. You will have regular appointments throughout treatment.
Common side effects
- Very dry lips, which almost everyone gets; use lip balm frequently
- Dry skin, eyes and nose; nosebleeds can occur
- Sensitivity to sunlight; use high-factor sunscreen
- Muscle and joint aches, especially after exercise
- Temporary hair thinning in some people
- Changes in blood fats and liver tests, checked with blood tests
Pregnancy: strict rules
Isotretinoin can cause severe birth defects if taken during pregnancy, even in small amounts. Anyone who could become pregnant must follow a pregnancy prevention programme. This usually includes a negative pregnancy test before starting, regular tests during treatment and after stopping, and using effective contraception from before treatment begins until at least one month after the last dose.,Never share isotretinoin with anyone, and do not donate blood during treatment and for at least one month afterwards.
Mood and mental health
There have been reports of depression, anxiety, mood changes and, rarely, suicidal thoughts in people taking isotretinoin. It is not certain how much the medicine causes these changes, as severe acne itself affects mental health, but regulators in several countries have strengthened warnings and monitoring.,Before starting, tell your prescriber about any history of mental health problems. During treatment, you and your family should watch for changes in mood or behaviour. If you feel low, anxious, irritable or have any thoughts of harming yourself, contact your healthcare provider straight away or seek urgent help.
Sexual side effects
Regulators have also highlighted rare reports of sexual side effects, such as reduced sex drive and erectile problems, which in a few cases have continued after stopping. Tell your prescriber if you notice changes.
Daily skin care during treatment
- Use a gentle, fragrance-free cleanser and a moisturiser
- Apply lip balm many times a day
- Use sunscreen of SPF 30 or higher every day
- Avoid waxing, laser hair removal and harsh skin treatments during treatment and for at least six months afterwards, as skin can tear or scar
- Use lubricating eye drops if your eyes are dry; you may find contact lenses uncomfortable
Things to avoid
- Vitamin A supplements
- Tetracycline antibiotics, which can interact
- Excess alcohol, which can strain the liver and raise blood fats
- Donating blood during and for one month after treatment
Blood tests
Your prescriber will usually check liver function and blood fats before starting and during treatment. Results are usually fine, but sometimes the dose needs adjusting.
Frequently asked questions
Will my acne come back?
Many people have long-lasting improvement. Some need a second course.
Can I drink alcohol?
It is best to keep alcohol to a minimum.
Can I exercise?
Yes, but you may notice more aches. Stay hydrated and build up gradually.
But I have read frightening stories online
Serious side effects are uncommon, and you will be closely monitored. Talk through your worries with your dermatologist so you can make an informed decision.
Your next step: Before starting isotretinoin, agree a mood check-in plan with your prescriber and someone close to you.
Related: Signs of depression
Sources: British Association of Dermatologists, UK Medicines and Healthcare products Regulatory Agency (2023 safety measures), US Food and Drug Administration iPLEDGE programme, American Academy of Dermatology.
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