Isotretinoin: What You Should Know Before Starting

If you’ve tried other acne treatments and still have painful cysts or widespread scarring, isotretinoin might be on the table. This medicine, often known by brand names like Accutane, is a powerful oral retinoid that can dramatically cut oil production and shrink the glands that cause severe acne. Many people get clear skin after a single course, but the drug carries real risks and rules you can't skip.

How isotretinoin works and what to expect

Isotretinoin is a vitamin A derivative. It reduces sebum (skin oil), slows clogged pores, and lowers inflammation. Most people notice drier skin and chapped lips within weeks. Acne may actually flare early on before it gets better; that’s normal but frustrating. Typical treatment lasts 4–6 months with doses often adjusted by weight and how well you tolerate side effects.

Results vary: some people have long-term remission after one course; others need a repeat or a different plan. While it treats active acne well, it won’t erase deep scars—ask your dermatologist about scar treatments after your course ends.

Safety, tests, and everyday tips

Pregnancy and isotretinoin don’t mix. The drug causes severe birth defects. If you can become pregnant, you’ll need two reliable birth-control methods and regular pregnancy tests before and during treatment. Most programs require monthly tests and strict agreement to prevent pregnancy.

Common side effects are dry lips, dry eyes, nosebleeds, and skin sensitivity to sun. Less common but serious effects include raised cholesterol or liver enzymes, and rare mood changes. Your doctor will check blood lipids and liver tests before starting and during treatment. Avoid high doses of vitamin A and be cautious with certain antibiotics (like tetracyclines) because some combinations can raise risk of intracranial pressure.

Practical tips: keep lip balm handy, use gentle cleansers, wear sunscreen, and skip waxing or aggressive skin procedures while on treatment. Tell your doctor about any new medicines, supplements, or mood changes right away. If you plan to get pregnant after treatment, discuss timing—doctors usually recommend waiting at least one month after stopping isotretinoin before trying to conceive.

Isotretinoin can be life-changing for severe acne, but it needs careful handling. Talk openly with a dermatologist, ask how they monitor side effects, and weigh benefits against risks. If you want help preparing questions for your appointment, jot down your acne history, current products, and any mental health concerns—these details help your doctor make the safest plan for you.