Is Accutane (isotretinoin) worth it?

Dr. Eric Howell, board-certified dermatologist, takes an in-depth look at Accutane (isotretinoin), one of the most effective yet controversial treatments for severe acne.

Medically reviewed by:
Dr. Eric Howell
Dermatologist

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In this article, Dr. Eric Howell, board-certified dermatologist, explains how Accutane (isotretinoin) works, its potential side effects, and who might benefit from it the most. With years of experience treating acne, Dr. Howell shares his professional insight on whether this powerful oral medication is the right choice and what patients should consider before starting treatment.

Pros and Cons of taking Accutane

Dr. Howell gives you an a clear breakdown of the pros and cons of taking Accutane (isotretinoin) to help you weigh your options:

Pros

Highly effective – Often clears persistent acne when other treatments fail.
Works long-term – Most people experience significantly improved skin
Targets root causes – Reduces oil production, inflammation, and bacteria
Prevents scarring – By clearing cystic acne, reduces the risk of scarring.
Improves quality of life – Boosts self-esteem and mental well-being.

Cons

Bothersome side effects – Severe dryness, nosebleeds, and sun sensitivity.
Birth defects – if taken during pregnancy.
Needs medical supervision – Due to potential serious side effects.
Mental health concerns – Some may have mood changes or depression.
Strict regulations – Women must follow guidelines to avoid pregnancy at all costs.

Is Accutane (isotretinoin) worth it for patients with severe acne?

Dr. Howell says that Accutane (isotretinoin) is a highly effective medication for patients with severe acne, cystic, or nodular acne that has not responded to other treatments such as oral antibiotics, spironolactone or topical acne treatments. Accutane can greatly reduce acne breakouts in some cases, clearing it long-term, making it a life-changing option. Although it comes with potential side effects, the benefits of clearer skin, reduced scarring, and improved confidence often outweigh the risks for severe cases.

Is Accutane (isotretinoin) worth it for patients with moderate acne?

Dr. Howell says that Accutane may be worth considering for moderate acne if other treatments haven’t worked or if acne is causing scars, it’s painful, or causing emotional distress. However, because it has strong side effects, dermatologists typically reserve it for cases that don’t respond to other treatments.

Accutane (isotretinoin) worth it for patients with mild acne?

Dr. Howell says that he usually does not recommend Accutane for his patients with mild acne due to its potential risks and side effects. Milder acne cases can often be managed with hormonal or topical treatments, lifestyle changes, and oral antibiotics. However, in rare cases, if mild acne is painful, stubborn, chronic, or causing psychological distress, he may consider a low-dose Accutane regimen.

Is Accutane (isotretinoin) safe for women?

Dr. Howell says that Accutane is generally safe for women when taken under medical supervision, but it requires strict precautions due to the risk of severe birth defects if taken during pregnancy. Women on Accutane must follow the iPLEDGE program, which includes using two forms of birth control, taking monthly pregnancy tests, and avoiding pregnancy for at least one month before, during, and after treatment.

Aside from pregnancy risks, women may experience common side effects like dry skin, chapped lips, sun sensitivity, and joint pain. Some may also notice temporary changes in menstrual cycles. While rare, Accutane has been linked to mood changes in some users, so monitoring mental health is important.

When is Accutane (isotretinoin) prescribed?

Dr. Howell says that he only prescribes isotretinoin under strict guidelines due to its potential risks. You may be a candidate if you meet all of the following criteria:

Your acne is severe enough to cause scarring.
You have had persistent acne for several years.
Your acne has not responded to oral antibiotics, topical retinoids, or other standard treatments.

Because of serious potential side effects, isotretinoin is distributed through a restricted program called iPLEDGE, which is FDA-regulated. This program ensures that all prescribers, patients, and pharmacies follow strict safety measures

Medical requirements to get started with Accutane (isotretinoin)

Dr. Howell says that there are a few requirements before a patient can get started on Accutane therapy:

Key requirements during Accutane treatment

You must receive a new prescription each month—refills are not automatic.
Blood donation is prohibited while on isotretinoin and for 30 days after stopping to prevent birth defect risks in potential recipients.
Routine blood tests are required to monitor liver function and cholesterol levels.

Requirements for women who can get pregnant

Because isotretinoin is highly teratogenic (causing severe birth defects), strict pregnancy prevention measures are mandatory. Anyone who can become pregnant must:

Take monthly pregnancy tests before each prescription refill.
Use two forms of birth control simultaneously, such as:
- A hormonal method (birth control pill, patch, injection, implant, or IUD)
- A barrier method (latex condom with spermicide or diaphragm)

Commit to 100% abstinence from one month before starting Accutane until one month after stopping.

Additional considerations

The iPLEDGE program strongly advises against relying on abstinence alone unless the patient has never been sexually active or is completely certain they will remain abstinent.
Certain contraceptives, such as progesterone-only mini-pills, internal condoms, and the rhythm method, are NOT considered acceptable birth control options under iPLEDGE.

How long does Accutane treatment last?

Dr. Howell says that he usually prescribes isotretinoin between 4 to 6 months, and in many cases, acne usually clears after one round¹. Some may require a second course.

Ensuring the success of your Accutane treatment

Dr. Howell says that in order to get the best results from Accutane, follow these essential steps:

Stick to your dermatologist’s plan

Take your medication exactly as prescribed, ideally with a meal containing fat for better absorption.
Attend all follow-up appointments to monitor progress and side effects.

Manage side effects with proper skin care

Use a gentle cleanser and non-comedogenic moisturizer to prevent dryness.
Apply lip balm regularly to avoid chapped lips.
Avoid harsh skincare products, exfoliants, and other retinoids that can cause irritation.
To prevent nosebleeds, use a saline nasal spray or a thin layer of petroleum jelly inside your nostrils.
Moisturize your entire body at least twice daily with a thick, fragrance-free lotion (like CeraVe, Eucerin, or Vanicream).
Use a humidifier at night to maintain moisture levels in your skin; clean it every 2-3 days and deep clean it weekly.

Protect your skin from the sun

Since Accutane increases sun sensitivity, apply SPF 50+ sunscreen, wear a hat and sunglasses, and avoid excessive sun exposure.

Stay hydrated and maintain a healthy diet

Drink plenty of water to help manage dryness.
Eat a balanced diet to support overall skin health.

Monitor your mood and health

Watch for any mood changes or depressive symptoms and report them to your doctor.
Keep up with routine blood tests to check liver function and cholesterol levels.

Be patient and consistent

Accutane takes time to work—most patients see significant improvements between months 3-5.
Avoid picking at your skin to prevent scarring and irritation.

What to avoid while taking Accutane?

Dr. Howell emphasizes that the most critical precaution during Accutane treatment is preventing pregnancy, as isotretinoin is highly teratogenic and can cause severe birth defects. Women must follow strict birth control measures and men should take precautions to avoid getting their partner pregnant.

Other important things to avoid:

Excess vitamin A intake – Since Accutane is derived from vitamin A, consuming too much can lead to toxicity. Limit foods high in vitamin A (liver, egg yolks, full-fat dairy, oily fish) and avoid vitamin A supplements, cod liver oil, and fish oil capsules.
Alcohol consumption – Accutane can strain the liver, and alcohol increases the risk of liver damage and high cholesterol levels.
Excessive sun exposure – Your skin becomes highly UV-sensitive, making sunburn and hyperpigmentation more likely. Always wear SPF 50 sunscreen, a hat, and sunglasses.
Waxing or laser treatments – Your skin becomes more fragile, making it prone to burns, irritation, and scarring.
Harsh skin care products – Avoid retinoids, exfoliants, strong acids, and acne treatments that can worsen dryness and irritation.
Picking or squeezing pimples – Accutane makes skin more sensitive, increasing the risk of scarring—let breakouts heal naturally.
Sharing your medication – Accutane is a potent prescription drug that should only be taken under medical supervision.

Following these precautions will help ensure safe and effective Accutane treatment while minimizing risks and side effects.

What are some Accutane (isotretinoin) alternatives?

Dr. Howell says that if you’re looking for alternatives to Accutane (isotretinoin) for treating your acne, there are several options depending on your skin type, acne severity, and medical history.

Prescription acne medications

Oral antibiotics (Doxycycline, Minocycline, Sarecycline) – Help reduce inflammation and bacteria in moderate to severe acne.
Oral contraceptives (for females) – Birth control pills containing estrogen and progestin can regulate hormones that trigger acne.
Spironolactone – A hormonal treatment that reduces androgen levels, often used for hormonal acne in females.
Topical retinoids (Tretinoin, Adapalene, Tazarotene) – Vitamin A derivatives that help unclog pores and improve skin turnover.

Over-the-counter acne creams

Benzoyl peroxide – Kills acne-causing bacteria and reduces inflammation.
Salicylic acid – Exfoliates skin and helps clear clogged pores.
Azelaic acid – Has antibacterial and anti-inflammatory properties, useful for mild to moderate acne.

However, Dr. Howell says that if you have tried many of all of these medications and your acne has not responded to them, then you may be a good candidate for Accutane treatment. Consult a dermatologist to get started.

Frequently asked questions on whether is Accutane worth it for acne or not

Is Accutane a permanent cure for acne?

Dr. Howell explains that while Accutane is one of the most effective treatments for severe acne, it isn’t a guaranteed permanent cure. Clinical studies now suggest that long-term remission rates may be lower than once believed, partly because it’s being prescribed more often for less severe cases, where patients may have higher expectations for total clearance. Earlier use was typically reserved for more severe, treatment-resistant acne, where even partial improvement felt significant. Additionally, some early cases labeled as “cured” may have coincided with patients naturally aging out of their acne. Many people do experience long-lasting results after one course, but mild breakouts can return—especially in those with hormonal acne or a genetic tendency. In such cases, a second course or ongoing maintenance with topical treatments may be necessary. So, while not a permanent fix for everyone, Accutane remains the most powerful and durable acne treatment available.

Is Accutane bad for your body?

Dr. Howell says that accutane is a powerful medication with potential side effects, but when taken under medical supervision, it is generally safe and effective. Its most common side effects include dry skin, chapped lips, joint pain, and sun sensitivity², which are manageable with proper skincare and hydration. More serious but rare risks include liver enzyme changes, increased cholesterol levels, and mood changes, which is why regular blood tests and checkups are required. The biggest concern is its severe birth defect risk, requiring strict pregnancy prevention measures. While Accutane does impact the body, its effects are temporary and reversible after stopping treatment, and for many, the long-term benefits outweigh the risks.

Is Accutane dangerous?

Dr. Howell says that Accutane (isotretinoin) is a safe medication if taken under medical supervision and if taking pregnancy preventive measures to avoid pregnancy. Accutane is highly effective for severe acne, but it comes with potential side-effects, including dry skin, nosebleeds, muscle pain, and increased sun sensitivity. More serious concerns include birth defects, liver issues, and increased cholesterol levels, all of which require regular monitoring. Some users also report mood changes, though a direct link to depression is still debated. Despite these risks, under careful medical supervision, the benefits of Accutane usually outweigh the potential downsides.

Will acne come back when you stop taking Accutane?

Dr. Howell explains that while Accutane often leads to long-term improvement, it doesn’t guarantee permanent clearance. Because it shrinks oil glands and dramatically reduces sebum production, most patients see significant improvement during and after treatment. However, acne can return—especially in those with hormonal acne, a strong genetic predisposition, or if the initial course was shortened or underdosed. When breakouts do recur, they’re usually milder and more responsive to topical treatments or a second course. To help maintain results, get follow-up treatment with your online dermatologist, use prescription topical treatments and stick to a consistent skincare routine.

Does Accutane make you gain weight?

Dr. Howell says that weight gain is not a known side-effect of Accutane. However, isotretinoin may lead to increased levels of leptin and adiponectin, hormones involved in metabolism and fat regulation, particularly in those whose BMI increased. Since ghrelin (the hunger hormone) remained unchanged, isotretinoin is unlikely to directly influence appetite or weight gain³. Dr. Howell says that any changes in BMI (weight) may be individual variations rather than a direct effect of the medication.

Article References:
¹ https://pmc.ncbi.nlm.nih.gov/articles/PMC2835909/
² https://pmc.ncbi.nlm.nih.gov/articles/PMC9180136/
³ https://pmc.ncbi.nlm.nih.gov/articles/PMC5004210/