Is Accutane Worth It for Treating Acne?

Isotretinoin is effective for severe cystic acne, but it's important to know the side effects

An Asian girl looks at severe acne on her cheek in a compact mirror.


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Accutane (isotretinoin) is an effective medication for severe, hard-to-treat acne. But, concerns about serious possible side effects—including mental health problems and severe birth defects—keep some parents from considering it as an option for their teenagers.

Whether Accutane is worth it is a decision that only you and your dermatologist can make together. On one hand, about 50% of people who complete a course of Accutane will never need acne treatment again. On the other, side effects are common, and your dose may need to be adjusted to reduce side effects while maintaining effectiveness.

This article explains how Accutane works and the side effects it can cause. It also covers the requirements you will need to follow while using Accutane in order to prevent serious side effects.

Illustration shows progression of acne severity from blackheads through cysts and nodules.

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What Is Accutane?

Accutane (isotretinoin) is a medication used to treat severe or nodular acne that doesn't improve with other treatments. This drug is for people who've tried many other acne treatments without success, including oral antibiotics and multiple topical medications.

Accutane was formerly a popular brand name of isotretinoin that's no longer being sold. However, some people still refer to isotretinoin as Accutane.

Along with the generic form, brands that are currently available in the U.S. include:

  • Absorica
  • Amnesteem
  • Claravis
  • Myorisan
  • Zenatane

Accutane is a powerful drug, but isotretinoin is also a naturally occurring component of vitamin A, an essential vitamin that you get from your diet. Large doses of vitamin A supplements can have the same effects as isotretinoin drugs—and that goes for the dangerous side effects as well as the positive effects.

Despite side effect concerns, isotretinoin is sometimes preferable to taking antibiotics long-term, which comes with its own set of negative consequences—including antibiotic resistance.

How Does Accutane Work?

Isotretinoin is an oral medication that comes in capsule form. The drug works systemically, meaning that it circulates through the bloodstream, targeting multiple acne-affected areas of the body at the same time (e.g., the face and upper back).

Isotretinoin is the only medication that effectively targets all four causes of acne. The medication:

  • Shrinks the sebaceous glands and makes them produce less oil in your skin
  • Prevents pores from clogging
  • Reduces acne-causing bacteria Propionibacterium acnes (P. acnes) on the skin
  • Reduces skin inflammation

Most people take this drug for four to six months. Some people need to take it for an additional four to six months to see an improvement.

1:30

Click Play to Learn More About Isotretinoin for Acne

This video has been medically reviewed by Casey Gallagher, MD

Benefits of Accutane

Accutane is the single most effective drug for treating severe acne that hasn't responded to other treatments. It treats all types of acne, including cystic and nodular acne, along with the pain and inflammation that come with them. Accutane may also prevent acne scars.

After using isotretinoin:

  • Some people have slightly worsening acne, especially when starting to use this medication.
  • Rarely, some people have much worse acne during or after using this drug.
  • Most people get much better permanently or make temporary improvements.

The benefits of Accutane go beyond improvements in acne. Multiple studies have shown that when the drug is successful, it can also lead to improvements in self-esteem and quality of life.

How long does it take for Accutane to clear acne scars?

Accutane doesn't have any effect on existing acne scars. However, some of the red and brown spots on your skin will clear up as your acne heals. A few months after you finish treatment with isotretinoin, your dermatologist can assess any scars that you have and talk to you about your treatment options.

Side Effects of Accutane

The most common side effects of isotretinoin include:

  • Red, cracked, and sore lips
  • Dry skin, eyes, mouth, or nose
  • Nosebleeds due to dry nasal passages
  • Peeling skin, especially on the palms and soles
  • Joint and muscle pain
  • Temporary thinning of hair

Less common but more serious side effects can include:

  • Headache, stomach pain, and/or chest pain
  • Vision problems
  • Reduced night vision
  • Dizziness
  • Nausea and vomiting
  • Seizures
  • Difficulty swallowing or pain when swallowing
  • Jaundice
  • Impaired wound healing
  • Muscle weakness
  • Difficulty hearing or ringing in the ears
  • Painful or constant dryness of the eyes
  • Fainting
  • Fast or pounding heartbeat

Risk of Mental Health Problems

Although successful treatment with Accutane is linked to improvements in quality of life, the drug is known to trigger severe and potentially even life-threatening side effects.

Rare but possible mental health effects include:

The link to psychiatric side effects is very controversial, and the research results are still not completely clear about this association. The mental state of people taking this drug should be closely monitored by doctors and parents/guardians should be on alert for any mood or behavioral changes.

If you are having suicidal thoughts, dial 988 to contact the 988 Suicide & Crisis Lifeline for support and assistance from a trained counselor. If you or a loved one are in immediate danger, call 911. For more mental health resources, see our National Helpline Database.

Risk of Birth Defects

A high risk of birth defects is also a big concern, enough that there's a very strict protocol for preventing pregnancy in anyone taking this drug.

Possible effects can include:

Specific birth defects that are linked to isotretinoin include:

  • Deformities of the skull, ears, eyes, or face
  • Cleft palate
  • Central nervous system abnormalities
  • Brain malformation
  • Hydrocephalus (fluid buildup in the brain)
  • Microcephaly (abnormally small head)
  • Cranial nerve deficits
  • Heart defects
  • Kidney, thymus gland, and parathyroid gland abnormalities

If someone taking any form of isotretinoin becomes pregnant, the drug must be discontinued immediately and the pregnancy should be evaluated by an obstetrician experienced in reproductive toxicity.

Accutane in Semen

It's likely that small amounts of isotretinoin are present in the semen of males taking this drug. It's unknown whether this may harm a fetus, but conception should be avoided. If a pregnancy does occur, the female's doctor should be notified immediately about the possibility of isotretinoin exposure.

What Are the Requirements Before Prescribing?

You should only consider Accutane if you meet all of the following criteria:

  • Your acne is severe enough to leave scars.
  • You have had acne for several years.
  • Your acne hasn't adequately improved with antibiotic pills or topical treatments.

Isotretinoin is not an easy medication to get, as it is marketed under a special "restricted distribution program" to help reduce the risk of side effects. Prescribers, patients, and even pharmacies must be registered with the FDA-approved iPLEDGE program.

Requirements include:

  • A new prescription for isotretinoin each month
  • Not donating blood while taking isotretinoin and for 30 days after your last dose

Anyone who can become pregnant is required to:

or

  • Commit to 100% abstinence from one month prior to starting isotretinoin until one month after the last dose

The iPLEDGE program recommends appropriate contraception decisions be made rather than a pledge of abstinence for anyone who is or has been sexually active, even if they don't currently have a partner.

Certain birth control pills, including the progesterone-only mini-pills, are not considered an acceptable form of birth control under the iPLEDGE program. Neither is using an internal condom or the rhythm method.

Who Shouldn't Take Accutane?

You should not take Accutane if:

  • You can control your acne with other treatments.
  • There is a chance that you could become pregnant.
  • You or an immediate family member has a history of severe depression.

Do not get pregnant while on Accutane. If you are not willing to follow iPledge mandates for using two birth control methods, taking monthly pregnancy tests, or abstaining from intercourse entirely, then Accutane is not for you.

How to Decide if Accutane Is Worth It?

To decide if Accutane is worth it, it helps to:

  • Consider the facts: Learn everything you can about isotretinoin and ask your dermatologist questions if you are unsure about something. Make sure you are aware of all the benefits and side effects.
  • Compare your options: Weigh the pros and cons of taking Accutane versus using a different treatment instead. You may find that writing out lists for both sides helps.
  • Sit with your feelings: Ask yourself what matters most to you. Do you feel it is more important to resolve your acne, or to find a medication that has a lower risk of side effects? Do you feel okay with using two forms of birth control, or would you rather avoid that?

If you are having trouble answering some of these questions, you may want to consult with a dermatologist and ask about alternatives to Accutane as well.

Alternatives to Accutane

Other possible alternatives to Accutane include:

  • Topical retinoids, such as Retin-A (tretinoin), Tazorac (tazarotene), and Differin (adapalene)
  • Oral antibiotics
  • Oral contraceptives plus spironalactone (females only)
  • Corticosteroid injections
  • Surgical removal for large or painful cysts or nodules
  • Chemical peels
  • Laser and light therapies

Some doctors may recommend one or more of these treatments in addition to isotretinoin, as well. Remember that it can take several weeks for isotretinoin to start showing results.

Summary

Isotretinoin is the strongest and most effective acne medication available. It is so powerful that 50% of people who complete a course of Accutane will never need an acne treatment again. Isotretinoin is only prescribed for severe acne that does not respond to other treatments, as it is associated with a high risk of side effects. Most people who use it will experience dry skin and lips. Although rare, the drug is also linked to depression and suicidal thoughts.

Using Accutane when pregnant will result in birth defects. If you do choose to take this drug, you will need to use two forms of birth control or abstain from sex until your course is complete. If you have any questions about Accutane, talk to your dermatologist.

15 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
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Additional Reading

By Vincent Iannelli, MD
 Vincent Iannelli, MD, is a board-certified pediatrician and fellow of the American Academy of Pediatrics. Dr. Iannelli has cared for children for more than 20 years.