Using Isotrentinoin (Accutane) for Acne

Accutane (isotretinoin) is a medication used to treat severe or nodular acne that doesn't improve with other treatments. This drug is for people 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 isotretinoin 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 considering it as an option for their teenagers.

What Is Accutane?

Accutane is a powerful drug, but isotretinoin is also a naturally occurring component of vitamin A, an essential vitamin that you get from your diet. Large doses of vitamin A supplements can 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 Does It Work?

Accutane works against acne in three ways.

• First, it shrinks the sebaceous glands and makes them produce less oil in your skin.
• When cells are sloughed off into the sebaceous glands, the drug makes them less sticky and less able to form blemishes.
• It gets rid of acne-causing bacteria in the glands and on the skin.

How Effective Is It?

Accutane is the single most effective drug for treating severe acne that hasn't responded to other treatments. About 50% of people who take it experience cleared skin to the point that they never need to treat acne again.

Outcomes after using isotretinoin:

• Some people have slightly worsening acne, especially when starting to use this medication
• Rarely, some people have much worse acne during or after using this drug
• Most people get much better permanently or make temporary improvements

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

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
• Reduced night vision
• 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

Accutane has been linked to several possible mental health side effects.

Possible mental health effects include:

• Depression
• Anxiety
• Suicide and suicide attempts
• Psychosis
• Exacerbation of bipolar disorder

The link to psychiatric side effects is very controversial, and the research results are still not completely clear about this association. 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.

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:

• Miscarriage
• Premature birth
• Death of a newborn due to birth defects

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 defects
• Kidney, thymus gland, and parathyroid gland abnormalities

If someone taking any form of isotretinoin becomes pregnant, the drug must be discontinued immediately and the pregnancy should be evaluated by an obstetrician experienced in reproductive toxicity.

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.

Requirements include:

• A new prescription for isotretinoin each month
• You can't donate blood while taking isotretinoin and for 30 days after your last dose

Anyone who can become pregnant is required to:

• Take monthly pregnancy tests
• Use two forms of birth control (typically hormonal birth control pills, patches, or shots PLUS a barrier form such as a diaphragm or external latex condom)

or

• Commit to 100% abstinence from one month prior to starting isotretinoin until one month after the last dose

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 an internal 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 you meed all of the following criteria:

• Your acne is severe enough to leave scars
• You have had acne for several years
• Your acne hasn't adequately improved with 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 any scars that you have 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, there are other alternatives you can try.

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 you or 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 begins having any side effects.