Accutane (isotretinoin) is a brand name medication indicated for the treatment of acne. It works by reducing the size and activity of the sebaceous glands and improving skin health and appearance.

Accutane is generally recommended by dermatologists for acne that does not improve with the use of other treatments. Results are usually seen about 8 to 16 weeks after starting treatment.

Accutane is a prescription-only medication and should be used only as directed by a dermatologist. Women under the age of 55 (and anyone who can become pregnant) should sign a consent form acknowledging the risk of birth defects from taking Accutane while pregnant.

Accutane (brand name) is no longer available in the United States, however it remains available in other countries. Isotretinoin is still prescribed under its generic name as well as the brand name Absorica, among others.

close up of blister pack of yellow capsules

Indications for use

Accutane is indicated for the treatment of severe acne and acne that does not improve with the use of other acne treatments (such as antibiotics, ointments, and creams) or changes in skin care routine. Resolution of acne typically occurs following 16 to 24 weeks of treatment with Accutane.

Does Accutane shrink your nose?

Accutane does not shrink your nose, however it does promote cellular regeneration, making the skin appear finer and possibly giving the impression of a smaller nose.

Accutane also helps decrease inflammation of the sebaceous glands and may help in the treatment of rhinophyma, an inflammatory condition of the sebaceous glands that results in the formation of bumps and growths on the nose. By decreasing inflammation, Accutane may help the nose return to its original appearance and make it look smaller.

It is important to emphasize that Accutane is only indicated for the treatment of severe acne and should be used only as directed by a dermatologist.

Dosing instructions

Accutane capsules should be taken by mouth, with a full glass of water, during a meal, and at the times established by your doctor. If you forget a dose, skip that dose and take the next dose as scheduled. Do not take a double dose.

Doses of Accutane vary based on the severity of the condition. In most cases, the starting dose is between 0.5 and 1 mg per kg of body weight per day. In some cases, a doctor may increase the dose to up to 2 mg per kg of body weight per day.

Duration of treatment will depend on the daily dose and how long it takes to achieve full resolution of acne, which is typically around 16 to 24 weeks after starting treatment.

Side effects

The most common side effects that can occur from treatment with Accutane include:

Dry skin, eyes, and nose;
Difficulty seeing at night;
Conjunctivitis;
Blepharitis (inflammation of the eyelids);
Diarrhea;
Nausea and/or vomiting;
Headache;
Back pain;
Muscle or joint pain;
Stuffy nose;
Frequent sneezing;
Sore throat.

Acne may worsen during the first 7 to 10 days of treatment, however this usually improves over time without needing to change the dose.

While rare, Accutane can also cause serious allergic reactions that require immediate medical attention. It is important to stop taking Accutane and go to the nearest emergency department if you experience symptoms like difficulty breathing; cough; chest pain; a feeling like your throat is closing; swelling of the mouth, tongue, or face; urticaria; fever; burning of the eyes; or red or purple skin rash with blistering or peeling.

Can Accutane cause depression?

One of the side effects that has been reported with the use of Accutane is depression, which can present with symptoms like sudden changes in mood and behavior, crying fits, feelings of low self-esteem and self-worth, loss of interest in things you once enjoyed, difficulty sleeping, and thoughts of suicide or self harm.

Depression that occurs with Accutane primarily affects people with a history of depression, therefore it is important to tell your doctor about any symptoms of depression you may be experiencing so that treatment can be reevaluated or a referral placed to a psychiatrist or other mental health professional.

Contraindications to use

Accutane should not be prescribed for children less than 12 years of age and is contraindicated during pregnancy and lactation. People with liver failure, high cholesterol, high triglycerides, or excess vitamin A, as well as those being treated with tetracyclines, should not take Accutane.

Accutane should not be taken by people with an allergy to isotretinoin, soy, or parabens, which are preservatives found in Accutane capsules.

Accutane should not be taken during pregnancy due to the risk for serious birth defects involving the face, eyes, heart, and nervous system, which can happen from taking just a single dose. Accutane can also lead to miscarriage, premature birth, and stillbirth. Accutane should never be used in people who are pregnant or planning to become pregnant.

For this reason, a pregnancy test should be ordered prior to the start of treatment to rule out a potential pregnancy. It is also recommended to use two effective forms of birth control during treatment. Women and people who can become pregnant should be advised of the risks of taking Accutane while pregnant and sign a consent form acknowledging receipt of this information. Pregnancy tests should be repeated during treatment and 5 weeks after stopping Accutane.

Precautions and care instructions

Important precautions while taking Accutane include:

Applying a lip balm or moisturizer frequently;
Taking warm (not hot) showers for the shortest time possible in order to prevent dry skin;
Applying oil-free sunscreen with SPF 30 or higher,even on cloudy days, to prevent sunburn, as Accutane makes skin more sensitive to the sun;
Avoiding use of exfoliants on the face and body to reduce skin irritation;
Avoiding laser treatments or dermabrasion during treatment and for 5 to 6 months after stopping Accutane, as this medication can affect wound healing;
Avoiding waxing during and for 6 months after stopping treatment in order to prevent dermatitis and scarring;
Drinking at least 8 glasses of water a day;
Using saline nasal spray or applying a thin layer of Vaseline to the borders of the nostrils for people who present with a dry nose;
Avoiding the use of contact lenses in the case of dry eye;
Using artificial tears as indicated by your doctor or other healthcare provider;
Avoiding strenuous physical activity, as this can make side effects like joint and muscle pain worse;
Using two types of effective contraception, which should be started 1 month prior to beginning treatment with Accutane and continued for the duration of treatment and for 1 month after stopping Accutane.

In addition, blood tests like a complete blood count (CBC), cholesterol, triglycerides, and glucose should be checked at regular intervals during treatment with Accutane. It is also important to avoid donating blood during treatment and for up to 1 month after.

It is important to follow all medical advice on how to manage any side effects that may occur as a result of Accutane use.