Isotretinoin for Acne

What Is Isotretinoin and How Does It Work?

Isotretinoin is a powerful medication used to treat severe inflammatory acne. Isotretinoin (not to be confused with tretinoin) is classified as a retinoid and is made from a synthetic form of vitamin A. It is taken orally, in pill form, once or twice daily.

It's considered the most effective prescription treatment available for severe acne. Isotretinoin can successfully treat and completely clear up acne, even acne that has not improved with other treatments.

How Does Isotretinoin Work?

Isotretinoin works by shrinking the oil, or sebaceous, glands in the skin. This reduces the amount of oil that is produced.

When your skin isn't producing excess oil, it isn't hanging around clogging pores and creating pimples. By controlling the oil, acne is also controlled.

Unlike most acne medications, you don't have to continuously use isotretinoin to keep breakouts at bay. Most people only need one (five to six months) course of treatment to get good results. Some people do require a second course of treatment to completely clear the skin.

Pimples rarely come back after treatment is finished. But if needed, you can be transitioned to a topical acne medication after your course of isotretinoin to maintain your newly cleared skin.

What Are the Side Effects?

While isotretinoin is a valuable treatment for severe acne, it does come with side effects. Some of these can be severe, so you'll be carefully monitored by your healthcare provider while you're taking this medication.

The most common side effects of isotretinoin include:

• Dry, peeling, flaking, and itchy skin
• Dry eyes, mouth, and nose
• Chapped lips
• Nosebleeds
• Photosensitivity
• Joint pain

Not as commonly, isotretinoin causes:

• Thinning hair and hair loss
• Decreased night vision
• Fatigue
• Headaches
• Severe chest or abdominal pain

Very rarely, isotretinoin may cause:

• High blood triglycerides
• Elevated liver enzymes
• In pregnant women, severe birth defects

Your healthcare provider will discuss the possible side effects with you before you start treatment. Remember, if you have any questions, don't be afraid to ask.

Doesn't Isotretinoin Also Cause Depression?

Probably the most widely discussed side effects of isotretinoin are depression and suicide. There have been reports of depression, psychosis, suicide attempts, and suicide in people taking isotretinoin.

Exactly how or why this happens isn't known, but some researchers believe the drug may disrupt the way serotonin is made and used by the body.

Most people who take isotretinoin never experience any psychiatric problems. There is no conclusive link between isotretinoin use and depression, and some research has cast doubt on whether there's any link at all.

Just as a precaution, though, make sure you tell your healthcare provider if you have a history of depression or mental illness. Know the warning signs and tell your doctor immediately if you experience any symptoms of depression or psychosis or if you are having suicidal thoughts.

What Is the iPledge Program?

Prepare to become very familiar with iPledge as anyone taking isotretinoin is required to be enrolled in this program.

The primary goal of iPledge is to ensure no woman takes isotretinoin while pregnant or becomes pregnant during treatment. Healthcare providers who prescribe isotretinoin, and pharmacists who dispense it, must also register with the program.

Before receiving your first prescription, and for each month during treatment, you will have certain requirements that must be met. This can include monthly pregnancy tests, using two forms of birth control, and picking up your prescription within a certain window of time.

It's not just women who can become pregnant who must register with iPledge. Men and women who can't become pregnant also must comply with certain requirements before taking isotretinoin.

• iPledge Requirements for Women of Childbearing Potential
• iPledge Requirements for Men and Women of Non-Childbearing Potential

Should I Take Isotretinoin?

Isotretinoin is best for moderate acne to severe acne. If you have mild acne, your healthcare provider will likely have you try other acne medications first.

Of course, not everyone is a candidate for isotretinoin treatment. But if you have already tried other acne treatments without much success, if your acne is severe, or if you have widespread acne of the back or body, isotretinoin may be an option.

Your healthcare provider is your best resource, so ask for their opinion. Even if isotretinoin isn't the treatment for you, your doctor will have other treatment options available, so it's worth making that appointment.

A Word from Verywell

Isotretinoin has proven to be a successful acne treatment. For those who suffer from severe inflammatory or cystic acne, it may be a viable treatment option, especially if your acne has not responded well to other medications. Ultimately, you and your dermatologist must decide if isotretinoin is right for you.