Table of ContentsView AllTable of ContentsWhat It IsHow It WorksBenefitsSide EffectsRequirementsWho It’s Not ForIs It Worth It?Alternatives
Table of ContentsView All
View All
Table of Contents
What It Is
How It Works
Benefits
Side Effects
Requirements
Who It’s Not For
Is It Worth It?
Alternatives
Isotretinoin (which used to be sold under the brand name Accutane) is an effective medication for severe, hard-to-treat acne. But, concerns about serious possible side effects—including mental health problems and severe birth defects—keep some parents from considering it as an option for their teenagers.
Whether isotretinoin is worth it is a decision that only you and your dermatologist can make together. On one hand, about 50% of people who complete a course of isotretinoin will never need acne treatment again. On the other, side effects are common, and your dose may need to be adjusted to reduce side effects while maintaining effectiveness.
This article explains how isotretinoin works and the side effects it can cause. It also covers the requirements you will need to follow while using isotretinoin in order to prevent serious side effects.
Boy_Anupong / Getty Images
What Is Accutane (Isotretinoin)?
Isotretinoin is a medication used to treatsevereornodular acnethat doesn’t improve with other treatments. This drug is for people who’ve tried many other acne treatments without success, including oral antibiotics and multipletopical 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:
Isotretinoin 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 takingantibioticslong-term, which comes with its own set of negative consequences—including antibiotic resistance.
How Does Isotretinoin Work?
Isotretinoin is an oral medication that comes in capsule form. The drug works systemically, meaning that it circulates through the bloodstream, targeting multiple acne-affected areas of the body at the same time (e.g., the face and upper back).
Isotretinoin is the only medication that effectively targets all four causes of acne. The medication:
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.
1:30Click Play to Learn More About Isotretinoin for Acne
1:30
Click Play to Learn More About Isotretinoin for Acne
Benefits of Isotretinoin
Isotretinoin is the single most effective drug for treating severe acne that hasn’t responded to other treatments.It treats all types of acne, including cystic and nodular acne, along with the pain and inflammation that come with them. Isotretinoin may also prevent acne scars.
After using isotretinoin:
The benefits of Isotretinoin go beyond improvements in acne. Multiple studies have shown that when the drug is successful, it can also lead to improvements in self-esteem and quality of life.
How long does it take for isotretinoin to clear acne scars?Isotretinoin doesn’t have any effect on existing 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.
How long does it take for isotretinoin to clear acne scars?
Isotretinoin doesn’t have any effect on existing 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.
Side Effects of Isotretinoin
The most common side effects of isotretinoin include:
Less common but more serious side effects can include:
Risk of Mental Health Problems
Although successful treatment with isotretinoin is linked to improvements in quality of life, the drug is known to trigger severe and potentially even life-threatening side effects.
Rare but possible mental health effects include:
If you are having suicidal thoughts, dial988to contact the988 Suicide & Crisis Lifelinefor support and assistance from a trained counselor. If you or a loved one are in immediate danger, call911.
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:
Isotretinoin in SemenIt’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 conception should be avoided. If a pregnancy does occur, the female’s doctor should be notified immediately about the possibility of isotretinoin exposure.
Isotretinoin 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 conception 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?
You should only consider isotretinoin if you meet all of the following criteria:
Isotretinoin is not an easy medication to get, as it is 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:
Anyone who can become pregnant is required to:
or
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 theprogesterone-only mini-pills, are not considered an acceptable form of birth control under the iPLEDGE program. Neither is using aninternal condomor therhythm method.
The iPledge Program for Isotretinoin Medications
Who Shouldn’t Take Isotretinoin?
You should not take isotretinoin if:
Do not get pregnant while on isotretinoin. If you are not willing to follow iPledge mandates for using two birth control methods, taking monthly pregnancy tests, or abstaining from intercourse entirely, then isotretinoin is not for you.
How to Decide if Isotretinoin Is Worth It?
To decide if isotretinoin is worth it, it helps to:
If you are having trouble answering some of these questions, you may want to consult with a dermatologist and ask about alternatives to isotretinoin as well.
Alternatives to Isotretinoin
Other possible alternatives to isotretinoin include:
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.
6 Accutane Alternatives for Treating Acne
Summary
Isotretinoin is the strongest and most effective acne medication available. It is so powerful that 50% of people who complete a course of isotretinoin will never need an acne treatment again. Isotretinoin is only prescribed for severe acne that does not respond to other treatments, as it is associated with a high risk of side effects. Most people who use it will experience dry skin and lips. Although rare, the drug is also linked to depression and suicidal thoughts.
Using isotretinoin when pregnant will result in birth defects. If you do choose to take this drug, you will need to use two forms of birth control or abstain from sex until your course is complete. If you have any questions about isotretinoin, talk to your dermatologist.
15 SourcesVerywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.American Osteopathic College of Dermatology.Accutane.American Academy of Dermatology Association.Isotretinoin: FAQs.Demirci Saadet E.Investigation of relapse rate and factors affecting relapse after oral isotretinoin treatment in patients with acne vulgaris.Dermatol Ther.2021 Aug 24:e15109. doi:10.1111/dth.15109Bremner JD.Isotretinoin and neuropsychiatric side effects: Continued vigilance is needed.J Affect Disord Rep.2021 Dec;6(1):100230. doi:10.1016/j.jadr.2021.100230American Academy of Dermatology Association.Isotretinoin: The truth about side effects.Food and Drug Administration.Isotretinoin capsule information.Chandrasekaran S, De Sousa JFM, Paghdar S, Khan TM, Patel NP, Tsouklidis N.Is isotretinoin in acne patients a psychological boon or a bane: A systematic review.Cureus.2021 Aug 2;13(8):e16834. doi:10.7759/cureus.16834National Organization for Rare Disorders.Fetal retinoid syndrome.U.S. Food and Drug Administration: FDA AccessData.Accutane (isotretinoin capsules).Gurel A, Gurel G, Fırat F.Effect of systemic isotretinoin therapy on semen parameters.Ann Med. 2023 May;55(1):2207038. doi:10.1080/07853890.2023.2207038iPledge.Patient introductory brochure.U.S. Food and Drug Administration.The iPLEDGE program: The pharmacist guide for the iPLEDGE program.Alberta.Acne: Should I take isotretinoin for severe acne?.University of Michigan, Michigan Health.How dermatologists treat acne: 5 options explained.American Academy of Dermatology Association.Lasers and lights: How well do they treat acne?Additional ReadingBaldwin HE.Pharmacologic treatment options in mild, moderate, and severe acne vulgaris.Semin Cutan Med Surg. 2015;34(5 Suppl):S82-5. doi:10.12788/j.sder.2015.0162Zaenglein AL, Pathy AL, Schlosser BJ, et al.Guidelines of care for the management of acne vulgaris.J Am Acad Dermatol. 2016;74(5):945-73.e33. doi:10.1016/j.jaad.2015.12.037
15 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.American Osteopathic College of Dermatology.Accutane.American Academy of Dermatology Association.Isotretinoin: FAQs.Demirci Saadet E.Investigation of relapse rate and factors affecting relapse after oral isotretinoin treatment in patients with acne vulgaris.Dermatol Ther.2021 Aug 24:e15109. doi:10.1111/dth.15109Bremner JD.Isotretinoin and neuropsychiatric side effects: Continued vigilance is needed.J Affect Disord Rep.2021 Dec;6(1):100230. doi:10.1016/j.jadr.2021.100230American Academy of Dermatology Association.Isotretinoin: The truth about side effects.Food and Drug Administration.Isotretinoin capsule information.Chandrasekaran S, De Sousa JFM, Paghdar S, Khan TM, Patel NP, Tsouklidis N.Is isotretinoin in acne patients a psychological boon or a bane: A systematic review.Cureus.2021 Aug 2;13(8):e16834. doi:10.7759/cureus.16834National Organization for Rare Disorders.Fetal retinoid syndrome.U.S. Food and Drug Administration: FDA AccessData.Accutane (isotretinoin capsules).Gurel A, Gurel G, Fırat F.Effect of systemic isotretinoin therapy on semen parameters.Ann Med. 2023 May;55(1):2207038. doi:10.1080/07853890.2023.2207038iPledge.Patient introductory brochure.U.S. Food and Drug Administration.The iPLEDGE program: The pharmacist guide for the iPLEDGE program.Alberta.Acne: Should I take isotretinoin for severe acne?.University of Michigan, Michigan Health.How dermatologists treat acne: 5 options explained.American Academy of Dermatology Association.Lasers and lights: How well do they treat acne?Additional ReadingBaldwin HE.Pharmacologic treatment options in mild, moderate, and severe acne vulgaris.Semin Cutan Med Surg. 2015;34(5 Suppl):S82-5. doi:10.12788/j.sder.2015.0162Zaenglein AL, Pathy AL, Schlosser BJ, et al.Guidelines of care for the management of acne vulgaris.J Am Acad Dermatol. 2016;74(5):945-73.e33. doi:10.1016/j.jaad.2015.12.037
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
American Osteopathic College of Dermatology.Accutane.American Academy of Dermatology Association.Isotretinoin: FAQs.Demirci Saadet E.Investigation of relapse rate and factors affecting relapse after oral isotretinoin treatment in patients with acne vulgaris.Dermatol Ther.2021 Aug 24:e15109. doi:10.1111/dth.15109Bremner JD.Isotretinoin and neuropsychiatric side effects: Continued vigilance is needed.J Affect Disord Rep.2021 Dec;6(1):100230. doi:10.1016/j.jadr.2021.100230American Academy of Dermatology Association.Isotretinoin: The truth about side effects.Food and Drug Administration.Isotretinoin capsule information.Chandrasekaran S, De Sousa JFM, Paghdar S, Khan TM, Patel NP, Tsouklidis N.Is isotretinoin in acne patients a psychological boon or a bane: A systematic review.Cureus.2021 Aug 2;13(8):e16834. doi:10.7759/cureus.16834National Organization for Rare Disorders.Fetal retinoid syndrome.U.S. Food and Drug Administration: FDA AccessData.Accutane (isotretinoin capsules).Gurel A, Gurel G, Fırat F.Effect of systemic isotretinoin therapy on semen parameters.Ann Med. 2023 May;55(1):2207038. doi:10.1080/07853890.2023.2207038iPledge.Patient introductory brochure.U.S. Food and Drug Administration.The iPLEDGE program: The pharmacist guide for the iPLEDGE program.Alberta.Acne: Should I take isotretinoin for severe acne?.University of Michigan, Michigan Health.How dermatologists treat acne: 5 options explained.American Academy of Dermatology Association.Lasers and lights: How well do they treat acne?
American Osteopathic College of Dermatology.Accutane.
American Academy of Dermatology Association.Isotretinoin: FAQs.
Demirci Saadet E.Investigation of relapse rate and factors affecting relapse after oral isotretinoin treatment in patients with acne vulgaris.Dermatol Ther.2021 Aug 24:e15109. doi:10.1111/dth.15109
Bremner JD.Isotretinoin and neuropsychiatric side effects: Continued vigilance is needed.J Affect Disord Rep.2021 Dec;6(1):100230. doi:10.1016/j.jadr.2021.100230
American Academy of Dermatology Association.Isotretinoin: The truth about side effects.
Food and Drug Administration.Isotretinoin capsule information.
Chandrasekaran S, De Sousa JFM, Paghdar S, Khan TM, Patel NP, Tsouklidis N.Is isotretinoin in acne patients a psychological boon or a bane: A systematic review.Cureus.2021 Aug 2;13(8):e16834. doi:10.7759/cureus.16834
National Organization for Rare Disorders.Fetal retinoid syndrome.
U.S. Food and Drug Administration: FDA AccessData.Accutane (isotretinoin capsules).
Gurel A, Gurel G, Fırat F.Effect of systemic isotretinoin therapy on semen parameters.Ann Med. 2023 May;55(1):2207038. doi:10.1080/07853890.2023.2207038
iPledge.Patient introductory brochure.
U.S. Food and Drug Administration.The iPLEDGE program: The pharmacist guide for the iPLEDGE program.
Alberta.Acne: Should I take isotretinoin for severe acne?.
University of Michigan, Michigan Health.How dermatologists treat acne: 5 options explained.
American Academy of Dermatology Association.Lasers and lights: How well do they treat acne?
Baldwin HE.Pharmacologic treatment options in mild, moderate, and severe acne vulgaris.Semin Cutan Med Surg. 2015;34(5 Suppl):S82-5. doi:10.12788/j.sder.2015.0162Zaenglein AL, Pathy AL, Schlosser BJ, et al.Guidelines of care for the management of acne vulgaris.J Am Acad Dermatol. 2016;74(5):945-73.e33. doi:10.1016/j.jaad.2015.12.037
Baldwin HE.Pharmacologic treatment options in mild, moderate, and severe acne vulgaris.Semin Cutan Med Surg. 2015;34(5 Suppl):S82-5. doi:10.12788/j.sder.2015.0162
Zaenglein AL, Pathy AL, Schlosser BJ, et al.Guidelines of care for the management of acne vulgaris.J Am Acad Dermatol. 2016;74(5):945-73.e33. doi:10.1016/j.jaad.2015.12.037
Meet Our Medical Expert Board
Share Feedback
Was this page helpful?Thanks for your feedback!What is your feedback?OtherHelpfulReport an ErrorSubmit
Was this page helpful?
Thanks for your feedback!
What is your feedback?OtherHelpfulReport an ErrorSubmit
What is your feedback?
