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.

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.

• 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

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)

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

• Isotretinoin: Overview

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References
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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: 12/3/20