Isotretinoin: What You Need to Know

Isotretinoin is a powerful prescription drug used to treat severe acne that hasn't responded to other treatments. It shrinks oil glands, reduces bacteria, and calms inflammation so pimples and cysts stop forming. Because it works deep inside the skin, results are often dramatic but the drug also brings real risks you must manage.

Who is a candidate? Dermatologists usually reserve isotretinoin for nodular or scarring acne, or acne that doesn't improve after long antibiotic courses. Doctors consider your medical history, current meds, and whether you're pregnant or could become pregnant. In many countries there are strict programs to prevent fetal exposure because isotretinoin causes severe birth defects.

How it’s taken: The usual approach is a daily oral capsule for 4 to 6 months, though total dose and length vary by weight and severity. Your doctor will calculate a target cumulative dose to reduce relapse risk. Missing doses can lower effectiveness, so follow the plan and keep follow-up appointments.

Side effects and safety checks

Common side effects are dry lips, dry skin, nosebleeds, and mild hair thinning. You can manage these with heavy moisturizers, lip balm, and humidifiers. Less common but important issues include raised blood lipids and liver enzymes—your doctor will check blood tests before and during treatment.

Isotretinoin is highly teratogenic. Women who can get pregnant must use two reliable forms of birth control and take regular pregnancy tests. Many countries require enrollment in pregnancy-prevention programs and monthly tests. Do not donate blood while taking isotretinoin and for a set time after stopping—rules vary, so ask your provider.

Interactions and mental health

Avoid taking high-dose vitamin A supplements with isotretinoin because both increase the risk of toxicity. Some antibiotics like tetracyclines can increase risk of raised pressure in the skull; inform your doctor before combining treatments. There have been reports of mood changes and depression with isotretinoin. While a direct cause is debated, tell your doctor about any mood shifts, and seek help immediately for suicidal thoughts.

Alternatives: If isotretinoin isn't right for you, options include hormonal treatments for women, topical retinoids, oral antibiotics, and procedures like chemical peels or light therapy. These work for many people but may not stop scarring acne as reliably.

Buying and prescriptions: Only take isotretinoin with a prescription and medical supervision. Beware of online pharmacies that sell it without proper checks—fake or substandard products can be dangerous. If you need help finding a trusted pharmacy, ask your dermatologist or pharmacist for recommendations.

Practical tips: Use gentle, fragrance-free skincare; apply sunscreen daily; avoid waxing while on treatment; and plan for follow-up blood tests. Keep a written list of side effects to report to your doctor. Proper monitoring and open communication with your care team make the treatment much safer and more effective.

Expect skin to get worse at first, then better over months. Many patients enjoy years without severe acne; some need a second course. Ask your doctor how long to wait before another treatment and what to expect in the year after the therapy.