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Isotretinoin: The truth about side effects


Dermatologists prescribe isotretinoin (also called Accutane®) to treat deep, painful acne cysts and nodules. When other treatment fails, this medication can diminish or clear severe acne and prevent new acne scars.

Illustration of a teen girl washing her face
Myths and misconceptions about this medication are common, especially when it comes to side effects. Here’s what you should know about the possible side effects.

Known side effects

If a female takes isotretinoin while pregnant, this medication can cause:

  • Severe birth defects

  • Miscarriage

  • Stillbirth

Prevent this side effect: To get a prescription for isotretinoin, a female who can become pregnant must take two pregnancy tests to make sure she’s not pregnant. She must also agree that while taking this medication, she will have a monthly pregnancy test and use two forms of birth control.

Illustration of a teen boy with severe acne
It’s common to experience one or more of the following while taking isotretinoin:

  • Dry skin, severely chapped lips

  • Nosebleeds

  • Dry, irritated eyes

  • Dry mouth

Treat these side effects: These will clear once you stop taking the medication. Until then, you can get relief with moisturizer, lip balm, and artificial tears. For nosebleeds, apply petroleum jelly just inside your nose. This helps keep the tissue moist, which can prevent nosebleeds.

When you take isotretinoin, you may become:

  • Extremely sensitive to the sun

Illustration teen girl with sunburn
Manage this side effect: Your dermatologist will tell you how to protect your skin from the sun while taking isotretinoin. Once you stop taking isotretinoin, this sensitivity will go away.

Because isotretinoin effectively treats so many people with severe acne, many people are surprised by this possible side effect:

  • Acne worsens

Know this side effect is temporary: When you start taking isotretinoin, acne can worsen before it begins to clear. This happens with many acne treatments.

While taking isotretinoin, you may develop:

  • Trouble seeing at night (night blindness)

  • Thinning hair

  • Muscle (or joint) pain

Understand these side effects are temporary: These side effects tend to go away when you stop taking isotretinoin. Lost hair tends to grow back.

Unproven side effects

People have reported the following serious side effects, which research has NOT shown isotretinoin can cause:

  • Depression

  • Thoughts of committing suicide

  • Inflammatory bowel disease (IBD)

Illustration of doctor sharing research results
What may cause these side effects: It’s possible that having severe acne increases the risk of developing these side effects. Research shows that people who have severe acne and are NOT taking isotretinoin can become depressed. Some people develop such a deep depression that they think about taking their own life. When acne clears, the depression and thoughts of suicide also tend to disappear.

Researchers have also studied the connection between acne and IBD. To date, studies do not show that taking isotretinoin increases the risk of developing IBD. It’s possible that the genes which increase your risk of having severe acne also increase your risk of developing IBD.

Dermatologists carefully monitor each patient

If your dermatologist prescribes isotretinoin, your dermatologist will watch you closely. This includes face-to-face appointments. While taking this medication, you will need to see your dermatologist once a month. During these appointments, tell your dermatologist what you’re feeling, even if it seems unrelated to taking isotretinoin. Other side effects, aside from the ones listed above, are possible.

Your dermatologist can help you sort out what’s happening.


Images
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References
Huang YC and Chen YC.” Isotretinoin treatment for acne and risk of depression: A systematic review and meta-analysis.” J Am Acad Dermatol 2017;76:1068-76.

iPLEDGE Program, Patient information. Last updated November 2016. Last accessed February 2020.

Lee SY, Jamal MM, et al. “Does exposure to isotretinoin increase the risk for the development of inflammatory bowel disease? A meta-analysis.” Eur J Gastroenterol Hepatol. 2016 Feb;28(2):210-6.

Racine A, Cuerq A, et al. “Isotretinoin and risk of inflammatory bowel disease: a French nationwide study.” Am J Gastroenterol. 2014;109(4):563-9.

Rashtak S, Khaleghi S, et al. “Isotretinoin exposure and risk of inflammatory bowel disease.” JAMA Dermatol. 2014;150(12):1322-6.

Soundararajan V, Gwillim E, et al. “Poster 8292 Frequency of depression in dermatologist-managed patients who have acne, isotretinoin-exposure vs no isotretinoin exposure: Pharmacovigilance analysis of a large Midwestern US population from the RADAR (Research on Adverse Drug events And Reports) program.” J Am Acad Dermatol 2019;81: suppl 1, AB67.

U.S. National Library of Medicine, “Identifying the genetic predictors of severe acne vulgaris and the outcome of oral sotretinoin treatment (SA).” ClinicalTrials.gov Identifier: NCT01727440. Last accessed February 2020.

Zaenglein AL, Pathy AL, et al. “Guidelines of care for the management of acne vulgaris.” J Am Acad Dermatol 2016;74:945-73.

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