Isotretinoin: What You Need to Know Before Starting
Isotretinoin is one of the most effective medicines for severe, scarring, or treatment-resistant acne. It can clear acne that didn’t respond to topicals or antibiotics, but it’s powerful—and it comes with rules. If you’re considering isotretinoin, this quick guide explains how it works, key risks, and simple steps to make treatment safer and easier.
How isotretinoin works and who it's for
Isotretinoin shrinks oil glands, cuts oil production, and reduces the bacteria and inflammation that cause acne. Doctors usually reserve it for nodulocystic acne, widespread inflammatory acne, or acne that risks scarring. Typical treatment lasts about 4–6 months; daily doses often fall between 0.5 and 1 mg per kg of body weight. The goal is a cumulative dose around 120–150 mg/kg, but your doctor may adjust based on response and side effects.
Side effects, monitoring, and practical tips
Expect dryness first: chapped lips, dry skin, and dry eyes are the most common effects. You may also see rises in blood lipids and liver enzymes, so providers usually check baseline blood tests (lipids, liver function) and repeat them during treatment. Serious risks include birth defects—isotretinoin is highly teratogenic—so anyone who can become pregnant must follow strict pregnancy prevention rules: reliable contraception, negative pregnancy tests before and during treatment, and regular follow-ups.
Mental health changes are reported by some people. If you notice new or worsening depression, mood swings, or suicidal thoughts, contact your prescriber right away. Avoid donating blood while on isotretinoin and for at least one month after stopping.
Drug interactions and safety tips: don’t take vitamin A supplements while on isotretinoin (it adds to the toxicity). Avoid tetracycline antibiotics at the same time because of a rare risk of increased brain pressure. Limit alcohol—both can affect your liver and lipids. Waxing, chemical peels, and laser treatments can irritate skin while you’re on the drug, so check with your dermatologist before cosmetic procedures.
Everyday care makes a big difference. Use a gentle cleanser, a rich moisturizer, and broad-spectrum sunscreen daily—sunburn risk can rise because skin gets thinner and more sensitive. For dry lips, petroleum jelly or a thick lip balm helps. If your skin peels, reduce active skincare ingredients (retinoids, AHAs, high-concentration benzoyl peroxide) until irritation eases.
Alternatives exist: topical retinoids, oral antibiotics, hormonal therapies for women (combined oral contraceptives or spironolactone), or procedures like light/laser treatment. Those can work well for many people but may not control severe nodular acne the way isotretinoin can.
Talk openly with your dermatologist about goals, risks, and monitoring. If you follow the rules—blood tests, contraception if needed, and skin care adjustments—many people finish a course and enjoy long-term improvement or clearance. Ask questions and check in regularly; this medicine works best with a clear plan and honest follow-up.
