Isotretinoin is a medication indicated for the treatment of acne. It acts to reduce the size and activity of the sebaceous glands, helping to improve the health and appearance of the skin. It is commonly known by the brand name, Accutane, although this brand is no longer available on the market.

Isotretinoin is generally recommended by dermatologists for the treatment of acne that has not responded to other types of treatment. It may take around 8 to 16 weeks to see initial results with this medication.

Isotretinoin is a prescription-only medication that can be found in pharmacies and drug stores. It comes in 10 and 20 mg capsules and should only be used under the supervision of a dermatologist.

Taking isotretinoin during pregnancy can cause birth defects in the fetus. Women under the age of 55 (and anyone with the potential to become pregnant) should sign a consent form before starting treatment with isotretinoin, acknowledging understanding of the risks involved should they become pregnant while taking isotretinoin.

Indications for use

Isotretinoin is indicated for the treatment of severe acne and acne that fails to improve with other treatments such as antibiotics, ointments, creams, and changes in skin care routine. Full resolution of acne is typically noted after 16 to 24 weeks of treatment.

Read about other acne treatments.

Does isotretinoin "shrink" your noise?

Isotretinoin does not shrink your nose, however it does promote cellular regeneration, which may make the skin thinner and give the appearance of a smaller nose.

In addition, some studies suggest that isotretinoin can help in the treatment and prevention of rhinophyma, an inflammatory condition involving the sebaceous glands of the nose that causes growths and bumps to form on the nose. Isotretinoin helps to decrease inflammation and size of the sebaceous glands and may help the nose return to its original appearance.

It is important to stress that isotretinoin is only indicated for the treatment of severe acne and should only be used as directed by a doctor or other licensed healthcare professional.

Dosing instructions

Isotretinoin capsules should be taken by mouth, with food, following the schedule as indicated by the prescribing provider. If you forget a dose, skip that dose and take the next scheduled dose the following day, being sure not to double a dose.

Doses of isotretinoin will vary based on the severity of the acne. The usual starting dose is 0.5 to 1 mg per kg of body weight taken once a day. Your doctor may increase the dose up to 2 mg per kg of body weight in some cases.

The duration of treatment will vary based on dose and treatment response, with full resolution of acne generally requiring about 16 to 24 weeks of treatment.

Side effects

The most common side effects of isotretinoin are:

Dryness of the skin, eyes, and nasal mucosa;
Difficulty seeing at night;
Conjunctivitis;
Inflammation of the eyelids;
Diarrhea;
Nausea and/or vomiting;
Headache;
Backache;
Muscle and joint pain;
Nasal congestion (stuffy nose);
Frequent sneezing;
Sore throat.

Acne may worsen during the first 7 to 10 days of treatment with isotretinoin, however this usually improves without the need to change the dose of the medication.

While rare, isotretinoin can cause a severe allergic reaction requiring immediate medical attention. Stop taking isotretinoin right away and seek emergency medical attention for any symptoms of an allergic reaction, including difficulty breathing, cough, chest pain, a feeling like your throat is closing, peeling of the skin, or red or purple skin lesions.

Can isotretinoin cause depression?

Depression is one of the side effects reported with the use of isotretinoin. Depression may present as sudden changes in mood or behavior, crying spells, low self esteem, loss of interest in activities you once enjoyed, trouble sleeping, or thoughts of self harm or suicide.

Depression with the use of isotretinoin typically occurs in people with a history of depression, therefore it is important to tell your doctor about any current or past history of depression prior to taking isotretinoin. Your doctor may consider a different treatment approach or recommend you are followed by a psychiatrist or other mental health professional while taking isotretinoin.

Contraindications

Isotretinoin should not be used in children under 12 years of age. It should also be avoided during lactation and in people with liver problems, high cholesterol or triglycerides, an excess of vitamin A, and in those being treated with tetracyclines.

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

Isotretinoin is contraindicated in pregnancy due to the risk for serious fetal malformations involving the face, ears, heart, and nervous system with even one dose of this medication. In addition, isotretinoin can cause miscarriage, premature birth, and stillbirth. It should never be used in people who are pregnant or who are planning to become pregnant.

For this reason, the dermatologist or other prescribing provider should order a pregnancy test prior to starting treatment in anyone with the potential to become pregnant. The use of two methods of birth control is also recommended while being treated with isotretinoin. Patients must sign a form prior to starting treatment confirming that they have received these instructions. Pregnancy tests should be repeated during treatment and 5 weeks after stopping use of isotretinoin.

Care instructions

While being treated with isotretinoin, some important care instructions include:

Apply moisturizer or lip balm frequently;
Use warm (not hot) water in the bath/shower and avoid staying in the water too long to prevent dry skin;
Apply an oil-free sunscreen with SPF 30 or higher,even on cloudy days, to prevent sunburn, as isotretinoin makes the skin more sensitive to the sun;
Avoid the use of exfoliants on the face and body to reduce skin irritation;
Avoid laser treatments and dermabrasion during treatment and for 5 to 6 months after stopping treatment, as isotretinoin can affect skin healing;
Avoid waxing while taking isotretinoin and for 6 months after to avoid dermatitis and scarring of the skin;
Drink at least 8 glasses of water per day;
Use saline nasal spray or apply a thin layer of vaseline to the inner edges of the nostrils to combat dryness;
Avoid wearing contacts in the case of dry eye;
Use artificial tears, as indicated by a doctor;
Avoid strenuous physical activity as this can worsen side effects such as muscle and joint pain;
Use two effective forms of birth control beginning 1 month prior to starting treatment and continuing for at least 1 month after treatment ends.

In addition, blood tests will be ordered by your doctor to check your complete blood count (CBC), cholesterol, triglycerides, and blood sugar during treatment. Avoid donating blood during treatment and for up to 1 month afterward.

It is important to follow all treatment instructions to help minimize any side effects that may arise during treatment with isotretinoin.