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Isotretinoin FAQs


Will isotretinoin cure me?

Treatment with isotretinoin often results in prolonged clearance of acne, which can be permanent for some patients. 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.

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 two approved forms of birth control

Isotretinoin and Females

It is especially important that a woman not be pregnant or become pregnant while taking isotretinoin.

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

  • Severe birth defects

  • Miscarriage (baby dies before birth)

  • Premature birth

Other potential side effects include the following.

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.

Is it safe to remove hair with wax while taking isotretinoin?
No waxing, please. Waxing can cause permanent scars in people taking isotretinoin. To avoid scarring, you must not wax while taking isotretinoin and for six months after you stop taking isotretinoin. This applies to hot wax and cold wax.

Does isotretinoin increase risk of sunburn?
If you plan to spend time outdoors, it is important to know that isotretinoin can make your skin more sensitive to the sun. You can sunburn unexpectedly and quickly. To protect your skin, dermatologists recommend that people taking isotretinoin:

  • Seek shade when outdoors

  • Wear a shirt, wide-brimmed hat, and pants

  • Apply sunscreen to all skin that will be exposed

    Isotretinoin: Think sun protection

    It is important that patients taking isotretinoin protect their skin from the sun.

The type of sunscreen you use is important. Be sure to use sunscreen that offers:

  • Broad-spectrum protection (bottle may say “UVA/UVB protection”)

  • An SPF of 30 or greater

  • Water resistance

Because isotretinoin can make your skin more sensitive, it is especially important that you not tan. This includes not using indoor tanning (sunlamps and tanning beds) while taking isotretinoin.


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

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