Isotretinoin: The truth about side effects
Dermatologists prescribe isotretinoin 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.
You may have heard this medication called Accutane® instead of isotretinoin. Accutane is a brand name of isotretinoin that is no longer available.
Whether you call it Accutane or isotretinoin, myths and misconceptions about this medication are common. This is especially true when it comes to side effects. It's important to remember that all medications have potential side effects. Here’s what you should know about the possible side effects of isotretinoin.
Side effects: What we know
Pregnancy risks: If a person takes isotretinoin while pregnant, this medication can cause:
Severe birth defects
Miscarriage
Stillbirth
Prevent pregnancy risks: To get a prescription for isotretinoin, a patient who can become pregnant must take two pregnancy tests to make sure they're not pregnant. Patients who can get pregnant must also agree that while taking this medication, they will have a monthly pregnancy test and use two forms of birth control.
Dryness: 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
Applying an oil-free moisturizer can reduce dryness without causing breakouts
Moisturizer works best when you apply it immediately after washing.
Treat dryness: Once you stop taking the medication, dryness will clear. 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.
Sun-sensitive skin: When you take isotretinoin, you may become extremely sensitive to the sun.
Protect your skin from the sun while taking isotretinoin
This medication can make your skin more sensitive to the sun. You can sunburn quickly and unexpectedly.
Manage sun-sensitive skin: To protect your skin from the sun, dermatologists recommend that you Practice Safe Sun. Your dermatologist may also give you other tips. Once you stop taking isotretinoin, this sensitivity will go away.
Acne worsens: Because isotretinoin effectively treats so many people with severe acne, many people are surprised by this possible side effect.
When you start taking isotretinoin, acne may worsen
This possible side effect is temporary.
Worsening acne is a temporary side effect: When you start taking isotretinoin, acne can worsen for 1-2 months before it begins to clear. This happens with many other acne treatments.
Can affect your eyesight, hair, muscles, or joints: While taking isotretinoin, you may develop:
Trouble seeing at night (night blindness)
Thinning hair
Muscle (or joint) pain
These side effects are temporary: When you stop taking isotretinoin, these side effects tend to go away. If you experience thinning hair, your hair should grow back.
Other possible side effects: When taking isotretinoin, other concerning side effects may occur. These include:
Rash
Stomach problems
Unhealthy cholesterol levels
If you develop any of these side effects, contact your dermatologist.
Uncommon side effects include:
Increasing pressure on the brain, which can lead to problems with your eyesight, permanent loss of eyesight, and, in rare cases, death.
Liver damage
While you’re taking isotretinoin, your dermatologist will monitor you closely. That’s why patients need certain tests like pregnancy tests and blood tests.
Side effects: What we need to learn
While some people have reported the following serious side effects, we don't have enough evidence to know whether isotretinoin is linked to or can cause the following:
Depression
Thoughts of committing suicide
Inflammatory bowel disease (IBD)
Researchers continue to study isotretinoin and possible side effects
Dermatologists use findings from this research to help their patients decide whether to take isotretinoin and to watch their patients for signs of side effects.
What we do know: It’s possible that having severe acne increases the risk of developing these side effects. Research shows that people who have severe acne can become depressed. This is true for people who take isotretinoin and for those who don't. Some people who have severe acne 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.
When a patient with acne develops depression, dermatologists take this seriously. They are trained to spot warning signs that a patient could be depressed. Before prescribing isotretinoin, dermatologists also screen patients carefully for possible signs of depression and thoughts of suicide. This helps them determine if the medication is a good option for you.
Researchers have also studied the connection between acne and IBD. While some studies suggest that taking isotretinoin may increase the risk of developing IBD, other studies have not found this to be true.
To find out whether this medication can cause IBD, researchers continue to study this possible side effect. This research takes time. Researchers have to account for many considerations. For example, it's possible that the genes which increase your risk of having severe acne also increase your risk of developing IBD.
Dermatologists monitor each patient
Before prescribing isotretinoin, your dermatologist will talk with you about your acne and give you information about isotretinoin. This can help you decide whether this medication is right for you.
If you and your dermatologist decide that isotretinoin is the right treatment, your dermatologist will watch for warning signs of side effects. You will meet with your dermatologist every 30 days, either in-person or through telemedicine. This allows your dermatologist to check in with you to see how you’re doing. If all is well, your dermatologist can write another 30-day prescription for isotretinoin.
Writing a new prescription every 30 days is a safeguard that helps protect your health. In the United States, a doctor can only prescribe isotretinoin for 30 days. To get another prescription, you need to check in with your dermatologist.
During your check-ins, tell your dermatologist how you feel, 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.
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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, Last accessed December 2021.
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 isotretinoin 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.
Last updated: 9/12/23