Isotretinoin for Acne

If you are thinking about using isotretinoin for acne, you likely have lots of questions. Like, what are the side effects? What is iPledge? And, most importantly, is isotretinoin the best treatment for you?

This guide will help you learn more about isotretinoin, and help you understand how it works and what to expect from your treatment.

What Is Isotretinoin and How Does It Work?

Isotretinoin is a powerful medication used to treat severe inflammatory acne. It is an oral medication that is taken once or twice daily. Isotretinoin (not to be confused with tretinoin) is classified as a retinoid, 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.

Isotretinoin is available as a generic medication. Brand name formulations include Zenatane, Claravis, Myorisan, Amnesteem, Sotret, and Absorica. This drug debuted in 1982 as Accutane, but that brand name was discontinued by manufacturer Roche Holding AG in June 2009.

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 up 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 (16 to 20 week) course of treatment to get good results. Some people do require a second course of treatment to completely clear the skin.

After treatment is finished, pimples rarely come back. But if needed, after your course of isotretinoin you can be transitioned to a topical acne medication 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 doctor during the entire time 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
Thinning hair
Decreased night vision
Fatigue

Not as commonly isotretinoin causes:

Nausea and vomiting
Headaches
Bone and joint pain
Diarrhea or rectal bleeding
Severe chest or abdominal pain
Difficult or painful swallowing
High blood triglycerides
Severe birth defects

Risk of Severe Birth Defects

Isotretinoin can cause miscarriage and severe birth defects in babies whose mothers take the drug while pregnant. It's very important that you do not get pregnant while taking isotretinoin, and for at least one month after stopping treatment. You also may not breastfeed while taking this medication.

There is some speculation that isotretinoin may be linked to the development of inflammatory bowel disease. But at this point there is not enough evidence to prove or disprove this, Basically, the jury is still out on this one.

Your doctor 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 effect of isotretinoin is 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.

Don't let this possible side effect scare you too much. 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 if there's really any link at all.

Just as a precaution, though, make sure you tell your doctor 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, psychosis, or if you are having suicidal thoughts.

What Is the iPledge Program?

Prepare to become very familiar with iPledge. 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. Doctors 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.

Should I Take Isotretinoin?

Isotretinoin is meant to be taken only by those with severe acne. If you have mild to moderate acne, your doctor will 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 quite severe, or if you have widespread acne of the back or body, isotretinoin may be an option.

Your doctor is your best resource, so ask for her 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 acne has not responded well to other medications. Ultimately, you and your dermatologist must decide if isotretinoin therapy is right for you.