skip to Main Content
Clear Skin Is Possible At The Dermatology & Skin Surgery Center Of Wilmington

Isotretinoin: The Cure for Severe Acne

Do you feel as if you’ve tried every acne treatment imaginable, but still suffer from persistent breakouts? Severe acne is a painful condition, both physically and mentally, but you don’t have to continue to suffer. If you’ve tried acne washes, topical creams, diet changes, and more but still haven’t achieved clear skin, it may be time to consider isotretinoin, commonly called Accutane.

This month, we’re exploring what isotretinoin is, how it works, who is a good candidate, the iPledge program, and much more.


What is Isotretinoin (Accutane)?

Isotretinoin is the generic name for Accutane, a prescription medicine used to treat severe acne that is cystic, nodular, deep, scarring, and long-lasting. Since the brand name version is no longer produced, all patients use the generic isotretinoin, which has the same efficacy as the original. It is currently the most effective acne treatment available to patients, and, in most cases, it clears acne that has not responded to other treatments.

Isotretinoin is an oral synthetic vitamin A derivative. The high dose of vitamin A shrinks oil glands so that they produce less pore-clogging sebum (oil). It also reduces cell shedding and the stickiness of cells in the hair follicles so that they don’t hang around and clog pores. A dermatologist determines the proper dose of isotretinoin for each individual based on the person’s height, weight, and acne severity.


Who is a Good Candidate for Accutane?

Good candidates for isotretinoin are people who have tried other treatments with little or no success, and those who have cystic and nodular acne that leaves scars. Women who wish to use isotretinoin must not be pregnant and or become pregnant while taking the medication because it is known to cause severe birth defects.

During the treatment, some patients may experience a temporary worsening of their acne symptoms, called a “purge,” though the majority of patients do not experience this side effect. The entire course of treatment typically lasts four to six months. Your dermatologist will determine the duration of treatment that you should follow depending on the severity of your acne and how well you tolerate the medicine.


What is the iPledge Program?

There are health risks associated with using isotretinoin, so every patient who uses the medication must participate in the iPledge program. The goal of the program is to ensure that all patients are using the medication safely and that women who are using isotretinoin do not become pregnant while taking it.

Each month before filling your prescription, you will need to log into the iPledge website and answer a series of questions about how to take isotretinoin correctly. Your dermatologist and pharmacist also register with iPledge and must use the program to okay your prescription before you can fill it each month.

Women must use two forms of birth control while taking isotretinoin. They also need to have two negative pregnancy tests before they can begin treatment. The first will be one month before starting treatment, and the second will be in the month that you begin. Each subsequent month, women must continue to test negative for pregnancy. Your dermatologist will enter the negative result in iPledge so that your pharmacist can fill the prescription.

Patients who use isotretinoin must not donate blood while taking the medication. Isotretinoin can increase a patient’s levels of cholesterol and triglycerides, as well as cause abnormal liver enzymes, therefore you may need to have routine blood tests to ensure you’re tolerating the medicine well.


Side Effects of Isotretinoin

Most people who use isotretinoin experience minor side effects, but the symptoms go away after completing treatment. The majority of patients feel that the benefits outweigh the minor downsides, especially with countermeasures such as a thick moisturizer, a great lip balm, and sunscreen suitable for sensitive skin. Common side effects include:

  • Dry or cracked lips
  • Dry skin
  • Dryness inside the nasal cavity and nosebleeds
  • Dry eyes – some patients may not tolerate contacts well while taking isotretinoin
  • Peeling on the palms and soles of the feet
  • Sensitivity to the sun – the daily use of sunscreen is essential; avoid sun exposure as much as possible
  • Thinning hair


Some patients benefit from taking a lower dose of the medicine in the first month of treatment to reduce the intensity of the side effects.

Severe side effects are possible, but very rare. You should alert your dermatologist right away if you experience any of the following:

  • Mood changes or thoughts of suicide – this occurs in less than 1% of patients, and the research is mixed on whether isotretinoin is responsible. Many parents worry about this with their teens, so monitor them closely and let your doctor know right away if you suspect mood changes.
  • Headaches
  • Joint, back, or muscle pain
  • Loss of bone density


Patient Precautions

While taking isotretinoin, we can’t emphasize enough that women should take every precaution to prevent pregnancy. Women should also refrain from breastfeeding while on the medicine as it may pass to the baby.

All patients should avoid waxing, laser, and dermabrasion treatments while on isotretinoin and for at least six months after. While taking the medication, the skin becomes thinner and more sensitive, so these treatments can cause scarring if done too soon.

Patients should also avoid drinking alcohol, especially to excess, while taking isotretinoin because it can cause an elevation of liver enzymes.


Isotretinoin Results

Every person is unique and will respond to treatment differently, so success varies from person to person. At least 50% of patients never need to treat their acne again. Some people may need a second round of isotretinoin, while others need nothing more than a mild product, such as Retin-A or an over-the-counter salicylic acid or benzoyl peroxide cream.

One benefit of taking isotretinoin is that, afterward, your skin often responds better to conventional acne therapies such as OTC creams or mild prescription medicines.

By the end of treatment, 85% of patients are completely clear. Most patients continue to experience improvements after concluding treatment, as the medicine stays in your body for about a month after your last dose.


Is Isotretinoin the Right Acne Treatment for You?

Should you take isotretinoin? That’s a decision that you and your dermatologist should make together. There’s a lot of misinformation about isotretinoin that makes it sound scary, but it’s a well-tolerated treatment that has completely transformed the lives of many acne sufferers.

If you’re interested in learning more about isotretinoin and whether it’s the right acne treatment for you, schedule an appointment with one of our dermatologists today.


Contact the Dermatology and Skin Surgery Center of Wilmington when you’re ready to take control of your acne. Since 2001, Skin Surgery Center’s fellowship-trained Mohs surgeons and board-certified dermatologists have provided patients with exceptional treatment outcomes. Book your appointment today.

Contact Us

Back To Top