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POV: You have severe acne and have tried everything — every lifestyle and diet change and every over-the-counter (OTC) product on the planet — but it won’t fricken’ go away. Ugh.
What if we told you that there’s *another* option — a prescription called isotretinoin (formerly known as Accutane) that some experts refer to as a “cure” for acne?
No, really. In 2019, almost 350,000 people in the U.S. were treated with this drug for acne. And 4 out of 5 people find symptom relief with a course of Accutane.
But (there’s always a “but,” isn’t there?), Accutane does have a less-than-stellar reputation, which makes a lot of people nervous about even considering it. The drug carries risks of some serious side effects, especially when used alongside certain other medical conditions or before pregnancy.
That doesn’t necessarily mean the stigma around taking Accutane is justified, though. Accutane is sometimes the only thing that can clear up severe acne, which can also have serious side effects like facial scarring, skin infection, reduced self-esteem, social isolation, and depression.
So, is Accutane worth it? Technically, only you and your dermatologist can decide that, but we think we can help you along the way. Here’s what you need to know about taking isotretinoin for acne, including what you can expect during and after treatment, what real people who’ve used Accutane think about it, and what else you can do to reduce your symptoms.
Accutane is the former prescription drug brand name for isotretinoin, a vitamin A derivative often used to treat severe acne (isotretinoin is now sold under the generic names Zenatane, Absorica, Myorisan, Claravis, and Amnesteem instead). Even though the name Accutane stopped being used in 2009, lots of people still call the generic form of this drug Accutane, so we’ll do the same here, too.
In addition to reducing the amount of acne-causing sebum on your skin, Accutane also reduces bacteria on the skin, clears clogged pores, and reduces inflammation, according to the American Academy of Dermatology (AAD).
“Accutane is a life changing medication for a lot of people that take it,” says Muneeb Shah, DO, Dermatology Resident Physician at Campbell University (and @dermdoctor on TikTok. We’re starstruck AF).
“People [with] really debilitating acne that creates permanent scarring, that is extremely painful, that interferes with their quality of life and their ability to do their jobs or go to school… may want to consider Accutane because it is the most effective treatment,” he says.
You heard him. If you feel like you’ve tried everything and your acne is still affecting your day-to-day life, Accutane could be the solution.
Typically, Accutane is reserved for people with nodulocystic acne, a severe form of inflammatory acne that consists of nodules and cysts (hence the name) and often leads to scarring. Nodules and cysts are large (and often painful) bumps deep beneath the skin’s surface. So, not your average zit.
But some dermatologists will also prescribe it for more moderate cases of inflammatory acne.
According to Melanie Palm, MD, board certified dermatologist at Art of Skin MD, Accutane is prescribed “when traditional therapies, including topical prescription medications and oral antibiotics or oral anti-androgens, have failed to clear acne.”
Traditional therapies can fail if any type of acne becomes treatment-resistant to antibiotics over time. At that point, a prescription medication like Accutane is the only thing that will help.
“For patients that undergo a successful course of isotretinoin, there is about a 70 to 80 percent chance they will never experience acne again,” says Palm. “It truly is one of the only ‘cures’ we have for acne, but the risks and benefits must be carefully reviewed with your dermatologist.”
Basically, you might be a good candidate for Accutane if you have:
- severe acne, such as nodulocystic acne
- scarring from acne
- acne not responsive to other OTC and/or other more conservative prescription treatments
Who shouldn’t take Accutane?
Because of the side effect profile and the fact that anyone taking Accutane has to be monitored with frequent lab work, it tends to only be worth it for people with moderate to severe acne, says Shah.
Additionally, some people should (or even need to) avoid using Accutane, says Palm. This includes:
- people who are pregnant, trying to conceive, or breastfeeding
- people with a history of allergic reactions to isotretinoin or soy
- people who have or had a mental health illness, like depression
- people with high levels of vitamin A
- people with kidney or liver disease
- anyone who can’t complete monthly blood work during the course of taking Accutane
- anyone who can’t practice sun avoidance (retinoids cause sun sensitivity)
- anyone with a history of excessively dry, sensitive, or eczema-prone skin
As far as people with other existing skin conditions like rosacea and psoriasis, using Accutane is case-dependent.
According to a 2011 study, Accutane has been shown to effectively treat moderate to severe acne in people who have rosacea and psoriasis. Other studies even suggest that isotretinoin treatment may help treat papulopustular rosacea and pustular-type psoriasis.
Taking Accutane can cause some pretty serious side effects, so you and your derm will work closely together to make sure everything is A-OK.
Side effects are monitored through a computer-based risk management system called iPledge, which requires physicians to confirm that their patients are taking Accutane as prescribed and are not having serious side effects, Shah explains. This is also the system used to make sure you’re doing everything you can to avoid pregnancy while on the medication.
Your pharmacist won’t dispense the medication until you and your prescribing physician register for the iPledge program.
Additionally, your prescription will need to be filled every month after you’ve checked in with your doctor and submitted a new round of lab work — you can’t receive the full course of treatment in one prescription or receive automatic refills.
It sounds scary, we know. But this is all put into place to help your doctor ensure that Accutane is not causing any serious or harmful side effects.
Let’s dive into what to look out for:
Physical side effects
Isotretinoin is effectively high doses of vitamin A, which is fat-soluble. That means your bod stores any excess vitamin A in your liver rather than peeing it all out.
That also means that chronic, excessive, or sudden increased intake of vitamin A can be toxic, causing a condition called hypervitaminosis A. Symptoms of hypervitaminosis A include increased intracranial pressure (aka pseudotumor cerebri), dizziness, nausea, headaches, skin irritation, and bone and joint pain. If left unchecked, it can also cause a coma or even death.
Hypervitaminosis A is usually caused by supplemental vitamin A and retinoids, not your diet. So, you’ll want to avoid vitamin A supplements if you’re taking isotretinoin.
Since isotretinoin works by decreasing the amount of oil in your skin, almost every single person will experience dry skin, chapped lips, a dry nose (to the point of nose bleeding), and dry eyes or mouth, depending on the dosage given.
“The number one side effect for Accutane that almost everyone experiences is dryness… but it usually gets better,” says Shah. “The first 3 months will be the worst, and then the next 3 months it is usually much better.”
Other physical side effects might include:
- an initial worsening of your acne
- increased risk of sunburns/sun sensitivity
- headaches and dizziness
- blurred vision and/or difficulty seeing in the dark
- nausea or vomiting
- joint or muscle aches
- thinning hair
If you experience any of these side effects, it’s def a good idea to reach out to your dermatologist to check in.
And to clear the air — no, isotretinoin doesn’t cause inflammatory bowel disease.
Psychiatric side effects
Psychiatric side effects related to isotretinoin are controversial but include potential increased risk of:
- depression and suicidal ideation
- psychosis and mania
“In addition to monitoring [blood work], we also ask several important questions during our follow-up exams while [patients are] on the medication,” says Shah. “We ask about changes in mood because some people will experience depression while on the medication.”
If this happens, he adds, your doctor may stop the medication or decrease the dose.
Too much vitamin A can cause permanent harm to an unborn baby, so preventing pregnancy during treatment is a huge priority for people that can get pregnant.
To monitor this, you’ll have to do the following:
- If you can become pregnant, you must use two forms of birth control and provide two negative pregnancy tests before you can pick up your prescription.
- If you can’t become pregnant, you still need to enter the program before your prescription will get filled, but you won’t be asked to have proof of a negative pregnancy.
If this all sounds serious, that’s because the side effects of becoming pregnant while taking isotretinoin are serious. They include miscarriage, premature birth, and birth defects, including malformations of the eye, skull, lungs, and heart.
Unfortunately, these risks are not small: The miscarriage risk may be as high as 40 percent in pregnant people taking isotretinoin, and at least 35 percent of infants exposed to the drug in utero are born with birth defects of some kind, per the Organization of Teratology Information Specialists.
If you’re prescribed Accutane, your doctor should talk with you about avoiding certain medications during your treatment.
Palm recommends avoiding other acne-fighting products, like topical retinol, alpha-hydroxy acids (AHAs), and beta-hydroxy acids (BHAs), since using these products in combination with Accutane can damage your skin barrier.
You should also avoid taking vitamin A supplements, as we mentioned earlier, and tetracycline antibiotics like doxycycline. Using Accutane with tetracycline antibiotics can cause spinal fluid pressure in the brain to elevate in a condition called pseudotumor cerebri, which can lead to vision loss.
Dosage and length of treatment
Typically, a dermatologist will start you at 0.5 milligrams per kilogram (mg/kg) per day (based on your weight). Then they’ll bump your dosage up to 1.0 mg/kg per day after the first month if you tolerate the medication well.
The total length of a treatment course can range from 120 mg/kg to 220 mg/kg, which can take 4 to 5 months at the typical dosage.
Research also shows that lower doses of isotretinoin can effectively treat acne with a lower risk of side effects. Still, you might need to take the medication for more than 4 or 5 months to ensure you receive enough of it to permanently resolve your symptoms and avoid relapse.
“Our goal is to get you to reach a certain cumulative dose over the entire course,” says Shah. “Once you reach that threshold, you’re more likely to not have your acne return.”
Preventing side effects
Oral isotretinoin is very drying, so hydrating skin products should be the focus of your skin care routine instead of acne-fighting ingredients, which can cause extra irritation.
You should focus on hydrating (lots of H2O) in general and wear plenty of sunscreen (SPF 30 or higher!).
Caren Campbell, MD, a San Francisco-based dermatologist, also says some supplements can help relieve certain side effects. “[Your physician can advise you on taking] L-Carnitine for joint or muscle aches, and vitamin E for dry lips and dry skin.”
Monitoring for side effects: Labs and tests
After starting isotretinoin, you’ll need to see your dermatologist regularly. If your lifestyle doesn’t allow for frequent appointments, you might not be a good candidate for the medication.
Shah says your lipid levels and liver function will usually be checked at the start of therapy and then at least every 1 to 2 months during treatment, depending on your dermatologist.
“What we are looking for is an elevated spike in your liver enzymes or a spike in your triglycerides levels: those are the two [things] that we are monitoring through labs,” he explains. “If they become too elevated, we will decrease the medication or stop the medication.”
And because of the risks associated with getting pregnant, peeps who can get pregnant will need extra tests.
“You absolutely cannot get pregnant on the medication, and every month you will have to take a pregnancy test to make sure you are not pregnant,” says Shah.
According to Campbell, if your physician feels it’s appropriate to prescribe them, there may also be the option to lower triglyceride levels with fish oil or cholesterol medications like gemfibrozil or fenofibrate.
Per the AAD, most doctors prescribe Accutane for 4 to 5 months, though you might need slightly more or less time depending on how severe your acne is.
The good news? It doesn’t really matter what type of skin you have before you start taking Accutane: it works as well as it works on everyone, eliminating acne in about 85 percent of users.
“Different skin types do not really differ in their response,” says Palm, “[though] patients with severe acne may take longer treatment periods to complete a course, or in extreme cases, require oral steroids for the first month of isotretinoin use to prevent severe flares.”
“Absolutely — my skin, now in my 30s, is nearly flawless and I look younger.”
Name: Christy Snyder | Current age: 33 | Age of treatment: 12, 13, and 22 | Length of treatment: 6-month courses each time | Acne type: cystic acne | Effectiveness rating: 5/5
“100% Worth It. I can control my acne with a simple cleanser now vs. the slew of products I used in high school.”
Name: Sam Lowry | Current age: 29 | Age of treatment: 15 | Length of treatment: 8 months | Acne type: severe inflammatory acne | Effectiveness rating: 5/5
“Taking Accutane was worth it at the time because it really did work. The primary reason I started Accutane was for acne on my back, though I also had milder acne on my face. It cleared up my face extremely well and with long lasting effects, and it cleared my back moderately well (I still get some acne here, though it’s much milder and less noticeable). I think taking it so young helped make it “worth it” because I wasn’t as concerned about the risks of drinking alcohol or getting pregnant as I may have been if I had taken it when I was older.”
Name: Sydney Hanan | Current age: 23 | Age of treatment: 16 | Length of treatment: 6 months | Acne type: moderate inflammatory acne | Effectiveness rating: 4/5
“Yes! My skin is clear now and I feel way more confident. I still am on tazorac gel and duac cream, but my acne is so controlled. [I only have] minor breakouts.”
Name: Allie Donnici | Current age: 28 | Age of treatment: 13 | Length of treatment: 9 months | Acne type: severe inflammatory acne | Effectiveness rating:4/5
“Yes, because it cleared up a lot of acne issues I was struggling with long-term (like cystic acne on my back) despite not clearing up everything (currently struggle with hormonal acne).”
Name: Anonymous | Current age: 26 | Age of treatment: 16 and 19 | Length of treatment: 1 year for each round | Acne type: cystic acne | Effectiveness rating:3/5
It never hurts to double exhaust all your options if you’re not ready for isotretinoin. Here’s what you can try before entering the big leagues:
1. Figure out dietary, environmental and lifestyle stressors
Many people will tell you that eating certain foods will cause acne, and there may be some truth to those rumors. Recent research shows that the Western diet (aka a diet high in animal products and fatty/sugary foods) is associated with adult acne. Still, more research is needed before derms will start recommending major dietary changes to peeps with acne.
In addition to dairy, Campbell says high glycemic foods and whey protein can worsen acne, but she still doesn’t suggest changing your diet instead of using Accutane.
“Isotretinoin, when [prescribed] appropriately, can’t be replaced with other treatments,” she warns. “In moderate to severe cases, sometimes it’s the only way to prevent scarring — so all these preventative measures work together.”
There’s also some research suggesting stress can play a role in acne development and severity, but it’s not definitive. Still, relieving stress is always a good thing, so it won’t hurt to try (but we won’t guarantee it’ll help, either).
2. Be consistent with your routine
While the beauty aisle and its candy-colored packaging may be calling to you, it’s best to stick with the same products for at least 28 days, or in some cases 3 months (such as with topical retinoids).
Twenty-eight days is about the length of time it takes for the outer layer of skin to regenerate. It’s also the average length of a menstrual cycle, so if you’re working with acne-causing female hormones, sticking with a new product for a full cycle will help you figure out if and how the product adapts to your skin’s needs throughout the month.
3. Try OTC products
Maybe you’ve already tried every OTC product known on planet Earth, but in case you haven’t (or weren’t sure what actually works for acne), here are some tried-and-true acne-busting products you can grab at your local pharmacy or on Amazon.
- Differin Daily Deep Cleanser. Benzoyl peroxide is a gold standard ingredient for stubborn acne, because it both reduces inflammation and kills acne-causing bacteria on the skin. This cleanser contains five percent benzoyl peroxide, which should be strong enough to do the job without tons of irritation.
- Differin Adapalene Gel. Previously only available via prescription, adapalene is an FDA-approved treatment for acne. It’s a topical retinoid (waddup, vitamin A), so it works similarly to isotretinoin — just in a much less intense way.
- La Roche-Posay Effaclar Duo Dual Action Acne Spot Treatment Cream. For beating back individual pimples when they pop up, we like this spot treatment by La Roche-Posay; not only does it provide a solid punch of benzoyl peroxide, it also contains LHA and glycerin to exfoliate and hydrate the affected skin.
- Paula’s Choice Skin Perfecting 2% BHA Liquid Exfoliant. This leave-on product contains salicylic acid, an evidence-backed ingredient that exfoliates, brightens, and smooths skin while reducing acne lesions and post-acne hyperpigmentation. Love that for us.
4. Experiment with prescription topicals
The last thing you may want to try before taking the plunge and starting isotretinoin are prescription topicals, which often work better to defeat acne on the skin than OTC products (but aren’t as strong and don’t carry as many side effects as oral medications).
- Tretinoin. Kind of like Accutane “lite,” tretinoin and other prescription retinoids are lower-concentrate vitamin A products, which work in a similar way to isotretinoin. Some of the warnings are the same (they can cause extreme skin dryness and shouldn’t be used during pregnancy), but since the medication is only applied topically and not taken orally, those risks are lower.
- Clindamycin. This is a topical antibiotic that kills acne bacteria on the skin. If used too frequently, you can develop a resistance, so many doctors have their patients use it with benzoyl peroxide to avoid that happening.
- Azelaic acid. Another OTC option available in a prescription-strength, azelaic acid shows promise as possibly working as well as other common medications (like tretinoin) in reducing acne. It may also be better tolerated than some other options and may be used during pregnancy.
Again, you’ll need a prescription for these options. If you don’t currently have a dermatologist, consider using a telehealth platform like Nurx to get personalized advice and prescriptions for any of the above.
Is it worth taking Accutane?
We can’t tell you this because only you (and your derm) know how severe your acne is, how much it’s affecting your quality of life, and how many side effects you’re willing to deal with during treatment. There isn’t one answer.
We will say that if you’re an otherwise healthy person who can commit to the treatment plan (including showing up for monthly blood work, taking care of your skin, and avoiding pregnancy) and you’re sick of having persistent, problematic acne that doesn’t go away with other treatments, then you’re probably a good candidate for Accutane and might want talk with your doctor about it.
“People that end up trying Accutane have often failed other medications first,” says Shah. “[If you] have really debilitating acne that creates permanent scarring, that’s extremely painful, [or] that interferes with [your] quality of life and [your] ability to do jobs or go to school… it’s a risk-to-benefit analysis, and when the benefits outweigh the risks, then Accutane is a reasonable option.”
Does Accutane work permanently?
Often, yes… but not always.
“In about one-third of patients, [the results are] dramatic,” says Campbell. “In the other two-thirds of patients, it makes things better, but in 2 or 3 months, most patients need to restart topical medications to keep things under good control — and one-third of those patients need a second course of Accutane.”
Is isotreninoin (Accutane) safe?
Again, it’s not easy to give a “yes” or “no” answer. It really depends on your overall health. If you don’t have any coexisting conditions, aren’t pregnant or nursing, and you’re able to take the medication exactly as prescribed by your doctor, the risk of adverse events or serious side effects is minimal.
However, most people experience some side effects on Accutane unless they’re on a very low dose. So bear in mind that even when Accutane is “safe,” it still comes with some risks.
How fast do you see results on Accutane?
You may start noticing some improvement of symptoms as early as 10 days after starting Accutane, but Palm says it needs to be taken consistently for several months before you’ll really see the full effects of the drug.
How long do you have to be on isotretinoin (Accutane)?
Usually, doctors prescribe Accutane for 4 to 6 months, but some people need longer or shorter courses (as Campbell told us, some people will need to repeat the course after treatment is complete). This is assuming you’re on a standard dose of Accutane; a low dose course may require a longer treatment period.
What are the lifestyle and dietary restrictions when on isotretinoin (Accutane)?
You won’t have to make many dietary changes other than avoiding alcohol, says Palm, but there are a few lifestyle restrictions you’ll need to pay attention to:
- Stay out of the sun and/or diligently apply SPF when outdoors.
- Avoid using Accutane with other acne-fighting products to protect your skin barrier.
- Delay elective surgeries and procedures (isotretinoin can cause delayed wound healing).
- Use protection during sexual intercourse.
Make sure to tell your doctor ASAP about any changes to your overall health as well, including bowel movement changes, mood or mental health changes, and — of course — if you suspect you might have become pregnant.
When it comes to chronic acne, a dermatologist and an isotretinoin prescription may be a better acne army, especially if you have severe nodulocystic acne (or otherwise treatment-resistant breakouts) with scarring.
But if the potential side effects make you worry, don’t be afraid to keep asking questions, seek alternatives, or get a second opinion.