Doctor’s Note: Your Easy + Essential Guide to Accutane
As dermatologists, we often recommend Accutane for patients with severe acne that hasn’t improved with other treatments. While it’s known for strong results, it can also have side effects. In this guide, we’ll cover everything you need to know about Accutane.
Watch the video summary to the right, or read on for more info!
What is Accutane?
Accutane, also known as isotretinoin, is a prescription medication designed to treat severe, stubborn acne. It’s often used when other treatments, like topical creams or antibiotics, haven’t worked. Accutane reduces oil production in the skin by shrinking the size of oil glands. This means there’s less oil to clog pores, which helps reduce acne and prevent new breakouts.
Accutane can provide long-lasting, sometimes permanent, acne relief, which is why it’s used as a last-resort option. However, because of its strength, it requires careful monitoring and adherence to specific safety protocols, such as the iPledge Accutane program, which helps prevent pregnancy-related risks during treatment.
"Accutane" was the original brand name for the generic medication “isotretinoin”. The brand name is no longer used, but people still refer to it as “Accutane” because it's widely recognized!
How Does Accutane Work?
Accutane is part of a family of skincare ingredients known as retinoids, which are all derived from Vitamin A. Retinoids include a range of treatments like retinol and tretinoin, commonly used to improve skin texture, reduce acne, and boost cell turnover. Retinol, found in many over-the-counter products, works more gently on the skin and can help with mild acne and signs of aging. Tretinoin, a stronger retinoid, is available by prescription and is often used for moderate acne and skin renewal.
Accutane (isotretinoin) is the most powerful retinoid, designed specifically for severe acne. Unlike other retinoids applied to the skin, Accutane is taken as a pill, allowing it to work from the inside out, reducing oil production and acne more intensely than topical treatments. Accutane works by:
Reducing Oil Production: Accutane shrinks oil glands, which leads to less oil and fewer clogged pores.
Calming Inflammation: It has anti-inflammatory effects that can reduce swelling and redness, which are common in severe acne.
Speeding Skin Cell Turnover: Like other retinoids, Accutane encourages the shedding of dead skin cells, helping to keep pores clear.
Fighting Bacteria: Accutane limits the growth of acne-causing bacteria on the skin.
These combined effects make Accutane one of the most effective treatments for severe acne, including cystic acne, but it comes with some potential side effects and requires consistent monitoring.
What Does Accutane Treat?
Accutane is primarily prescribed for severe acne that hasn't responded to other treatments. It’s also used for stubborn hormonal acne. Also, low-dose accutane can be effective for acne rosacea (AKA “papulopustular rosacea”).
Severe Acne
Accutane is most commonly used for severe, cystic acne that hasn't responded to other treatment.
Hormonal Acne
It can also be effective for hormonal acne, helping to regulate oil production and reduce breakouts.
Rosacea
Accutane can be an effective treatment for acne-rosacea (AKA “papulopustular rosacea”).
What to Expect During Treatment
Accutane treatment usually lasts between 4 to 6 months. Treatment begins with a lower dose, which may be adjusted depending on tolerance and results. Some patients use a low dose of Accutane as an ongoing treatment if their acne is less severe but persistent. Here’s what to expect:
Consultation and Testing: Before starting, patients meet with a dermatologist. Blood tests check liver function and cholesterol, and female patients must have a negative pregnancy test, as Accutane can cause severe birth defects.
The First Month (and Accutane Purge): Many people experience an initial breakout, known as the “Accutane purge,” where acne temporarily worsens. This phase can be frustrating, but it often indicates that Accutane is working. The purge typically lasts a few weeks to a month, depending on the person.
Monthly Follow-Ups: Throughout treatment, patients have regular check-ups to monitor progress and adjust the dose if needed. Females also undergo monthly pregnancy tests as part of the iPledge Accutane program.
End of Treatment: At the end of the course, many patients experience long-term acne improvement. Some may need a second course, but this is less common.
There are very different requirements for patients who CAN get pregnant (ie menstruating patients) and patients who CANNOT get pregnant (men, transgender women, post-menopausal women). Let’s get into some differences!
Typical Accutane Course if You CAN Get Pregnant:
Menstruating Women + Transgender Men
Additionally, if you CAN get pregnant, you must be on two forms of birth control: a primary and a secondary. These are the choices for birth control:
Typical Accutane Course if You CANNOT Get Pregnant:
Men, Transgender Women, Post-Menopausal Women
You have fewer requirements that patients who can get pregnant.
For Men: We know that women should not get pregnant on Accutane, but is it okay to get your partner pregnant on this medication? The answer is unclear. A very small amount of Accutane will be in your semen. It is not known if this small amount of Accutane may harm the baby if your partner is or becomes pregnant.
Dry Skin and Lips: Dryness is very common. Many people rely on moisturizers and lip balms to keep skin comfortable.
Sun Sensitivity: Accutane can make skin more sensitive to the sun, so sunscreen is essential.
Muscle and Joint Aches: Active individuals may notice muscle or joint pain while on Accutane.
Mood Changes: Some people report mood shifts. If this happens, speak with your doctor.
Changes in Blood Tests: Accutane can raise cholesterol and liver enzyme levels, which is why blood tests are regularly done.
What Are Accutane Side Effects?
Accutane can lead to a range of side effects, from mild dryness to more severe changes. Here are some of the more common side effects:
Things to Avoid on Accutane
Certain activities or products should be avoided while on Accutane to reduce risks:
Alcohol: Accutane affects the liver, so it’s best to avoid alcohol to prevent further strain.
Vitamin A Supplements: Because Accutane is a form of Vitamin A, extra supplements can increase the risk of side effects.
Waxing or Laser Treatments: Skin is more sensitive on Accutane, so avoid these treatments to prevent irritation or scarring.
Pregnancy: Accutane can cause birth defects. The iPledge Accutane program requires two forms of birth control during treatment for women of childbearing age.
Accutane Pill Info
When you take an Accutane pill, take it with something fatty (peanut butter, eggs, etc). It will absorb better. If you take it on an empty stomach, you will not absorb the medication and just poop it out.
Also, please keep in mind (at least for US patients) that Accutane pills can be quite expensive. See some representative prices to the left. These are monthly prices for Accutane, and the typical Accutane course is ~6 months.
After Accutane, I Will Never Get Acne Again… Right?
…Not exactly. While many people think Accutane is the “cure” for acne, that’s not quite the case.
Research tells us that ~20% of patients experienced acne recurrence within three years after completing a course of Accutane. Some patients just need the help of additional topicals or antibiotics. About 4 in 10 do not have acne ever again!
Despite it not working 100% all the time for everyone, Accutane is still the next best thing we have to a “cure.”
Frequently Asked Questions About Accutane
Can you drink on Accutane?
It’s best to avoid alcohol while on Accutane because both affect the liver. Drinking may increase the risk of liver problems.
Does Accutane cause weight gain?
Weight gain is not a known side effect of Accutane. If you experience any unexpected changes, talk to your doctor.
How long does Accutane stay in your system?
Accutane stays in the body for about one month after the last dose. This is why certain precautions, like pregnancy avoidance, must continue even after treatment ends.
How to get on Accutane?
Start by consulting a dermatologist. They’ll evaluate your acne and determine if Accutane is right for you, explaining the iPledge requirements and any necessary tests.
Is Accutane covered by insurance?
Accutane is often covered by insurance when prescribed for severe acne, but coverage varies. Check with your provider for specific details.
Is 40 mg Accutane a high dose?
A 40 mg dose is a moderate dose for Accutane, though doses can range from lower (10-20 mg) to higher (up to 80 mg), depending on the severity of acne and patient tolerance.
Is 80 mg of Accutane a high dose?
Yes, 80 mg is considered a high dose and is generally reserved for those with very severe acne or those who haven’t responded to lower doses.
Does Accutane help with scars?
Accutane primarily treats active acne, not scars. However, by reducing breakouts, it may prevent new scars. Treatments like tretinoin after Accutane or other scar-specific therapies can help improve existing scars.
Can Accutane help with lichen plano pilaris?
Accutane is not typically used for lichen plano pilaris, a condition involving hair follicle inflammation. However, some dermatologists may consider it in unique cases.
Can you take fluticasone with Accutane?
Generally, yes. Fluticasone is a topical steroid, often used for inflammation, and does not interfere with Accutane, but always check with your dermatologist.
What does tretinoin do after Accutane?
Tretinoin can be used after Accutane to maintain clear skin, encourage cell turnover, and help with mild scars or texture issues.
Accutane Alternatives
For those who can’t take Accutane, there are other options, such as oral antibiotics, hormonal treatments, and light therapy. These alternatives may work well for some but are generally less potent than Accutane.