Isotretinoin: What You need to know before starting

Isotretinoin is a very strong oral medicine used for severe acne that doesn't respond to other treatments. It can clear cysts and nodules and often gives long-term improvement, but it also carries serious risks. Read practical facts so you can talk to your doctor with confidence.

How it works: isotretinoin shrinks oil glands, lowers oil production, and reduces the bacteria and inflammation that cause severe acne. It is related to vitamin A but is much more potent. Because it changes the skin and body chemistry, it needs careful monitoring.

Who is a candidate

Dermatologists usually recommend isotretinoin for nodulocystic acne, widespread scarring acne, or when antibiotics and topical treatments fail. If you have mild acne, other options are safer. Your doctor will weigh benefits against risks like birth defects, mood effects, and blood test changes before starting therapy.

Major risks and common side effects

The single biggest risk is severe birth defects—never take isotretinoin if you are pregnant or planning to become pregnant. Common side effects include very dry lips and skin, nosebleeds, dry eyes, and increased sensitivity to the sun. Less common but important risks are raised cholesterol and liver enzymes, and mood changes. You should not donate blood while on the drug and for a month after stopping.

Monitoring is mandatory. Most programs require two negative pregnancy tests and use of two contraception methods for people who can get pregnant. Doctors check liver tests and lipid panels before starting and during treatment, usually after one to two months and periodically after that. Follow-up visits also track skin response and side effects.

Dosing varies by weight and acne severity. Typical daily doses range from low (0.25 mg/kg) to standard (0.5–1 mg/kg). Treatment often continues until a cumulative dose is reached, commonly around 120–150 mg/kg, or until the dermatologist decides the skin has improved enough. Shorter or longer courses happen based on response and tolerance.

Practical tips: use heavy moisturizers and frequent lip balm, apply sunscreen daily, avoid harsh scrubs or waxing while skin is thin and fragile, and tell your doctor about mood or sleep changes right away. Don't take extra vitamin A or fish oil without asking; some supplements can increase risk. Avoid mixing with tetracycline antibiotics because of rare, serious brain pressure effects.

Keep records of prescriptions and lab results, and report any unusual pain, persistent headaches, vision changes, or severe stomach pain to your clinic immediately for evaluation and treatment.

Be cautious buying online. Legitimate isotretinoin requires a prescription and ideally a telehealth visit linked to a certified program. Fake or unverified sellers can deliver counterfeit pills that harm you. If cost is an issue, ask your clinic about generic options, patient assistance, or prescription coupons.

Alternatives include strong topical retinoids, oral or topical antibiotics, hormonal treatments for people with menstrual cycles, and procedural options like chemical peels and light therapy. For many with severe, scarring acne, isotretinoin remains the most effective choice. Talk openly with your dermatologist about goals, risks, and the monitoring plan before you start.