Isotretinoin for Acne: What Patients Should Know

Isotretinoin is an oral medicine related to vitamin A that can clear severe, scarring or stubborn acne for many people, often when other treatments have failed, and most people find their acne stays better for years afterwards. It must only be taken under a dermatologist’s care, because it can seriously harm an unborn baby, needs reliable contraception before, during and after the course, and requires regular check ups and blood tests to watch for side effects.

Isotretinoin is one of the most effective acne medicines available, and also one of the most misunderstood. This guide explains what it does, who it is for, the safety rules, and the common myths.

What is isotretinoin and how does it work?

Isotretinoin is a retinoid, part of the vitamin A family. You may know it by older brand names such as Roaccutane or Accutane. The British Association of Dermatologists (BAD) explains that it works by:

• Reducing sebum (oil) production
• Reducing the production of keratin, which can block pores

Because it targets these underlying drivers of acne, it can work where creams and antibiotics have not.

Who is isotretinoin for?

According to the BAD, isotretinoin is licensed to treat severe acne in people over 12 when other treatments have not worked, or when there is a risk of permanent scarring. Dermatologists may also consider it in some other situations, such as acne that keeps returning or causes significant distress, and they should explain the reasons.

It is usually not the first treatment for mild acne. Our guide to acne causes and treatment on Indian skin covers the usual first steps. If acne has already left marks, see acne scars treatment options.

Why must isotretinoin only be taken under a dermatologist?

The dose, length of treatment and monitoring are tailored to each person. The NHS notes that most people take it for around three months, though some need it for less or more time. Your dermatologist will decide what is right for you. Do not change your dose or stop suddenly without advice.

In India, isotretinoin is sometimes bought without a prescription, recommended by friends or salons for oily skin, or continued for long periods without check ups. This exposes people to risks that monitoring is designed to catch.

What are the pregnancy prevention rules?

This is the most important safety issue. The NHS states that isotretinoin can cause serious problems with how a baby develops during pregnancy. If there is any chance you could become pregnant:

• You must use contraception for at least 1 month before starting isotretinoin.
• You must continue contraception throughout treatment.
• You must continue contraception for at least 1 month after stopping.

The BAD describes a formal Pregnancy Prevention Programme in the UK, in which patients who could become pregnant are asked about contraception and monitored for pregnancy before, during and for a month after treatment. Your dermatologist will need to be certain you are not pregnant when you start. Whatever country you live in, the principle is the same: pregnancy must be avoided during treatment and for at least a month afterwards.

Other rules from the BAD and DermNet:

• Never share your capsules with anyone.
• Do not donate blood while taking isotretinoin and for at least 1 month after stopping, in case the blood is given to a pregnant person.

What side effects should I expect?

Most side effects are related to dryness and are manageable. Common ones, as described by the NHS, BAD and DermNet, include:

Side effect	What helps
Dry, cracked lips	Frequent lip balm
Dry, fragile or itchy skin	Gentle cleanser, non-greasy moisturiser for acne prone skin
Dry eyes, discomfort with contact lenses	Lubricating eye drops; glasses instead of lenses if needed
Sore or dry nose, possible nosebleeds	Tell your doctor, who can suggest how to manage it
Sun sensitivity, easy sunburn	Shade, clothing, sunscreen SPF 30 or more
Muscle and joint aches, especially after exercise	Avoid very intense exercise; tell your doctor
Headache	Tell your doctor, especially if severe or with vision changes
Acne flare in the first weeks	Usually settles; your dermatologist may adjust treatment

The BAD notes that blood tests may show mildly raised liver enzymes or changes in blood fat levels, which in healthy people are usually not serious and are monitored by your dermatology team. The NHS also lists problems with sex, such as erectile dysfunction and low sex drive, among possible side effects.

Serious side effects that need urgent help

The NHS and BAD list rare but serious effects. Seek urgent medical help if you have:

• Thoughts of self harm or suicide, hallucinations, or severe changes in mood or behaviour
• A severe headache with nausea, vomiting or blurred vision
• Severe tummy pain, vomiting or bloody diarrhoea
• Yellow skin or eyes
• A severe skin reaction or difficulty breathing
• Decreased night vision. Avoid driving in the dark if this happens

What about mood and mental health?

This is a common worry. The BAD explains that current research does not give a clear answer on whether isotretinoin causes mental health problems in some people. People with acne are more likely to have anxiety and depression, and several studies show isotretinoin can improve negative mood related to acne. Because of the possible risk, your dermatologist will ask about your mood before and during treatment.

Tell your dermatologist, and your family if you are comfortable, about any history of depression or anxiety. Stop and seek help immediately if you have thoughts of harming yourself.

What should I avoid while taking isotretinoin?

According to the NHS and BAD:

• Too much sun, sunbeds and sunlamps
• Other acne treatments on the skin, such as salicylic acid or benzoyl peroxide, unless advised
• Waxing, epilation, laser hair removal, chemical peels and microdermabrasion
• Tattoos and piercings during treatment
• Vitamin A supplements
• Certain antibiotics, including tetracycline and doxycycline
• Alcohol, which can affect the liver. The NHS advises not drinking while on isotretinoin
• Very intense exercise, which can cause severe muscle and joint pain

Tell your dermatologist about every medicine and supplement you take. If you are planning procedures for acne scars, ask how long to wait after finishing. See our guide to Hydrafacial and carbon peel for procedure precautions.

Common myths about isotretinoin

• “It is only for very bad acne.” It is mainly for severe acne, but also for acne that is scarring or not responding to other treatments.
• “It permanently damages the liver.” The BAD notes that mildly raised liver enzymes can occur and are monitored. Serious liver inflammation is rare, which is why blood tests matter.
• “Acne always comes back.” The BAD says most people find their acne stays better for several years.
• “It is safe to take without a doctor because many people use it.” The pregnancy risk and need for monitoring make supervision essential.
• “Men do not need to worry about anything.” Men still need monitoring for side effects, must not share capsules and must not donate blood during treatment.

When to see a dermatologist

See a dermatologist to discuss isotretinoin if:

• You have deep, painful acne lumps or cysts.
• Your acne is leaving scars or dark marks.
• Several treatments, including antibiotics, have not helped.
• Acne keeps coming back after stopping other treatments.
• Acne is affecting your mood, confidence or daily life.

If you are already taking isotretinoin, contact your doctor promptly about any mood changes, severe headache, vision problems, severe stomach pain or yellowing of the skin.

To discuss whether isotretinoin or another treatment suits your acne, Dr. Maria offers online consultations. Starting isotretinoin requires a proper assessment and monitoring plan with a dermatologist.