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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. 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

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

  • Severe birth defects

  • Miscarriage

  • Stillbirth

Prevent this side effect: 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 must also agree that while taking this medication, they 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 that this side effect is temporary: When you start taking isotretinoin, acne can worsen for 1-2 months before it begins to clear. This happens with many other acne treatments.

While taking isotretinoin, you may develop:

  • Trouble seeing at night (night blindness)

  • Thinning hair

  • Muscle (or joint) pain

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

Other possible side effects: When taking isotretinoin, other concerning side effects may occur. These include:

  • Rash

  • Stomach problems

  • Unhealthy cholesterol levels

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

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 serious side effects:

  • Depression

  • Thoughts of committing suicide

  • Inflammatory bowel disease (IBD)

Illustration of doctor sharing research results
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, and this has to be carefully considered.

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. 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, isotretinoin can only be prescribed 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.

Related AAD resource

Getty Images

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 isotretinoin treatment (SA).” 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: 12/3/20