Isotretinoin — better known as Accutane — is one of the most potent tools dermatologists have for treating severe nodulocystic acne. It’s a powerful drug with a high success rate…and a lot of online opinions.

To sort out the truth about isotretinoin, we interviewed our founder and board-certified dermatologist Sandra Lee, MD (aka Dr. Pimple Popper). Here’s her take on Accutane: how it works, what to expect, and whether it’s worth all the hype.

6 minute read

What is Accutane?

DPP: This is the brand name of a drug called isotretinoin that’s used to treat severe nodulocystic acne. That’s the deep, inflammatory acne that tends to leave permanent scars.

Interestingly, Accutane was originally developed as a chemotherapy drug. It was approved by the FDA to treat severe, cystic acne back in the 80s. You won’t find the brand Accutane in the U.S. anymore, but isotretinoin is now marketed with names like Absorica, Claravis, or Amnesteem.

Because it’s such a powerful drug, isotretinoin is very closely regulated by the FDA. Only your doctor (usually a dermatologist) can prescribe it, and there’s a strict monitoring process for patients. But when taken as directed, Accutane has a very good success rate — with a high percentage of patients experiencing clearer skin, often permanently.

How does isotretinoin work?

DPP: This drug is a vitamin A derivative, in the same family as topical tretinoin and retinol. It lowers the amount of oil that your sebaceous glands produce. It also reduces something called hyperkeratinization, which is when the skin cells inside the follicle don’t shed properly.

So it’s reducing the amount of oil and the dead cell buildup in your pores — the two things that C. acnes thrives on — which is why it’s so effective in treating inflammatory acne.

What’s it like to take isotretinoin?

DPP: If your dermatologist prescribes Accutane, there’s a strict protocol that you’ll follow. In terms of the routine, you typically take the pill twice a day, with food, because that increases the drug’s absorption.

Once you start taking isotretinoin, your skin will get much drier. It’s pretty common also to get side effects like chapped lips, itchy skin, dry nose and eyes, even mild nosebleeds. This is because the drug is depleting the skin’s natural oils. Some people also experience temporary hair thinning, rashes, achiness, or upset stomach. Your dermatologist can adjust the medication dosage to try to minimize these side effects.

During the first few weeks of taking Accutane, about 1 in 5 patients will experience something called purging, which is when their acne gets worse before it starts to subside. Most patients see results after about four to six months of treatment. Sometimes patients need a second course if their acne hasn’t cleared — either right after, or years later, if their acne returns.

Is Accutane safe?

DPP: You can find a lot of stories on the Internet about isotretinoin — many of them hopeful, but some of them scary. The truth is, this medication has been prescribed now for decades, and it’s really the single best way to manage treatment-resistant severe or scarring acne. If needed, I would take it, or even give it to my teenagers.

Isotretinoin really is safe when taken with a doctor’s supervision. The reason why it might seem scary is because we monitor patients to make sure they’re healthy while they’re taking it. This is why you have to get Accutane from your doctor — and never buy it online.

There are a couple of important things we look out for while a patient is taking Accutane. First, you’ll get blood tests while you’re taking the drug to check your liver and kidney function, as well as your fat and cholesterol levels. Sometimes, isotretinoin can affect these while you’re on it, so we need to keep tabs to avoid any complications.

It’s extremely, extremely important that you don’t take Accutane while you’re pregnant, or might become pregnant. It can cause serious birth defects. That’s why your dermatologist will have you sign an agreement required by the FDA called the iPledge. Both men and women need those monthly blood tests before they’re able to refill the medication. Women must also take regular pregnancy tests, and agree to using two forms of birth control.

The final thing we keep an eye on is our patients’ mental health while they’re taking isotretinoin. Rarely, some patients taking the drug become depressed or even suicidal — though the research hasn't proven that isotretinoin is the cause. Regardless, it’s important that you talk to your doctor if you have any mood changes during your treatment course.

How do you take care of your skin while taking isotretinoin?

DPP: Most patients experience significantly dry skin during their course of Accutane. I recommend using a very mild cleanser (like Cetaphil) and a very gentle shampoo. Some people find they don’t need to wash their face and hair nearly as often as they used to.

Hydrating and moisturizing is really important while you’re on your course of isotretinoin. Look for products that are formulated for acne-prone skin, since you want to avoid slathering on comedogenic lotions that can exacerbate acne. My SLMD Facial Moisturizer is perfectly balanced to protect the skin barrier without clogging pores.

For areas that become really dry or cracked (like the corners of your mouth, or in between your fingers), try layering on Aquaphor, pure shea butter, or petroleum jelly.

You also need a good sunscreen, since your skin may be more UV sensitive while on Accutane. Again, choose a noncomedogenic product, like SLMD Dual Defender, which is a lightweight moisturizer and broad-spectrum sunscreen in one.

Dr. Pimple Popper Tip: Start with an over-the-counter solution like SLMD Acne System to treat inflammatory acne.

How does someone know if they should go on Accutane?

DPP: The decision to take isotretinoin to treat severe or cystic acne is between a patient and their dermatologist. This is definitely not one of those times when you use an online pharmacy, or borrow a friend’s prescription — isotretinoin is nothing to experiment with on your own.

My general advice to people is that if you’ve tried a high-quality over-the-counter kit (like my SLMD Acne System) and you haven’t seen results after a few months, it’s time to make an appointment with your dermatologist. Also, if your acne is causing scars, you need to talk to a doctor.

Typically, a dermatologist will first recommend a variety of prescription medications, including topical or oral antibiotics, benzoyl peroxide, tretinoin, or a combination of those. If your acne doesn’t clear up, then isotretinoin might be the next option.

I always tell patients not to be afraid of taking Accutane if you’re a candidate. We have a system in place to keep you safe and healthy — and It can really be a life-changer for someone with severe cystic acne.