POSTED: 9 Aug 2023

What You Should Know About Isotretinoin and Roaccutane

If you’re struggling with persistent acne, you’ve likely heard of Isotretinoin, a medication widely used to treat severe acne. In this article we’ll cover all aspects of Isotretinoin for acne, including its various brand names like Accutane and Roaccutane. We will also discuss alternatives to Isotretinoin including the differences between Tretinoin vs Isotretinoin.

What is Isotretinoin?

Isotretinoin, also known by brand names such as Accutane and Roaccutane, is a prescription medication. It is used to treat severe acne that is resistant to other treatments. It belongs to a class of drugs called retinoids which are derivatives of Vitamin A.

What Does it Do?

Isotretinoin is extremely effective because it targets the four main contributing factors of acne. These are excess oil production, clogged pores, acne-causing bacteria and inflammation. Below are the main benefits of Isotretinoin (which also applies to Accutane and Roaccutane).

Treats Severe Acne

One of the main benefits of Isotretinoin is its effectiveness in treating severe acne such as cystic and nodular acne that has not responded to other treatments. It reduces the size and secretion of the sebaceous glands, leading to a significant reduction in acne lesions. Treatment with Isotretinoin often leads to long-term clearance of acne. Many patients experience a permanent reduction in acne breakouts or a significant decrease in severity after a full course of treatment.

Prevents Acne Scarring

Isotretinoin reduces the number, size and severity of acne lesions. Since there are fewer severe acne lesions, such as cysts or nodules, this prevents or reduces acne scarring. Scars often form as a result of the body’s attempt to heal severe inflammatory acne. So by treating the inflammation, Isotretinoin reduces the likelihood of this scarring.

Reduces Hyperpigmentation

Post-inflammatory hyperpigmentation (dark spots) can occur after acne heals, particularly in individuals with darker skin tones. While not scarring in the true sense, these marks can be as distressing as scars. Since Isotretinoin reduces inflammation and treats acne, this helps prevent dark spots from forming and keeps the skin tone more even.

Improves Overall Skin Texture & Rejuvenates Skin

By promoting proper skin cell turnover, Isotretinoin can improve the overall texture of the skin. It makes it smoother and less oily. Additionally, like all retinoids, Isotretinoin also stimulates your skin cells to produce more collagen. Firstly, this leads to smoother healing which improves the appearance of acne scars. It also helps treat signs of skin ageing like fine lines and wrinkles.

How Does it Work?

Isotretinoin works using a multi-targeted approach which makes it a highly effective treatment for severe acne. This comprehensive action often results in long-lasting improvement, with many patients experiencing extended remission from acne after completing a course of Isotretinoin. Below is a little more detail about how Isotretinoin for acne works.

Reduces Sebum Production

Sebum is the oily substance that sebaceous glands produce. An excess of it can lead to clogged pores. Isotretinoin dramatically reduces the size and activity of the sebaceous glands. This leads to a significant decrease in sebum production. By doing so, it prevents the clogging of pores and the formation of acne.

Prevents Clogged Pores

Isotretinoin alters the life and growth cycle of skin cells. It promotes the shedding of dead skin cells and prevents them from clogging the pores. By keeping the pores clear, it reduces the chances of blackheads and whiteheads forming. These are both precursors to more severe types of acne.

Anti-Inflammatory Effect

Acne often manifests with redness and swelling due to underlying inflammation. Isotretinoin has anti-inflammatory properties that reduces this inflammation. This calms the skin and speeds up the healing of existing acne lesions.


Propionibacterium acnes (P. acnes) bacteria contribute to the development of acne and the severity of the type of acne. Whilst isotretinoin doesn’t directly kill these bacteria but creates an environment where these bacteria struggle to thrive. By reducing oil production and preventing pore clogging, Isotretinoin deprives these bacteria of their ideal breeding ground.

Accutane vs. Roaccutane

Both Accutane and Roaccutane are brand names for Isotretinoin. The difference between the two is mainly in the branding and potentially in the formulation. Roaccutane is the most widely recognised and used brand of Isotretinoin in the UK. Accutane was the brand name primarily used in the United States. Accutane’s manufacturer discontinued it in 2009. This was largely due to competition and loss of market share for Accutane from generic versions of the drug. It’s essential to note that Isotretinoin is a potent medication with potential side effects and risks regardless of the brand or formulation. As such, you should only use it under the supervision of an experienced dermatologist.

Which is Better Isotretinoin Tablets or Isotretinoin Cream?

Isotretinoin is primarily prescribed as an oral medication as this is the form needed to treat severe acne, especially when other treatments have failed. The results can be long-lasting and because Roaccutane is a systemic treatment, it can target acne all over the body. Topical Isotretinoin in the form of gels or creams is less effective than oral. However, it can be an option for milder forms of acne or for maintenance. Since it is a localised treatment, there are fewer systemic side effects. It may also be more suitable for patients who can not tolerate systemic Roaccutane due to side effects or underlying health conditions.

Potential Side Effects

Oral Isotretinoin (Roaccutane) comes with a wide range of potential side effects. These can vary in intensity, and not all patients will experience them.

  • Dryness: this is one of the most common side effects and can affect the skin, lips, eyes and nasal passages.
  • Increased Sensitivity to Sunlight: the skin may burn more easily, so sun protection is essential.
  • Elevated Cholesterol and Triglycerides: this can elevate your risk of stroke and heart disease. Regular blood tests will monitor them.
  • Liver Function Changes: the medication can affect liver function. Regular blood tests will monitor for this.
  • Mood Changes: some patients have reported depression, anxiety or other mood changes. There are rare reports of suicidal thoughts.
  • Gastrointestinal Issues: Isotretinoin may cause or exacerbate conditions like inflammatory bowel disease.
  • Joint and Muscle Pain: some patients experience aches and pains especially with physical activity.
  • Vision Changes: dry eyes, impaired night vision or other vision changes may occur.
  • Skin Conditions: rarely, Isotretinoin may lead to skin conditions like eczema or cause skin healing to slow down.
  • Pregnancy Risks: Isotretinoin can cause severe birth defects. Women of childbearing age will need strict pregnancy prevention measures as well as regular pregnancy tests.
  • Allergic Reactions: though rare, like any drug, allergic reactions to Isotretinoin are possible.
  • Effects on Blood Sugar: there are reports of changes in blood sugar levels.

The potential side effects of Isotretinoin (aka Accutane or Roaccutane) underscore the importance of seeing a knowledgeable doctor who can monitor and manage these risks. Many of the side effects are reversible once you stop taking the medication. However, you should always consult with your doctor before stopping or adjusting your medication.

What To Expect From Isotretinoin Treatment

Isotretinoin treatment involves a complex that requires careful management and regular monitoring. It is a prescription-only medicine and you should only use it under the strict supervision of a Dermatologist. In general, here’s what you can expect if you embark on this treatment.

Initial Consultation

A thorough assessment by a dermatologist is necessary before starting Isotretinoin. This will include a discussion of medical history and potential side effects. In women of childbearing age, your doctor will also discuss pregnancy prevention due to the potential of severe birth defects associated with Isotretinoin. In addition, you doctor may advise against certain treatments such as lasers, chemical peels, waxing and skincare products during your treatment.

Treatment Duration

The typical course of Isotretinoin treatment lasts between 4 to 6 months though this can be longer. Regular check-ups are necessary to monitor progress and potential side effects. Some people may need a second course of treatment.

Regular Monitoring

You will need regular follow-ups with your doctor. This will include blood tests to monitor liver function and cholesterol levels. You may also need to undertake a pregnancy test during each visit. This is to ensure the treatment is still safe to continue. The doctor may adjust the dose of the Tretinoin based on your progress.

When Will I See results?

Isotretinoin typically requires some time before you can see noticeable results. It’s not uncommon for acne to worsen initially during Isotretinoin treatment. An initial flare-up may occur as the medication starts to work which leads to more breakouts. Dryness and other side effects may also begin during this time. This phase usually lasts for a month or less.

After 1-2 months from starting treatment, you might start to see some improvement. However the acne may still be quite active. You may continue to experience dryness and other side effects.

By 3-4 months most people reach a turning point. This is when you might see significant improvement in your acne. A standard course of Isotretinoin treatment usually lasts between 4 to 6 months. This depends on how your body responds to treatment and the severity of your acne. By the end of the treatment, most patients see significant clearing of their acne as well as improvement in their scars and hyperpigmentation.

Even after you stop the medication, your skin may continue to improve. Your doctor will usually schedule follow-up appointments to assess the long-term results and manage any remaining concerns. At this point they may recommend a topical retinoid like Tretinoin to maintain your results and build on them.

Tretinoin vs Isotretinoin

Tretinoin and Isotretinoin are both derivatives of Vitamin A. They are both prescription only medicines that are commonly used to treat acne. So a common question is what’s the difference between Isotretinoin vs Tretinoin? Tretinoin is a topical treatment that you apply directly to the skin. It is commonly used to address acne, scarring, hyperpigmentation, fine lines and sun-damaged skin. On the other hand, Isotretinoin is usually used as an oral, systemic treatment for severe acne that is unresponsive to other treatments.

When is it Best to Use Tretinoin vs Isotretinoin

Tretinoin promotes skin cell turnover and prevents clogged pores, aiding in the reduction of scars and hyperpigmentation. It is generally effective for mild to moderate acne, with noticeable improvements taking a few weeks. Isotretinoin, however, mainly works by reducing the skin’s oil glands’ size and the oil they produce. It slows down skin cell turnover inside pores, preventing clogging. As such it is reserved for treating severe, cystic or nodular acne. The results with Isotretinoin can be dramatic but usually take longer and require a treatment course of 4 to 6 months. Tretinoin is often used to maintain results after completing Isotretinoin.

Downsides & Side-Effects of Isotretinoin Vs Tretinoin

Both treatments have side effects, but they differ in intensity. Tretinoin’s common side effects include redness, peeling, or dryness of the skin. These are generally manageable with proper skincare. Isotretinoin’s side effects can be more severe, including dry skin, joint pain and potential mood changes. Due to these more significant side effects, you will need regular monitoring blood tests throughout your Isotretinoin treatment. Your doctor will discuss all of these benefits and downsides when deciding between Tretinoin vs Isotretinoin.

Isotretinoin, better known as Accutane or Roaccutane, offers a powerful solution for those grappling with severe acne. However, it’s essential to recognise that this treatment needs to individualised. The severity and type of acne, dosage, adherence to the treatment plan and individual response to the medication can all affect how quickly you see results.

Due to the risks and side effects of Isotretinoin, you will need s thorough consultation with a dermatologist who can help you determine whether this treatment is suitable for your acne, lifestyle and medical background. They will counsel you about the benefits, downsides and alternatives to empower you to make informed decisions. They will also discuss with you the possibility of Isotretinoin vs Tretinoin for you. You will need to maintain regular communication with your doctor throughout the treatment, as adjustments to the dosage and length may be necessary. You will also need to undergo blood and pregnancy tests during this period. Whilst Roaccutane is a highly effective treatment, patience and adherence are key to achieving the best results.

Through our doctor-led prescription skincare service, we provide personalised treatments like Tretinoin for acneacne scars and hyperpigmentation. Book a virtual consultation with us today and let our doctors create a bespoke treatment plan for your specific needs and skin goals. The journey towards better skin starts here.


Authored by:

Dr Amel Ibrahim
Aesthetic Doctor & Medical Director
Founder City Skin Clinic
Member of the Royal College of Surgeons of England
Associate Member of British Association of Body Sculpting GMC Registered - 7049611

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