How does Accutane work?

Dr. Amit Om, board-certified dermatologist, explains how Accutane (isotretinoin) works in the treatment of acne and how long you need to take it.

Medically reviewed by:
Dr. Amit OM
Dermatologist

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What is Accutane (isotretinoin)?

Dr. Amit Om, board-certified dermatologist, says that Accutane (also known as isotretinoin) is the only FDA approved treatment for severe, nodular or cystic acne which tends to leave permanent marks and scars on the skin.

When is acne considered severe?

Dr. Om says acne is classified as severe when it includes the following characteristics:

Numerous inflamed pimples and pustules (red, swollen, pus-filled bumps)
Large, painful nodules or cysts (deep, hard lumps under the skin)
Extensive involvement across the face, chest, back, or shoulders
Scarring or dark marks as acne heals
Significant emotional distress or impact on self-esteem.

How many pimples define severe acne?

While there’s no exact number, Dr. Om says that he assess the severity based on the type and extent of breakouts:

Mild acne: Fewer than 20 comedones, 15 pimples, or 30 total lesions
Moderate acne: Between 20-100 comedones, 15-50 pimples, or 30-125 total lesions
Severe acne (or active acne causing deep scarring): More than 5 large nodules, many inflamed pustules, or over 125 total lesions

Severe acne rarely responds to over-the-counter treatments and often requires prescription medications like oral antibiotics, isotretinoin (Accutane), or hormonal therapy. If your acne is persistent, painful, or affecting your confidence, consult a dermatologist for a tailored treatment plan.

Does Accutane (isotretinoin) get rids of severe acne?

Yes, Accutane (isotretinoin) is the most effective treatment for severe acne and can lead to long-term or even permanent clearance. Most people see significant improvement after a 4-6 month course, with many achieving clear skin that lasts. However, some people may need a second course if their acne returns. Because of potential side effects—including dry skin, joint pain, and birth defects if taken during pregnancy—it requires lab work and close monitoring by a dermatologist.

How does Accutane work?

Dr. Om says that Accutane is a type of vitamin A that helps control how skin cells grow. It attaches to receptors (RARs and RXRs) in the nucleus, which turn certain genes on or off. This helps control skin cell growth, reduce swelling, and shrink oil glands, making it useful for treating acne.

What does Accutane do?

Reduces oil production – It significantly shrinks the sebaceous (oil) glands in your skin, leading to much less oil production. Since excess oil clogs pores and feeds acne-causing bacteria, this helps prevent new breakouts.
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.
Reducing inflammation – It has strong anti-inflammatory effects, helping to calm the redness, swelling, and pain associated with severe acne.

How long does Accutane take to work?

Dr. Om says that most people on Accutane (isotretinoin) typically take 4 to 6 months to get rid of acne, although in some instances a second course may be necessary. Dr. Om also added that most patients will start noticing some improvement within the first couple of months, but it is perfectly normal for acne to initially worsen before getting better.

Dr. Om gives you a general timeline of what to expect:

Weeks 1-4: Skin gets drier, lips become chapped, and acne flares up temporarily.
Months 2-3: Breakouts start to decrease, and skin texture improves.
Months 4-6: Acne is significantly reduced or cleared.
Post-Treatment: Many people remain acne-free long-term, but some may need a second course.

Results vary depending on dosage, severity of acne, and individual response. Lower doses may take longer, while higher doses work faster but can cause more side effects.

Is Accutane sold over the counter?

Accutane is not sold over the counter due to the seriousness of the side effects it can cause and due to the fact that it requires lab work and close monitoring. To get it you need a prescription from a board-certified dermatologist in order to get it.

How can I get a prescription for Accutane?

You can get an Accutane prescription by having a photo consultation via Miiskin. Your online dermatologist will determine if Accutane is right for you and will guide you through the step by step process.

Frequently asked questions about Accutane

Is Accutane (isotretinoin) only used for acne?

Dr. Om says that although Accutane (isotretinoin) is primarily used to treat severe acne, it is sometimes prescribed off-label for other skin conditions. Dermatologists may prescribe it to treat hidradenitis suppurativa (a chronic inflammatory skin condition)¹, rosacea, folliculitis, and sebaceous gland disorders like sebaceous hyperplasia².

Is Accutane no longer available?

The brand name Accutane was discontinued by Roche Pharmaceuticals, however, the active ingredient, isotretinoin, is sold under several brands including generic options.

Does Accutane (isotretinoin) cause birth defects?

Dr. Om says that Accutane (isotretinoin) causes severe birth defects in up to 60% of infants exposed in utero which include brain, heart, and facial abnormalities, if taken during pregnancy³ ⁴. Due to this high risk, any women of childbearing age must follow strict iPLEDGE program guidelines⁵, including using two forms of birth control and taking monthly pregnancy tests before, during, and for one month after stopping Accutane to prevent pregnancy-related risks.

Does Accutane (isotretinoin) cause purge?

Dr. Om says that many people may experience initial acne worsening (also known as isotretinoin purge) when starting isotretinoin, usually in the first few weeks of treatment. This happens because isotretinoin pushes out deep, clogged pores, leading to a temporary increase in breakouts before the skin clears⁶. Dr. Om says that the isotretinoin purge is temporary and typically improves within 4 to 6 weeks as the medication starts working; he also added that if it is too severe it can be mitigated with additional acne medications.

Does Accutane (isotretinoin) cause weight gain?

Dr. Om says that there is no clinical evidence that Accutane causes weight gain. Some people may notice changes in appetite or metabolism, but these effects are rare and not well-documented. If weight changes occur during treatment, they are likely due to other factors like diet, lifestyle, or individual response to the medication.

Does Accutane (isotretinoin) cause hair loss?

Dr. Om notes that while isotretinoin (Accutane) could be linked to hair loss, it is uncommon. A study of 6,330 patients with hair loss found only 48 had taken isotretinoin, and just 19 (39.6%) experienced hair loss during or within two years after treatment. The most common cause was telogen effluvium (temporary shedding), affecting 42% of cases, while others had androgenetic alopecia or underlying conditions. Higher doses and longer treatment increased the risk, but in all cases it is uncommon. If noticeable, a dermatologist may adjust dosage⁷.

Can you drink on Accutane (isotretinoin)?

Dr. Om strongly advises against it. Accutane and alcohol affect the liver, increasing the risk of liver damage and high cholesterol levels. Since Accutane already requires regular blood tests to monitor liver function, drinking alcohol can make it harder for your body to process the medication safely. If you choose to drink, you should limit yourself to one drink per day and you should not do this before discussing it with your dermatologist.

Does Accutane (isotretinoin) cause dry or chapped lips?

Dr. Om says dry or chapped lips are one of the most common side effects of Accutane (isotretinoin) but the good news is that the medication is working! The medication significantly reduces oil production, leading to severe lip dryness, peeling, and cracking for most users. To manage this, he recommends you use thick, hydrating lip balms like Aquaphor, Vaseline, or CeraVe Healing Ointment and reapplying frequently throughout the day. Staying hydrated and avoiding harsh or matte lip products can also help reduce discomfort.

Article References:
¹ https://pubmed.ncbi.nlm.nih.gov/31535587/
² https://www.ncbi.nlm.nih.gov/books/NBK525949/
³ https://pmc.ncbi.nlm.nih.gov/articles/PMC3602257/
⁴ https://pmc.ncbi.nlm.nih.gov/articles/PMC8014951/
⁵ https://ipledgeprogram.com/#Main
⁶ https://www.aad.org/public/diseases/acne/derm-treat/isotretinoin/side-effects
⁷ https://apps.medsch.ucla.edu/posters/files/pdfs/[email protected]