Using Isotrentinoin (Accutane) for Acne

An Asian girl looks at severe acne on her cheek in a compact mirror.


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Accutane (isotretinoin) is a medication used to treat severe nodular acne when nothing else seems to work. This drug is for teens who've tried many other acne treatments without success, including oral antibiotics and multiple topical medications.

Accutane was formerly a popular brand name of isotretinoin that's no longer being sold. However, some people still refer to it as Accutane. Along with the generic form, brands that are currently available in the U.S. include:

  • Absorica
  • Amnesteem
  • Claravis
  • Myorisan
  • Zenatane

Although isotretinoin is effective for severe, hard-to-treat acne, concern about serious possible side effects—including mental health problems and severe birth defects—keeps some parents from looking at it as an option.

Illustration shows progression of acne severity from blackheads through cysts and nodules.


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What is Accutane?

Accutane is a powerful drug, but isotretinoin is also a naturally occurring component of vitamin A that's in everyone's blood. Large doses of vitamin A have the same effects as isotretinoin drugs—and that goes for the dangerous side effects as well as the positive effects.

Despite side effect concerns, isotretinoin is sometimes preferable to taking antibiotics long-term, which comes with its own set of negative consequences—including antibiotic resistance.

How Effective Is It?

Accutane is the single most effective drug for severe acne that hasn't responded to other treatments. In about 50% of people who take it, it clears the skin to the point that they never need to treat acne again. Meanwhile:

  • About 20% get a little worse
  • About .002% get much worse
  • The rest (almost 30%) get much better permanently or make temporary improvements

Most people take this drug for between four and six months. Some people need to take it for an additional four-to-six months to see an improvement.

You will usually need to find a dermatologist to prescribe isotretinoin, as it's usually not prescribed by pediatricians.

What Are the Side Effects?

The most common side effects of isotretinoin are significant, including:

  • Red, cracked, and sore lips
  • Dry skin, eyes, mouth, or nose
  • Nosebleeds
  • Peeling skin, especially on the palms and soles
  • Joint and muscle pain
  • Temporary thinning of hair

Less common but more serious side effects can include:

  • Headache, stomach pain, and/or chest pain
  • Vision problems
  • Dizziness
  • Nausea and vomiting
  • Seizures
  • Difficulty swallowing or pain when swallowing
  • Jaundice
  • Impaired wound healing
  • Muscle weakness
  • Difficulty hearing or ringing in the ears
  • Painful or constant dryness of the eyes
  • Fainting
  • Fast or pounding heartbeat

Risk of Mental Health Problems

Research has linked Accutane to several possible mental health side effects, which make its use in teenagers high controversial. Possible mental health effects include:

The mental state of people taking this drug should be closely monitored by doctors and parents/guardians should be on alert for any mood or behavioral changes.

If you are having suicidal thoughts, contact the National Suicide Prevention Lifeline at 1-800-273-8255 for support and assistance from a trained counselor. If you or a loved one are in immediate danger, call 911.

For more mental health resources, see our National Helpline Database.


Risk of Birth Defects

A high risk of birth defects is also a big concern, enough that there's a very strict protocol for preventing pregnancy in anyone taking this drug. Possible effects can include:

Specific birth defects that are linked to isotretinoin include:

  • Deformities of the skull, ears, eyes, or face
  • Cleft palate
  • Central nervous system abnormalities
  • Brain malformation
  • Hydrocephalus (fluid buildup in the brain)
  • Microcephaly (abnormally small head)
  • Cranial nerve deficits
  • Heart abnormalities
  • Kidney, thymus gland, and parathyroid gland abnormalities

If someone taking Accutane becomes pregnant, the drug must be continued immediately and the pregnancy should be evaluated by an obstetrician experienced in reproductive toxicity.

Accutane in Semen

It's likely that small amounts of isotretinoin are present in the semen of males taking this drug. It's unknown whether this may harm a fetus, but contraception should be avoided. If a pregnancy does occur, the female's doctor should be notified immediately about the possibility of isotretinoin exposure.

What Are the Requirements Before Prescribing?

These medications aren't easy to get, as they're "marketed under a special restricted distribution program" to help reduce the risk of side effects. Prescribers, patients, and even pharmacies must be registered with the FDA-approved iPLEDGE program.

Other requirements include:

  • Needing to get a new prescription for isotretinoin each month
  • Not being allowed to donate blood while taking isotretinoin and for 30 days after your last dose

Anyone who can become pregnant is required to:

The iPLEDGE program recommends appropriate contraception decisions be made rather than a pledge of abstinence for anyone who is or has been sexually active, even if they don't currently have a partner.

Certain birth control pills, including the progesterone-only mini-pills, are not considered an acceptable form of birth control under the iPLEDGE program. Neither is using a female condom or the rhythm method.

Frequently Asked Questions

How severe should your acne be for you to consider Accutane?

You should only consider Accutane if:

  • Your acne is severe enough to leave scars
  • AND has been present for several years
  • AND hasn't responded completely to antibiotic pills or topical treatments

How long does it take for Accutane to clear acne scars?

Accutane doesn't have any effect on acne scars. However, some of the red and brown spots on your skin will clear up as your acne heals. A few months after you finish treatment with isotretinoin, your dermatologist can assess what scars remain and talk to you about your treatment options.

What else can I take if Accutane doesn't work?

If Accutane doesn't clear up your acne, you do have other alternatives to try. Some evidence suggests that oral Dapsone (diaminodiphenylsulfone) can be effective when isotretinoin has failed. Other recommendations may include:

  • Topical retinoids
  • Oral contraceptives plus spironalactone (females only)
  • Cyst or nodule removal techniques
  • Low-dose prednisone
  • Chemical peels
  • Laser and light therapies

Some doctors may recommend one or more of these treatments in addition to isotretinoin, as well. Remember that it can take several weeks for isotretinoin to start showing results.

A Word From Verywell

Accutane certainly isn't the first acne treatment your teen should try, but by the time you're thinking about this drug, you've likely considered and tried many other acne treatments with mixed or poor results.

For the child with severe nodular acne that could leave scars, Accutane could be a good option, but your child should be well supervised as they take it. Make sure to stay in contact with your pediatrician while this drug is prescribed, especially if your child does begin having any side effects.

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