If you are struggling with persistent acne, you have probably heard of isotretinoin. It is the strongest treatment we have for severe acne. You may know it better by its brand names, Accutane and Roaccutane. It is a strong oral medicine derived from vitamin A, it is prescription-only, and you take it under a doctor’s care. In this article we explain what isotretinoin is, how it works, its side effects and what to expect from treatment. We also compare it with topical tretinoin, which is a very different medicine despite the similar name.
What is Isotretinoin?
It is a prescription medicine for severe acne that has not cleared with other treatments. It belongs to a class of drugs called retinoids, which are forms of vitamin A. In the UK it is reserved for severe acne, or acne at risk of lasting scarring. It is used when antibiotics and topical treatments have not cleared the skin. Accutane and Roaccutane are both brand names for the same drug. It is a strong medicine with real risks, so a dermatologist only starts it after a full check-up.
What Does Isotretinoin Do?
It works so well because it targets all four main drivers of acne, which are excess oil, clogged pores, acne bacteria and inflammation. This is why it can clear acne that nothing else has touched. The main benefits include:
- Treats severe acne: it works extremely well for severe cystic and nodular acne that nothing else has cleared. It shrinks the oil glands and cuts the number of acne spots. Many people see long-term clearance or a lasting drop in severity after a full course.
- Prevents acne scarring: by cutting the number, size and depth of acne spots, it lowers the risk of scarring. Scars form as the skin heals deep inflammatory spots, so calming that inflammation early helps protect the skin.
- Reduces hyperpigmentation: post-inflammatory hyperpigmentation (dark marks left after a spot heals) is common, particularly in darker skin tones. By settling acne and inflammation, isotretinoin helps prevent new dark marks from forming.
- Improves skin texture: by smoothing out skin cell turnover and cutting oil, it leaves the skin smoother and less greasy. Like other retinoids it also supports collagen, which aids smoother healing of acne scars.
How Does Isotretinoin Work?
It works in several ways at once, which is what makes it so strong. It shrinks the oil glands, steadies how skin cells shed and calms inflammation in the skin. This combined action is why many people stay clear for a long time after finishing a course. In more detail:
- Reduces sebum production: sebum is the oily substance the glands produce, and too much of it clogs pores. It sharply shrinks the size and action of the oil glands, so far less sebum reaches the surface.
- Prevents clogged pores: it helps the skin shed dead cells well rather than letting them block the pore. This cuts the blackheads and whiteheads that act as precursors to more severe acne.
- Calms inflammation: much of the redness and swelling of acne comes from inflammation. It has anti-inflammatory effects that settle the skin and speed up healing of existing spots.
- Limits acne bacteria: Cutibacterium acnes (formerly known as P. acnes) feeds acne. It does not kill these bacteria directly, but by drying up oil and clearing pores it removes what they need to thrive.
What’s the Difference Between Accutane and Roaccutane?
Both Accutane and Roaccutane are simply brand names for isotretinoin. The difference is mainly branding rather than the drug itself. Roaccutane is the most widely recognised brand in the UK, whilst Accutane was the brand used in the United States. Accutane’s manufacturer discontinued it in 2009, largely because of competition from generic versions. Generic isotretinoin is the same medicine and works in the same way. Whatever the brand, it is a strong drug, so you should only use it under the care of an expert dermatologist.
Which is Better, Isotretinoin Tablets or Cream?
Doctors mainly prescribe it as a tablet, because the oral form is what severe acne needs when other treatments have failed. Because it works through the whole body, it can also reach acne anywhere, and the results can be long-lasting. Topical isotretinoin, as a gel or cream, is weaker than the tablets. It can suit milder acne or upkeep, and it causes fewer side effects across the body. This is because it works only where you put it. It may also be an option for people who cannot tolerate oral isotretinoin.
What are the Side Effects of Isotretinoin?
Oral isotretinoin comes with a wide range of possible side effects. They vary in strength, and not everyone will get them, but they are the reason the treatment needs close medical care. The most common and most important include:
- Dryness: this is the most common side effect and can affect the skin, lips, eyes and nasal passages.
- Sun sensitivity: the skin can burn more easily, so daily sun protection is vital.
- Raised cholesterol and triglycerides: these blood fats can rise, which is one reason routine blood tests are needed.
- Liver function changes: isotretinoin can affect the liver, so blood tests track this throughout treatment.
- Mood changes: some people report low mood, anxiety or other changes, with rare reports of suicidal thoughts. Any mental health changes should be raised with your doctor straight away.
- Bowel symptoms: isotretinoin may rarely cause or worsen gut problems such as inflammatory bowel disease.
- Joint and muscle aches: these are fairly common, especially with exercise.
- Vision changes: dry eyes, poorer night vision or other changes can occur.
- Slower skin healing: rarely, the skin can heal more slowly or develop conditions like eczema.
- Birth defects: isotretinoin can cause serious harm to an unborn baby, which is covered in more detail below.
Many of these side effects go away once you stop the medicine. You should never stop or adjust the dose yourself though, always speak to your doctor first.
Is Isotretinoin Safe in Pregnancy?
This is the single most vital safety point. It is highly teratogenic, which means it can cause serious birth defects, so you must never take it in pregnancy. In the UK, anyone who can become pregnant must join a strict Pregnancy Prevention Programme. This involves reliable contraception before, during and after treatment, along with regular pregnancy tests. Since 2023 there are also extra UK safeguards. Doctors counsel every patient about possible mental health and sexual side effects, and check for these at each appointment. These rules exist to keep a very strong drug as safe as possible.
What to Expect From Isotretinoin Treatment?
It is a complex treatment that needs careful handling and regular checks. Only a dermatologist can prescribe and manage it. In general, here is what the process looks like:
- Initial consultation: a doctor looks at your skin and medical history before you start, and talks through the side effects with you. If you can become pregnant, they will talk through pregnancy prevention. They may also advise pausing treatments like lasers, chemical peels, waxing and certain skincare during your course.
- Treatment duration: a typical course lasts 4 to 6 months, though it can be longer. Some people need a second course further down the line.
- Regular checks: you will have regular follow-ups, including blood tests for liver function and cholesterol, and pregnancy tests where needed. Your doctor may adjust the dose of isotretinoin based on how you respond.
When Will I See Results?
It takes time, and acne commonly gets worse before it gets better. An initial flare can happen as the medicine starts to work, often with extra breakouts and dryness. This phase usually lasts a month or less. After 1 to 2 months you may start to see some progress, though the acne can still be active and the dryness continues. By 3 to 4 months most people reach a turning point and clearly improve. A standard course runs 4 to 6 months, depending on the severity of your acne and how your body responds. By the end, most people see major clearing, along with better scarring and hyperpigmentation. Your skin can keep improving even after you stop. At that stage many doctors suggest a topical retinoid like tretinoin to maintain and build on the results.
What’s the Difference Between Tretinoin and Isotretinoin?
Tretinoin and isotretinoin are both forms of vitamin A, and both are prescription medicines for acne. The similar names cause a lot of mix-ups. The key difference is how they are used. Tretinoin is a topical treatment that you apply to the skin, whilst isotretinoin is usually an oral treatment for severe acne. They differ in when they are used and in their side effects:
- When each is used: tretinoin boosts skin cell turnover and keeps pores clear, which helps with mild to moderate acne, scarring and hyperpigmentation, with results over a few weeks. Isotretinoin mainly shrinks the oil glands and suits severe, cystic or nodular acne, with bigger results over a 4 to 6 month course. Many people then use tretinoin to maintain those results.
- Side effects compared: tretinoin’s side effects are usually mild and local, such as redness, peeling or dryness, and are manageable with good skincare. Isotretinoin’s side effects can be tougher, which is why it needs routine blood tests throughout treatment. Your doctor will weigh all of this up when deciding which is right for you.
What About Low-Dose (Microdosing) Isotretinoin?
Not everyone needs a full-strength course. Some people use a much lower dose over a longer period, an approach often called microdosing or low-dose isotretinoin. The aim is still long-term control of acne, but with fewer side effects and less disruption. It is not right for everyone, and it is still a prescription medicine that needs a doctor’s care. However, it is a useful option to discuss with your doctor.
Isotretinoin is a strong but demanding treatment. Whether it is right for you depends on the type and severity of your acne, your health history and how your skin responds. Because of the risks, a dermatologist prescribes and oversees it, and talks you through the benefits, downsides and other options.
At City Skin Clinic, we do not provide isotretinoin. Our online clinic offers safe and effective topical skin treatments using ingredients like tretinoin and azelaic acid where appropriate. Our doctors treat acne, acne scars and hyperpigmentation with bespoke compounded topical treatments designed around you. These can suit milder acne, or help maintain your skin after a course of isotretinoin. To start your personalised plan, you can get acne treatment online in the UK, book a virtual video consultation or use our online consultation form. The journey towards great skin and hair starts here.
This article is intended for general informational purposes only and is not a substitute for medical advice, diagnosis or treatment. Always consult a qualified medical professional with any concerns about your skin or treatment options.
