Isotretinoin: Answers to questions patients often ask | AAD

Isotretinoin: Answers to questions patients often ask

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Will isotretinoin cure me?

About 85% of patients see their skin permanently clear after one course of treatment. A course of treatment generally lasts about 4 to 5 months. It can run shorter or longer. 

Some patients do not clear after one course of treatment, and a second course of treatment may be an option. Studies show this helps some patients see clear skin. You should wait at least 8 weeks between treatments. The skin often continues to clear for a while after patients stop taking the medicine.

                before and after isotretinoin  Before and after taking isotretinoin: This woman treated cystic acne for years without success (left). After taking isotretinoin, her skin cleared (right).

How do I use isotretinoin?

This medicine comes in pill form. You will take one or two pills a day as your dermatologist prescribes.

Before taking isotretinoin, you must enroll in the iPLEDGE™ program. Created by the U.S. Food and Drug Administration (FDA), this program helps to ensure that patients:

  • Do not start taking isotretinoin while pregnant. 
  • Do not become pregnant while taking isotretinoin.
    Because iPLEDGE™ informs patients about other possible side effects, all patients must enroll in this program before taking isotretinoin.

How long will I have to take isotretinoin?

One course of treatment generally takes about 4 to 5 months. You may need a shorter or longer treatment time.

How does isotretinoin work?

 This is the only acne treatment that attacks all four causes of acne — excess oil production, clogged pores in the skin, too much of the bacteria P. acnes, and inflammation. This makes isotretinoin very effective.

Do I need to take any precautions while using isotretinoin?

Yes. You will need to learn about the potential side effects before you decide whether to take isotretinoin.

If you and your dermatologist decide that this medicine is right for you, you will need to do the following: 

  • Enroll in the iPLEDGE™ program.
  • Return to your dermatologist every month for a follow-up appointment. 
  • Immediately report any possible side effect to your dermatologist.
  • Do not wax to remove hair while taking this medicine — and for 6 months after you stop taking isotretinoin.
  • Protect your skin from the sun and do not use a tanning bed, sun lamp, or other indoor tanning device. 
  • Do not donate blood while taking isotretinoin and for 30 days after you take your last pill.

Females only
Patients who can get pregnant also need to take the following precautions:

  • Take the required pregnancy tests.
  • Use 2 approved forms of birth control.

What are possible side effects?

A number of possible side effects can occur while taking this medicine. It is essential that a woman not take this medicine while pregnant and not become pregnant while taking this medicine. Isotretinoin can cause:

  • Severe birth defects. 
  • Miscarriage (baby dies before birth).
  • Premature birth.

Other potential side effects include:

Depression: A connection between taking isotretinoin and developing symptoms of depression/anxiety has been suggested. Dermatologists take reports of depression seriously. Results from some studies, however, show that sometimes patients treated with isotretinoin have fewer symptoms of depression and anxiety. These patients also have improved quality of life.

Inflammatory bowel disease (IBD): There have been reports of patients developing IBD after taking isotretinoin. IBD includes Crohn’s disease and ulcerative colitis. To date, research has not found strong evidence to prove this. Results from a recent, large-scale study that looked at this possible connection suggest otherwise. In this study, which involved thousands of patients, taking isotretinoin did not increase the risk of IBD.

The risk of developing IBD may be linked to having severe acne. More studies are required.

Thoughts of hurting yourself or suicide: Research is needed to find out whether these would have occurred if the person had not been taking isotretinoin.

Other serious side effects that have been reported include:

  • Bad headache.
  • Blurred vision.
  • Dizziness.
  • Nausea or vomiting.
  • Seizures (convulsions).
  • Stroke.

More common and less serious side effects are:

  • Dry eyes.
  • Dry skin.
  • Chapped lips.
  • Nasal passage so dry that nosebleeds occur.
  • Diminished ability to see in the dark.

The AAD believes that this medicine can be appropriate treatment for severe acne, as long as prescribing doctors educate their patients about the potential risks. Patient safety is dermatologists’ primary concern. Dermatologists monitor their patients for IBD, depression, and other possible side effects.

Related resources:

Learn more about isotretinoin:

References:

Elminan M, Bird ST, Delaney JA et al. “Isotretinoin and Risk for Inflammatory Bowel Disease.” JAMA Dermatol. 2013 Feb 1;149(2):216-20.

Images used with permission of the American Academy of Dermatology National Library of Dermatologic Teaching Slides.

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