Thinking About Accutane? What to Know About Isotretinoin for Acne

For people with severe or treatment-resistant acne, Accutane® (isotretinoin) can be life-changing. Laura Norman, PA-C, of Boulder Medical Center Dermatology, explains how treatment works, what to expect, and how our team helps patients safely navigate the process.

Most people have heard about Accutane, also known as isotretinoin, in one way or another. It is a medication used for severe acne or for acne that is not responding to other medications. It can be life-changing for people who have been struggling with breakouts.

What Is Isotretinoin (Accutane)?

Isotretinoin is an oral medication derived from vitamin A. It was first approved by the FDA in 1982 for the treatment of severe nodular (cystic) acne that hasn’t responded to other therapies. While the original brand name “Accutane” was discontinued, the same medication is now available under several brand names, including Absorica, Absorica LD, Claravis, Myorisan, and Zenatane.

Isotretinoin works through multiple mechanisms:

Dramatically reduces sebum (oil) production by shrinking the oil glands
Decreases the concentration of acne-causing bacteria (Cutibacterium acnes) on the skin
Reduces inflammation
Helps prevent clogged pores from forming

No other acne medication addresses all four of these pathways simultaneously, which is why isotretinoin is uniquely effective. It is also the only acne treatment that is curative, meaning that the majority of people who take it do not have significant acne after finishing treatment.

Who Is Isotretinoin For?

Isotretinoin is FDA-approved for patients 12 years and older with significant acne.

This can include:

Moderate to severe acne that hasn’t improved with oral and/or topical treatments
Acne that is causing scarring
Acne causing significant psychological or emotional distress

How Is Isotretinoin Taken?

Isotretinoin is an oral medication that is taken daily with food. The amount taken daily is weight-based, usually around 1 mg/kg of body weight.

The medication is taken for an average of 6-8 months.

At Boulder Medical Center Dermatology, our providers typically stop treatment when two criteria are met:

Cumulative dose target: Treatment goals are individualized for each patient. Current guidelines generally recommend a cumulative dose of at least 150 mg/kg. In some cases, a higher cumulative dose may be recommended to help reduce the risk of acne returning.
Clinical appearance: Equally important, your skin should be clear by the end of treatment. We generally like patients to be free of any new acne breakouts for at least one month before stopping isotretinoin. If acne scarring was present before treatment, those scars may remain after acne has cleared.

What Are the Common Side Effects of Isotretinoin?

Most side effects of isotretinoin are dose-dependent and go away when treatment ends. The most common include:

Chapped lips: This is almost universal. Applying petrolatum-based lip balms like Aquaphor or Vaseline frequently is typically the best remedy.
Dry skin: Apply a gentle, fragrance-free moisturizer at least twice daily.
Dry eyes: Use preservative-free artificial tears as needed. Contact lens wearers may find lenses less comfortable during treatment.
Dry nose and nosebleeds: Use a saline nasal spray and apply petrolatum jelly inside the nostrils.
Muscle and joint aches: Extra stretching before and after exercise may help. Over-the-counter pain relievers like ibuprofen can be used if appropriate.
Increased sun sensitivity: Wear SPF 30+ sunscreen daily and avoid prolonged sun exposure.

The “Purge”: Will Acne Get Worse Before It Gets Better?

Roughly a third of patients experience a temporary worsening or flare of acne during the first month of treatment. Another third of patients notice no change in their acne during that time, and the last third experience immediate improvement in acne.

If you experience a flare, don’t panic; it’s temporary and doesn’t mean the medication isn’t working. Your dermatology provider may adjust your dose or add a short course of other medications to manage it. We will often start at a lower dosage to minimize the risk of a severe flare.

What About Serious Side Effects?

While most side effects are mild and manageable, there are several important safety considerations:

Pregnancy and Birth Defects

This is the most critical safety concern. Isotretinoin can cause severe birth defects and should never be taken during pregnancy. In the United States, all patients (regardless of sex) must be enrolled in the national iPLEDGE program.

Patients who can become pregnant must use two forms of contraception starting one month before treatment, throughout treatment, and for one month after the last dose. Monthly pregnancy tests are required for patients who can become pregnant. As a note, abstinence (lack of sexual activity) counts for both forms of contraception.

Once isotretinoin is completely out of the system (about 30 days after the last dose), there is no ongoing risk to future pregnancies. There is also no risk for men whose partners become pregnant; however, they are still required to be enrolled in the program.

Mental Health

There has been a longstanding concern about a possible link between isotretinoin and depression or suicidal thoughts. However:

Studies have generally found that depression improves during isotretinoin treatment, likely because severe acne itself is a major cause of depression and anxiety.
A large study of over 443,000 patients found lower rates of suicide in patients treated with isotretinoin compared to the general population.
Individual case reports of mood changes do exist, so the FDA label includes warnings about psychiatric effects.

While the overall evidence does not support a direct link between isotretinoin and depression, it is still important to monitor your mood closely during treatment. Tell your dermatology provider immediately if you experience significant changes in mood, feelings of sadness, anxiety, or any thoughts of self-harm.

Laboratory Abnormalities

Isotretinoin can affect blood lipids and liver function. Blood tests are typically performed before treatment begins and repeated during treatment to help monitor for these changes.

Your Skincare Routine on Isotretinoin

Isotretinoin significantly changes the skin, making it drier and more sensitive. Here’s how to adapt:

Cleanser: Use a gentle, fragrance-free cleanser (like Cetaphil or CeraVe). Avoid harsh scrubs, exfoliants, and acne washes as your skin won’t need them, and they can cause irritation.
Moisturizer: Apply a rich, fragrance-free moisturizer at least twice daily.
Sunscreen: Use a broad-spectrum SPF 30+ sunscreen every morning. Your skin will be significantly more sun-sensitive during treatment.
Lip care: Apply a petrolatum-based lip balm (Aquaphor, Vaseline) frequently throughout the day.

Things to Avoid While Taking Isotretinoin

Pregnancy: The most critical restriction.
Vitamin A supplements: Isotretinoin is a vitamin A derivative, and additional vitamin A can increase toxicity.
Tetracycline antibiotics (such as doxycycline and minocycline): These medications should not be taken with isotretinoin because the combination can increase the risk of a rare but serious condition called pseudotumor cerebri, which causes increased pressure around the brain.
Skin waxing and aggressive skin procedures: Increased risk of scarring.
Donating blood: You cannot donate blood during treatment and for one month after stopping, to prevent the possibility of a pregnant person receiving your blood.
Excessive alcohol: Can increase the strain on the liver.

Frequently Asked Questions about Accutane / Isotretinoin

How long until I see results?

Most patients begin to see improvement within around 3 months. Some see improvement before that, and almost everyone will see significant change by month four.

Will my acne come back after I stop?

For most patients, no. Isotretinoin is the only acne medication that can provide long-term remission, and most patients do not experience significant acne after completing treatment. About 10% of patients may experience a recurrence at some point in their lives. In those cases, a second course of isotretinoin may be recommended.

What should I expect during Accutane treatment?

Because of the iPLEDGE program, isotretinoin is prescribed in 30-day increments, so patients have monthly follow-up appointments throughout treatment. These visits allow your dermatology provider to monitor your progress, manage side effects, answer questions, and adjust your dose if needed. Depending on your provider and where you live, some of these visits may be available through telehealth.

For example, at Boulder Medical Center Dermatology, the first one or two appointments are completed in the office. After that, most follow-up visits can be completed through telehealth as long as the patient is located in Colorado at the time of the appointment.

For patients who can become pregnant, two negative pregnancy tests, performed one month apart, are required before treatment can begin, and monthly pregnancy testing is required throughout treatment. Because these requirements can affect when you’re able to start medication, it’s a good idea to plan if you’re considering isotretinoin.

What if I go to school outside of Colorado?

Treatment can usually continue without interruption with some planning. If you’ll be outside Colorado at the time of your appointments, talk with your dermatology provider ahead of time. Depending on where you’ll be located, you may need to transition your care to a provider in that state temporarily.

This is a common situation, especially for college students. For example, BMC Dermatology regularly helps patients who attend school out of state plan for continued treatment. Patients can often start treatment at BMC and transition their care to a provider near their school, including through a student health center when available.

Let’s Talk

If you’re struggling with severe or persistent acne that hasn’t responded to other treatments, isotretinoin may be an option. Schedule an appointment with Laura Norman, PA-C, or another member of the Boulder Medical Center Dermatology team to explore your treatment options and find the right approach for you.

Meet Laura Norman, PA-C
Learn More About BMC Dermatology in Boulder, Louisville, and Longmont, Colorado

Article Sources

The information in this article is for educational purposes only and is not a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your health care provider regarding any medical condition or before making changes to your treatment plan.