- Accutane was the brand name for the generic skin medication isotretinoin
- The brand Accutane isn’t available in the United States any more, but generic and other brand-name versions of the drug are still available
- Isotretinoin is a prescription oral medication to treat severe acne
- The most serious side effects of isotretinoin include birth defects if taken during pregnancy
- Isotretinoin is usually recommended if other acne treatments have been unsuccessful
What Is Accutane?
Accutane is a trade name for a powerful acne medication isotretinoin. The U.S. Food & Drug Administration (FDA) first approved Accutane in 1982. Millions of people used Accutane in the years that followed, but in 2009 its manufacturer, Hoffman-La Roche Inc., pulled it from the shelves.
Other forms of FDA-approved isotretinoin continue to be sold, either as generic medications or under other brand names. Accutane is a form of vitamin A, an essential nutrient for healthy skin, eyes and immune system. Accutane is available by prescription only, and is usually taken twice daily.
The list of possible side effects and health problems associated with Accutane and other isotretinoin-based acne medications is long, and working closely with your dermatologist while taking these drugs is essential.
Does Accutane for Acne Work?
Accutane and other forms of isotretinoin are effective in treating severe acne, according to a 2018 review of 11 studies reported in the British Journal of Dermatology. And while high doses of isotretinoin are often prescribed because the individuals needing treatment have severe acne, a 2017 study in Advances in Dermatology and Allergology, found that low doses are effective in treating moderate acne breakouts.
Isotretinoin works by reducing the production of sebum, the oily substance produced by the sebaceous or oil glands in the skin to help lubricate and waterproof the surface of your skin. Too much sebum leads to the formation of pimples.
How to use it
Accutane and other isotretinoin medications are recommended only after other medicines and antibiotics have been tried and been unsuccessful at relieving severe acne symptoms. Pills are taken once or twice daily, depending on your dermatologist’s recommendation. Usually they should be taken with food to help with their absorption. Your dermatologist can provide you more medical advice to make sure you get the most out of your medication while remaining safe.
Acne before and after Accutane
It can take one or two months of Accutane and isotretinoin usage to see significant results, and as many as six months to see complete improvement. Some people however, need a few more months of treatment to have completely clear skin. If the acne breakout was severe, there may be some scarring after the lesions have cleared.
In some cases, acne may get a little worse soon after starting Accutane, but then the drug starts limiting sebum production and skin usually starts to clear within a relatively short time.
Who Should Take Accutane for Acne?
Because Accutane is so strong and can lead to a long list of side effects, it’s not recommended for people with mild acne breakouts. Instead, dermatologists prescribe Accutane for cystic acne or nodular acne, which is severe acne that forms when skin pores become blocked, leading to inflammation and infection. The medication is, however, effective for most kinds of acne.
Accutane may be taken by males or females, but women who are pregnant or who are trying to get pregnant should avoid the medication. People with liver disease may also not be good candidates for Accutane. If you are considering using any isotretinoin product, consult your doctor and share any serious health concerns you have.
There hasn’t been research into pediatric use of Accutane, so it should only be considered for use among teens and adults. Older adults, who may have health challenges that could be exacerbated by Accutane, may be advised against trying the medication. And because isotretinoin may cause depression, people who are prone to mental health problems should use the medication with care.
Safety and Side Effects
The range of possible side effects from Accutane is extensive, from chapped lips and peeling skin to temporary mental health problems and birth defects if the drug is taken by a woman who is pregnant. Because this risk is so strong, many dermatologists signed an iPledge agreement not to prescribe any isotretinoin drugs to women who are expecting. Female patients should take a pregnancy test before starting Accutane. And for women who are sexually active, using effective birth control is vital.
Most commonly, dry, peeling skin results from Accutane use. Your dermatologist can recommend a moisturizer that will be safe and effective while you are treating your acne. The dry skin and drying out throughout the body are triggered by the isotretinoin can also affect your nasal passages, resulting in nosebleeds.
Other common effects of isotretinoin include:
- Dry eyes
- Trouble with night vision
- Sensitivity to sunlight (may cause a yellowing of the skin)
- Joint and muscle pain
- Increased cholesterol
- Increased triglycerides
- Temporary liver problems
- Depression and suicidal thoughts
Isotretinoin is also associated with a higher risk of inflammatory bowel disease.
You should also avoid taking any vitamin A supplements while taking Accutane or any isotretinoin product. Too much vitamin A in the system can cause problems for your skin, eyes, respiratory system and thinking skills. It can also affect liver function.
When taking Accutane, you will be advised to take periodic blood tests to check for complications.
If Accutane or other isotretinoin medications aren’t right for you or you are concerned about their safety, ask your doctor about alternative treatments.
A different type of vitamin A derivative, tazarotene (Tazorac) has fewer side effects. It’s sold as a topical cream, as is adapalene (Differin). These topical retinoid medications all require a prescription. Retinoids help unclog pores and help other medications work more effectively and clearing away pimples.
Other topical medications, including benzoyl peroxide, is often enough to treat mild-to-moderate acne.
Oral antibiotics can also help treat severe acne. Antibiotics work because acne is, in part, the result of a bacterial infection. Oral antibiotics are usually taken with other acne medications, such as topical treatments to help reduce inflammation and dry oily skin. Commonly used antibiotics for acne include clindamycin, minocycline, doxycycline, tetracycline, azithromycin, and erythromycin.
One other treatment for hard, lump acne includes steroid injections, which should help reduce the swelling around your acne breakout.
Like any powerful medication, Accutane comes with some risks. Certainly you should never take it or any isotretinoin if you’re pregnant or not using effective birth control. But if you have exhausted other treatments and your acne hasn’t improved, you may want to consider starting with a low dose to see if it works.
Lower doses carry fewer side effect risks. Having severe acne can be upsetting and cause long-term psychological stress and skin scarring. But if you work with your dermatologist and report any side effects as soon as they emerge, you may be find the results you want without serious problems with Accutane.
- Vallerand IA, Lewinson RT, Farris MS, et al. Efficacy and adverse events of oral isotretinoin for acne: a systematic review. Br J Dermatol. 2018;178(1):76–85. doi:10.1111/bjd.15668
- Torzecka, J. D., Dziankowska-Bartkowiak, B., Gerlicz-Kowalczuk, Z., & Wozniacka, A. (2017). The use of isotretinoin in low doses and unconventional treatment regimens in different types of acne: a literature review. Postepy dermatologii i alergologii, 34(1), 1–5. doi:10.5114/ada.2017.65614