Considering Accutane? Here’s What You Should Know

Written by Quynh-Giao Sartor, MD, Board Certified Dermatologist on October 25, 2022 2 Comments


Accutane, known generically as isotretinoin, is a highly effective oral prescription medication for treating moderate to severe acne. This medication is a vitamin A derivative that minimizes oil production, promotes the shedding of dead skin cells, and reduces inflammation – which ultimately treats and prevents acne formation at a cure rate of 95% after the first course. It is available in multiple brand names, including Absorica, Zenatane, Claravis, Amnesteem, and Myorisan.

Although Accutane is the closest thing to a cure for acne, it can cause a number of side effects that patients should be aware of before starting this medication.

You Must Be The Right Candidate For Accutane

Once reserved as a last resort for those with severe, scarring, nodulocystic acne that is recalcitrant to other treatments, Accutane has become more commonly used in dermatology. Accutane is now indicated for moderate or even mild acne that is stubborn to other topical or oral treatments. The best Accutane candidate is compliant and understanding of the risks and side effects of Accutane so that they may prepare themselves for the treatment course.

You Must Register With iPledge

Because of its risks and potential side effects, isotretinoin is heavily regulated in the United States and requires registration with the iPledge Program. The iPledge Program is a national database that monitors who has been on and who currently remains on Accutane; it is able to confirm that the Accutane candidate understands the medication risks and further track their ongoing compliance with the iPledge Program requirements.

Periodic Blood Tests May Be Required

Accutane is metabolized through the liver and can disrupt one’s blood cholesterol and liver function enzymes. A baseline blood check is universally required prior to starting Accutane, so that the Accutane candidate’s baseline liver and cholesterol health may be assessed. Any persons who are child-bearing must have a pregnancy test done monthly.

After one begins Accutane, their dermatologist may choose to recheck bloodwork after two months. At two months of being on Accutane, one could expect mild elevation in blood cholesterol or liver enzymes. After two months, any changes in blood work tend to stabilize or improve. Any additional monthly bloodwork could be ordered per the discretion of the dermatologist. If the patient and dermatologist provider elect not to check bloodwork monthly, then any child-bearing patients must still have a urine pregnancy test checked at every office visit.

You Cannot Use Accutane While Pregnant

If taken during pregnancy, Accutane can lead to severe birth defects that permanently disfigure the child. Because of this, all Accutane patients who are child-bearing must take two pregnancy tests, spaced 30 days apart, before they can receive the prescription for Accutane. Child-bearing patients must also agree to use two forms of birth control 30 days before starting, during, and 30 days after stopping Accutane. Pregnancy, contemplation of pregnancy, non-compliance with contraception and breastfeeding are contraindications to Accutane.

Here’s a list of other skin care ingredients or products that should be avoided while pregnant.

You Might Have to Change Your Diet

Due to the risk of Accutane worsening cholesterol levels and causing liver stress and elevated liver enzymes, the dermatologist may ask the Accutane candidate to reduce their dietary intake of foods rich in sugars, carbohydrates, or cholesterol. Reducing alcohol intake also alleviates liver stress during the Accutane course.

Your Acne Might Get Worse Before It Gets Better

Some patients experience an increase in breakouts, otherwise known as a “purging period”, soon after starting Accutane. To mitigate the risk of a purge, many dermatologists will start patient on topical retinoids such as tretinoin or oral medications such as antibiotics.

Your Skin Is Going To Feel Dry

Accutane significantly suppresses skin oil production, which results in dryness in areas dense in area glands such as the lips and perioral skin. This dryness can be alleviated by applying emollients recommended by one’s dermatologist to the affected areas.

Side Effects May Include Muscle Aches And Upset Stomach

Although less common, side effects can include joint and muscle aches and, on rare occasions, stomach aches. The musculoskeletal side effects typically occur in those with active lifestyles, including runners and body builders. Stomach aches and cramps will usually lead to the dermatologist ordering a follow-up set of bloodwork to check on the Accutane patient’s liver function and cholesterol levels.

Depression And Suicidal Thoughts, While Not Common, Are Possible

When Accutane first received FDA approval in the 1980’s, it was plagued by a myth that it led to depression and suicide. Studies have not supported this. In fact, many patients feel their mental health improve after their acne has improved from the Accutane.

That said, several anecdotes have reported patients experiencing depressed or suicidal thoughts while taking the medication. If predisposed to depression, it is recommended to discuss with a dermatologist the risk of worsening mood symptoms while on Accutane.

You May Be On Accutane For A While

An Accutane course typically takes six to nine months to fully complete, although many patients requiring a longer treatment length. The exact length of treatment will depend on one’s clinical improvement and tolerance of side effects. Questions about one’s treatment course may be best addressed with a dermatologist.

What To Expect When You Stop Taking Accutane

After completion of the Accutane course, one should expect any side effects to completely subside within 30 days. The Accutane remains in one’s system for 30 days after the last capsule is taken, so it is recommended for child-bearing patients to continue two forms of contraception for 30 days after completing Accutane.

In general, Accutane is the best treatment for acne, particularly scarring acne refractory to other treatment options. It offers a 95% effectiveness rate, for which 95% of patients who complete the course will not have acne again. A minority of patients, approximately 5%, may have an acne recurrence and need to repeat their Accutane course later in life.

Other Accutane Resources

Quynh-Giao Sartor, MD

Quynh-Giao (QG) Sartor, MD is a Board Certified Dermatologist who obtained a Medical Doctorate and completed her internal medicine internship and dermatology residency at Baylor College of Medicine (BCM) in Houston. Dr. Sartor’s professional expertise includes medical dermatology as well as in-office cosmetic and surgical procedures. Dr. Sartor is passionate about connecting with patients, practicing open communication, and customizing a personalized plan for her patients.

2 Responses to “Considering Accutane? Here’s What You Should Know”

  1. Avatar Diane says:

    My cholesterol level is 219. I am wondering if I am a candidate for Accutane?

    • WD Staff WD Staff says:

      Hi Diane,

      Thanks for your great question. I pass it along to Dr. Sartor and she said your candidacy will depend on what your baseline cholesterol typically runs and depends as well as your family history.

      Your best bet would be to see a Board Certified Dermatologist for an in office consultation. Please feel free to give us a call at 512-328-3376!

      WD Staff

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