What you need to know about taking oral isotretinoin for severe acne

It’s not called Accutane anymore, but it can still help clear stubborn acne.

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Isotretinoin is used to treat severe acne when other treatments don’t work. If you’ve already tried several acne treatments, you may have wondered about taking isotretinoin. While there’s no proven “cure” for acne, taking oral isotretinoin might be pretty dang close. 

Starting a prescription acne treatment is a big choice, no matter which one you choose. We're here to answer the most common questions about treating acne with isotretinoin. 

What is isotretinoin? 

Isotretinoin is an oral acne medication that’s a vitamin A derivative (or retinoid). You may have heard of it as Accutane, which is actually a specific brand name that was discontinued years ago. Other brands of isotretinoin include Absorica, Claravis, and Zenatane.

Infographic Ingredient Guide Isotretinoin

How isotretinoin works to treat acne

Isotretinoin can help clear acne by addressing all four of its causes simultaneously.¹

  1. Oil production. Isotretinoin significantly reduces sebum production, resulting in less oily skin. 

  2. Clogged pores. It influences the way your skin sheds dead skin cells, reducing the formation of clogged pores (comedones). 

  3. Bacteria. It lowers the level of C. acnes, the naturally occurring bacteria that gives “acne” its name. 

  4. Inflammation. Isotretinoin has anti-inflammatory properties, so it can heal and improve breakouts, which are a form of inflammation. 

Does isotretinoin cure acne? 

While there’s no cure for acne, isotretinoin is the closest thing to it. According to the American Academy of Dermatology (AAD), those who treat their acne with isotretinoin may never have a breakout again. But that’s not always the case. Sometimes it can take multiple rounds of treatment to see lasting results. 

Who should use isotretinoin? 

Isotretinoin is for people with treatment-resistant acne, acne with physical scarring, or acne that’s contributing to significant psychological distress.² If you’re wondering if you should take isotretinoin, talk to your doctor about your options. You can only use isotretinoin if a medical provider prescribes it.

In many cases, providers recommend other forms of acne treatment before isotretinoin. Effective topical acne medications include tretinoin, clindamycin and oral antibiotics like doxycycline. There’s no true alternative to isotretinoin, but there are many other forms of acne treatment! 

How long does it take to see results? 

By the time you take isotretinoin, you may feel like you've been on your acne treatment journey forever and have tried everything. Clearing acne with isotretinoin can take months, but many people finally see the results they've been seeking for years.

The benefits of isotretinoin

Isotretinoin can be effective in treating severe acne by: 

  • Decreasing sebum (oil) production 

  • Helping to treat and prevent clogged pores

  • Helping decrease the number of acne-causing bacteria on the surface of the skin

  • Improving inflammation, including redness and swelling

The side effects of isotretinoin

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.³

  • 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 tears⁴ (did someone say “clear eyes”!?).

Less common are these potentially more serious side effects:

  • Hair thinning

  • Joint and muscle pain

  • Decrease in night vision

  • Increased sun sensitivity

These should also improve after treatment. Your in-person dermatologist can help you to manage these side effects if you experience any of them.⁵  

Your dermatologist will discuss the 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.⁶

Also, be wary of the rumor mill! There is not enough evidence to prove that isotretinoin can cause the following side effects:⁷

  • Inflammatory bowel disease (IBD)

  • Depression

  • Suicidal thoughts

Before trying isotretinoin, double-check that your current skincare routine doesn’t contain products with ingredients that may make breakouts worse. You may also want to try tretinoin, a prescription retinoid that works similarly to isotretinoin but is available in a topical cream, gel, or ointment. Tretinoin is available to Curology members prescribed it by their dermatology provider.

Isotretinoin and pregnancy

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 may be required to use two forms of birth control and will likely need to take regular pregnancy tests throughout your treatment. Isotretinoin (just like high doses of vitamin A) can harm the baby, so this is very important!⁸

Does Curology prescribe isotretinoin? 

At this time, Curology doesn’t prescribe isotretinoin. For now, an in-person dermatologist must prescribe isotretinoin, so we’re not able to provide it. 

Get your personalized skincare routine with Curology

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That said, we can prescribe you a topical treatment online, and new members get their first bottle for free. Just send us some pictures and answer some questions so one of our dermatology providers can review your skin. If Curology is right for you, we’ll prescribe you a Custom Formula with a mix of active ingredients like tretinoin, clindamycin, and ​​​azelaic acid, each chosen for your unique skin concerns. 

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• • •

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

  1. Alison Layton. The use of isotretinoin in acne. Dermato-endocrinology. (2009)

  2. Andrea L. Zaenglein, MD, et. al. Guidelines of care for the management of acne vulgaris. Journal of the American Academy of Dermatology. (2016).

  3. Alison Layton. The use of isotretinoin in acne. Dermato-endocrinology. (2009)

  4. American Academy of Dermatology. Isotretinoin: The truth about side effects.

  5. American Academy of Dermatology. Isotretinoin: The truth about side effects.

  6. Andrea L. Zaenglein, MD, et. al. Guidelines of care for the management of acne vulgaris. Journal of the American Academy of Dermatology. (2016).

  7. American Academy of Dermatology. Isotretinoin: The truth about side effects.

  8. Isotretinoin. MedlinePlus.

We’re here to tell you what we know. That’s why our information is evidence-based and fact-checked by medical experts. Still, everyone’s skin is unique—the best way to get advice is to talk to your healthcare provider.

*Trial is 30 days. +$4.95 S&H. Cancel anytime. Subject to consultation.

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