What are the best Accutane alternatives?

Dr. Amit Om, board-certified dermatologist, talks about 8 different Accutane alternatives and tells you when you may consider each of these alternatives.

Medically reviewed by:
Dr. Amit OM
Dermatologist

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What is Accutane?

Accutane, the brand name for isotretinoin, is an oral medication used to treat severe or treatment-resistant acne. According to Dr. Amit Om, a board-certified dermatologist, Accutane is a type of retinoid derived from vitamin A that works by targeting multiple causes of acne. It reduces oil gland size, decreases sebum production, limits bacterial growth, and helps prevent clogged pores and inflammation¹.

Unlike topical treatments or antibiotics, Accutane addresses the root causes of acne systemically, which often leads to long-term or even permanent improvement. Many patients experience significant clearing of acne that continues even after the medication is stopped. It is the closest thing we have to a “cure” for acne.

When is Accutane a good option for acne?

Dr. Om explains that Accutane is typically considered when other acne treatments have failed or when the acne is particularly severe. It may be the right option in cases where:

The acne is severe, nodular, or cystic, often causing scarring.
The patient has not responded to standard treatments, including oral antibiotics, hormonal therapies, or topical medications.
Acne is causing psychological distress or impacting quality of life.
There is a pattern of relapse after stopping other therapies.

While highly effective, Accutane isotretinoin does come with potential side effects and requires close monitoring by a dermatologist. These may include dryness, changes in cholesterol or liver enzymes, and teratogenic risks, meaning it should never be used during pregnancy. Regular lab work (including pregnancy tests) and monthly follow-ups are typically part of treatment².

Dr. Om emphasizes that when prescribed appropriately and monitored carefully, Accutane is absolutely worth it and can be a safe and transformative option for those struggling with persistent or scarring acne.

Can you get a prescription for Accutane online?

While Accutane isn’t something you can get through a typical online prescription service, it is available through licensed dermatologists on the Miiskin platform. They will evaluate your case and prescribe it, if medically appropriate.

How does Accutane work?

Dr. Om says that Accutane works by addressing four contributing factors that cause acne.

Reduces sebum production – It significantly shrinks oil glands in your skin, leading to much less oil production.
Prevents clogged pores – It normalizes the way skin cells shed, preventing dead skin and oil from accumulating and forming blackheads or whiteheads.
Kills bacteria – Accutane creates an environment where the bacteria that contributes to acne, can’t thrive.
Reduces inflammation – It has strong anti-inflammatory properties, helping to calm the redness, swelling, and pain associated with severe acne.

8 Alternatives to Accutane

Dr. Om says that Accutane (isotretinoin) is the most powerful and effective acne medication available—often leading to long-term or permanent clearing³ and there aren’t any other treatments that match its efficacy.

However, there are several less aggressive alternatives that can still be highly effective, especially when used as combination therapy compounded for each individual. These options are commonly used for mild to moderate acne, or for those who prefer to avoid Accutane due to its side effect profile or monitoring requirements.

Oral alternatives to Accutane

Birth control pills

Certain oral contraceptives can be an effective treatment for acne in women, especially when breakouts are linked to hormonal fluctuations. Birth control pills help regulate hormone levels, particularly androgens, which can reduce oil production and prevent clogged pores⁴. They’re often used in combination with other acne treatments for optimal results.

Oral spironolactone

Oral spironolactone is a medication that blocks androgen hormones by interfering with the receptor sites, helping to decrease oil production and reduce hormonal acne, particularly on the lower face and jawline. It’s prescribed to adult women with persistent or cyclical breakouts and is generally well-tolerated with long-term use⁵. This medication is not suited for men given its effects on blocking hormones.

Oral antibiotics

Oral antibiotics like doxycycline or minocycline are commonly prescribed for moderate inflammatory acne. They work by reducing acne-causing bacteria and inflammation. These medications are typically used short-term and often paired with topical treatments to prevent resistance and maintain results⁶.

Topical alternatives to Accutane

Topical retinoids

Topical retinoids, such as adapalene or tretinoin, are vitamin A derivatives that promote skin cell turnover and prevent clogged pores. They’re a first-line treatment for many types of acne and can also help improve skin texture and fade post-acne marks over time. Retinoids are usually part of a long-term skincare routine⁷.

Topical spironolactone

Topical spironolactone is a newer option that offers anti-androgen benefits without the systemic effects of the oral version – and because of that, it can be used in men and women alike. Applied directly to the skin, it can reduce oiliness and inflammation, making it a good choice for those with mild to moderate hormonal acne or those who can’t tolerate oral medications⁸.

Winlevi (clascoterone)

Winlevi is a topical anti-androgen cream approved for acne in both teens and adults. It works similarly to topical spironolactone by blocking androgen receptors in the skin, helping to reduce oil production and inflammation⁹. The downside is that since it is a new medication and there isn’t a generic available in the market, it is very expensive, making topical spironolactone a budget-friendly alternative.

Topical antibiotics

Topical antibiotics, such as clindamycin or dapsone, help control surface bacteria and calm inflammation in mild to moderate acne¹⁰. They’re usually combined with benzoyl peroxide or a topical retinoid to enhance effectiveness and reduce the risk of bacterial resistance. While not a long-term solution on their own, they can be useful as part of a combination regimen.

Other Accutane alternatives

Corticosteroids injections

Corticosteroids are not a long-term treatment for acne but can be used in specific situations for quick relief. In-office corticosteroid injections are often used to rapidly reduce inflammation and swelling in very large, painful cysts¹¹.

Frequently asked questions about Accutane alternatives

Can I just take vitamin A instead of Accutane?

Dr. Amit Om explains that while Accutane is derived from vitamin A, taking high doses of vitamin A is dangerous and should not be used as a substitute. The doses required to match Accutane’s effects would be very high and could lead to the same side effects and serious toxicity without delivering the same therapeutic benefits.

How do topical retinoids compare to Accutane for treating acne?

According to Dr. Om, topical retinoids like tretinoin or adapalene are excellent first-line treatments for mild to moderate acne, helping to unclog pores and improve skin turnover¹². However, they work locally and are much less potent than Accutane, which treats acne systemically and is reserved for more severe or resistant cases. To learn more about this read our article on tretinoin vs isotretinoin.

What are the best oral alternatives to Accutane for moderate to severe acne?

Dr. Om recommends oral antibiotics, hormonal therapies like birth control pills, and oral spironolactone as effective alternatives for moderate to severe acne. While these options may not offer permanent remission like Accutane, they can provide significant improvement, especially when used as combination therapy to address the underlying causes of the acne.

Can spironolactone be used instead of Accutane for hormonal acne?

Yes, Dr. Om often prescribes spironolactone in combination with topical retinoids as an alternative to Accutane for women with hormonal acne. Spironolactone works by blocking androgen activity, which helps reduce oil production and hormonal breakouts—particularly along the jawline and chin. Tretinoin unclogs pores and reduces the production of sebum in the skin.

Are some Accutane alternatives less harsh on the body?

According to Dr. Om, birth control pills can be very effective for treating hormonal acne in women by regulating androgen levels, which helps reduce oil production. While they don’t work as aggressively as Accutane, they can significantly improve breakouts, especially those that happen around cycles,and are often part of a long-term acne management plan.

Do Accutane alternatives work for cystic acne?

Dr. Om explains that while Accutane is the most reliable treatment for deep cystic acne, some alternatives—such as oral antibiotics, hormonal therapies, and spironolactone—can still help reduce inflammation and flare-ups. These options may be appropriate for milder cystic cases or for patients who are not yet ready for Accutane.

What skincare routine should I follow if I’m avoiding Accutane?

Dr. Om recommends a consistent routine that includes a gentle cleanser, a non-comedogenic moisturizer, and active treatments like a topical retinoid and benzoyl peroxide. Sunscreen is essential, and exfoliating products should be used cautiously. Sticking to a dermatologist-guided regimen can in some cases help manage breakouts without the need for Accutane, but for some people Accutane is the last resource after years of failed acne treatment.

Can you buy Accutane over the counter?

No, Dr. Om says you cannot buy Accutane over the counter. Accutane (isotretinoin) is a prescription-only medication in the United States due to its potency and potential for serious side effects.

Because of the risk of birth defects, Accutane is regulated under a special safety program called iPLEDGE, which requires monthly check-ins, lab monitoring, and strict pregnancy prevention protocols for eligible patients. Only licensed prescribers who are registered with the program can prescribe it, and pharmacies must also be iPLEDGE-certified to dispense it.

If you’re considering Accutane, you’ll need to see a dermatologist—either in person or through a teledermatology platform like Miiskin—for a full evaluation and enrollment in the program.

Article References:
¹ https://www.ncbi.nlm.nih.gov/books/NBK525949/
² https://www.ncbi.nlm.nih.gov/books/NBK525949/
³ https://pmc.ncbi.nlm.nih.gov/articles/PMC2835909/
⁴ https://www.ncbi.nlm.nih.gov/books/NBK279209/
⁵ https://pubmed.ncbi.nlm.nih.gov/37192767/
⁶ https://pmc.ncbi.nlm.nih.gov/articles/PMC7577330/
⁷ https://pmc.ncbi.nlm.nih.gov/articles/PMC5574737/
⁸ https://pubmed.ncbi.nlm.nih.gov/36412248/
⁹ https://pmc.ncbi.nlm.nih.gov/articles/PMC9297041/
¹⁰ https://pubmed.ncbi.nlm.nih.gov/16086756/
¹¹ https://www.ncbi.nlm.nih.gov/books/NBK573050/
¹² https://pmc.ncbi.nlm.nih.gov/articles/PMC5574737/
¹³ https://pmc.ncbi.nlm.nih.gov/articles/PMC5574737/