Ask Curology: Is isotretinoin safe to use?

What you should know about this acne medication, including the potential side effects.

Nicole Hangsterfer Avatar

Nicole Hangsterfer
Dec 04, 2020 · 5 min read

We’re here to share what we know — but don’t take it as medical advice. Talk to your medical provider if you have questions.

Welcome to Ask Curology, penned by one of our in-house medical providers in response to your questions about all things skincare. This week: years ago, it was known only as Accutane. Today, oral isotretinoin is a prescription acne treatment of many names (Absorica, Amnesteem, and Sotret, to name a few). No matter what you call it, we’re here to bust some myths and dish out some truths about this acne medication.

• • •

Dear Curology,

I’ve been struggling with acne for a while, and nothing seems to help. I’ve tried topical medications and oral antibiotics, but my breakouts don’t stop. I went to see my in-person dermatologist recently, and they recommended oral isotretinoin. I want to give it a try for my cystic acne, but I’m a little nervous about long-term side effects. What should I expect?

Signed,

Rx Hope

Dear Rx,

Thanks for writing in! And tell your dermatologist I say “hello.” We don’t prescribe oral isotretinoin (formerly known by its brand name, Accutane) here at Curology. So for the course of your treatment, your prescribing medical provider will work closely with you — in-person. But I hope I can at least calm your nerves with some relevant info.

So… how does Accutane work?

Isotretinoin is a vitamin A derivative, or retinoid, that’s taken orally. Oral isotretinoin treats acne by addressing all four of its causes: 1) excess oil production, 2) clogged pores in the skin, 3) breakout-causing bacteria, and 4) inflammation.¹ Isotretinoin can help clear acne when treatments like topical retinoids and oral antibiotics fail.²

The real side effects of isotretinoin

The name “Accutane” might scare some people away (eek!), but fear not! While there are potential side effects associated with isotretinoin, the most common ones are temporary. For the most part, they’re manageable throughout the course of your treatment.

  • Dry skin

  • Chapped lips

  • Dry eyes

  • Dry mouth

  • Nosebleeds

These should improve after you stop taking isotretinoin. In the meantime, you can treat these side effects with lip balm, moisturizer, and artificial tears³ (did someone say “clear eyes”!?).

Less common are these more annoying (and potentially more serious) side effects:

  • Worsening breakouts early in treatment

  • Hair thinning

  • Joint and muscle pain

  • Decrease in night vision

  • Increased sun sensitivity

These should also improve after treatment, and your in-person dermatologist can help you to manage these side effects if you experience any of them.⁴ Basically, if isotretinoin makes you feel like a vampire (or your breakouts just get a little worse before they get better), you’re not alone!

Your dermatologist will discuss the potential risks and benefits with you, as you decide together whether isotretinoin is right for you. Other more serious side effects, like high cholesterol and liver damage, have been reported, but please know that these are rare. Your dermatologist will monitor you closely to catch any side effects early and work with you to get them under control.⁵

Also, be wary of the rumor mill! There is not enough evidence to prove that isotretinoin can cause the following side effects:⁶

  • Inflammatory bowel disease (IBD)

  • Depression

  • Suicidal thoughts

You should absolutely avoid isotretinoin if you’re pregnant (or trying to be pregnant). Be aware that if you’re a female who may become pregnant, you will be required to take two forms of birth control and likely take regular pregnancy tests throughout your treatment. Isotretinoin (just like high doses of vitamin A) can be harmful to the baby, so this is very important!⁷

So…does it work?

In most cases, yes! The American Academy of Dermatology recommends isotretinoin for acne that is resistant to other treatment options, causing true scarring (like ice pick scarring), and causing significant distress to the patient.⁸ When used correctly, it has a very high success rate!

That said, there are many things to consider before taking this medication. This medication isn’t right for everyone, and there are other effective methods for treating acne. As a teledermatology practice, though, we want to be transparent about all of the treatment options out there — even those we don’t prescribe. At the end of the day, we want what’s best for you!!

I hope this general information helps. I recommend you speak to your dermatologist for specific, personalized medical advice. Feel free to reach out and leave me a comment if you need a good listener. Curology will be here if you ever need us in the future 💜

All my best,Nicole Hangsterfer, PA-C

We’re here to share what we know — but don’t take it as medical advice. Talk to your medical provider if you have questions.

P.S.

We did our research so you don’t have to.

  1. “It results in a significant reduction in sebum production, influences comedogenesis, lowers surface and ductal P. acnes and has anti-inflammatory properties. ” From The use of isotretinoin in acne. Alison Layton. Dermato-endocrinology. (May-June 2009).

  2. “Severe acne can be difficult to treat. When other treatments fail to clear the skin, isotretinoin may be an option.” American Academy of Dermatology. Isotretinoin: Overview. https://www.aad.org/public/diseases/acne/derm-treat/isotretinoin.

  3. American Academy of Dermatology. Isotretinoin: The truth about side effects. https://www.aad.org/public/diseases/acne/derm-treat/isotretinoin/side-effects.

  4. American Academy of Dermatology. Isotretinoin: The truth about side effects. https://www.aad.org/public/diseases/acne/derm-treat/isotretinoin/side-effects.

  5. Zaenglein AL, Pathy AL, Schlosser BJ, et al. Guidelines of care for the management of acne vulgaris [published correction appears in J Am Acad Dermatol. 2020 Jun;82(6):1576]. J Am Acad Dermatol. 2016;74(5):945–73.e33. doi:10.1016/j.jaad.2015.12.037

  6. American Academy of Dermatology. Isotretinoin: The truth about side effects. https://www.aad.org/public/diseases/acne/derm-treat/isotretinoin/side-effects.

  7. Zaenglein AL, Pathy AL, Schlosser BJ, et al. Guidelines of care for the management of acne vulgaris [published correction appears in J Am Acad Dermatol. 2020 Jun;82(6):1576]. J Am Acad Dermatol. Ibid.

  8. “It is the consensus of the current working group that the presence of moderate acne that is either treatment-resistant, or that produces physical scarring or significant psychosocial distress, is an indication for treatment with oral isotretinoin.” Zaenglein AL, Pathy AL, Schlosser BJ, et al. Guidelines of care for the management of acne vulgaris [published correction appears in J Am Acad Dermatol. 2020 Jun;82(6):1576]. J Am Acad Dermatol. Ibid

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