Need isotretinoin? We’ve broken down side effects, dosages and more

You may have heard celebrities swear by drugstore finds (Constance Wu said The New York Times “The Clearasil Facial Cleanser. Seriously. Or diet remedies, but when over the counter (OTC) options stop working for acne, many people find themselves turning to prescription.

Isotretinoin, in particular, was the “best-selling product […] with a turnover of 1.2 billion USD. (This is the most recent data on acne prescription, as of 2016). You may know it as the generic version of Accutane, which was taken off the market in 2009.

Isotretinoin works effectively by decreasing the amount of sebum on your skin, thereby eliminating a major factor in creating acne lesions.

You’ll find them in the form of “antibiotics, retinoids, anti-hormones and isotretinoin,” says Jennifer hollander, a board-certified nurse practitioner who has work experience in clinical and aesthetic dermatology.

And although many have great success with this pill, there is a lot of stigma and even fear associated with oral isotretinoin. If you’re wondering if this is the right skin trip for you, here’s how to prepare.

As someone with severe acne, I remember wishing there was a way to suck all the pimples out of my face. Acne is painful for the skin and for self-esteem, and there are studies on how it can cause or worsen depression. It is certainly more than an aesthetic condition!

And there is nothing inherently wrong with taking antibiotics or other medications prescribed to treat acne either, but discussing side effects, both mental and physical, with your dermis is essential. (I was actually on Accutane in the early 2000s, so more on that later).

Just as there is no silver bullet for people who suffer from acne, it would not be accurate to say that people should or should not use acne medication.

Your decision will be more nuanced than that. And if you’re tired of wasting money on products, you might be interested to learn that treatment resistant acne usually actually is. requires prescription drugs.

Isotretinoin is the closest thing to a cure that we currently have for acne and everyone’s acne will eventually get better with treatment.

Isotretinoin, which can treat all forms of acne, is most often used in people:

  • who have acne scars
  • whose acne does not respond to other over-the-counter treatments and / or other more conservative prescription treatments
  • who have other skin conditions like rosacea
  • who have severe acne, such as nodulocystic acne

“It is important for consumers with scarred acne to see a doctor for effective acne medication and not waste time and money on over-the-counter treatments while their scars continue,” Dr. Sandy Skotnicki, dermatologist and author Beyond soap said.

“Patients with very severe cystic acne need medication to treat their disease.”

Isotretinoin is actually high doses of vitamin A, which, if you have too much of it, can cause side effects seen with too much vitamin A called hypervitaminosis A. Vitamin A is stored in the liver, so excessive and chronic consumption can be harmful.

You will want to avoid vitamin A supplements during this time.

Psychiatric side effects

Psychiatric side effects related to isotretinoin are controversial but have historically been thought to include a potential increased risk of:

  • depression and suicidal ideation
  • psychosis and mania
  • anxiety
  • stress

Physical side effects

Since isotretinoin works by decreasing the amount of oil in your skin, almost everyone will have dry skin, chapped lips, and a dry nose (up to a point of nosebleed), depending on the dose. given.

It also increases the risk of sunburn / sun sensitivity. Joint or muscle pain is also relatively common in very active people.

Worsening of your acne during the initial period of treatment is also common and is not a reason to stop treatment. Immediately notify your dermatologist if it is severe.

Other reports of physical side effects which should be reported to your doctor as soon as possible if they occur while taking the medicine include:

  • headache and dizziness
  • blurred vision and / or difficulty seeing in the dark
  • nausea or vomiting

You may have read information about isotretinoin concerns causing inflammatory bowel disease, but studies have largely demystified this association.

1. A dermis will work with you to determine the dosage

“The standard dosage for isotretinoin is given in two divided doses, with food, for 15 to 20 weeks,” explains Hollander. “The dosage is weight dependent and may be increased slowly on subsequent visits to the office.”

Typically, a dermatologist will start you off at 0.5 mg / kg per day (depending on your weight). Then they go increase your dose at 1.0 mg / kg per day after the first month, if your body seems to tolerate the drug.

The capsules are meant to be taken whole and about 80% of people will see fair skin within 4 months, although the course of treatment is often based on weight.

The total duration of a treatment can vary from 120 mg / kg to 220 mg / kg. The average course lasts 4-6 months and people who need more will need to take an additional treatment of 4 to 6 months.

2. You will see your dermis every month for monthly checks.

After starting isotretinoin, you will also need to see your dermatologist once a month. “Labs are set up every month to monitor liver functionality,” Hollander explains. Other ordered tests may include a lipid panel, a complete blood count, and even a pregnancy test.

If your lifestyle does not allow this regularity of appointments, you may not be a good candidate for the drug.

3. Stay hydrated throughout the process!

“I always encourage patients to drink a ton of water while taking this medication and to keep a small tube of Aquaphor on hand. Patients should also apply an SPF of 30 or higher to the face and body as they are at a higher risk of sunburn, ”says Hollander.

Dermatologists often recommend stopping all other acne products and prescribing a sensitive facial cleanser and moisturizer.

Oral isotretinoin is very drying, so skin moisturizers should be the focus of your skin care routine, instead of anti-acne ingredients, which can cause additional irritation.

It never hurts to double down on all your options if you don’t want to take isotretinoin. Ultimately, the effectiveness of treatment differs from person to person and it is worth making sure that your anxieties are allayed first.

1. Identify food, environmental and lifestyle stressors

“Your esthetician will want to look at your diet, environmental stressors, and lifestyle habits that can make rashes worse,” says Catherine Richardson, esthetician and owner of Holiday Organic Skin Boutique in Boston, MA.

“Exposing the contributing factors gives you the ability to make small changes and pivot on the path to a complexion you’re proud of.”

2. Keep your products hydrating and simple

Avoid rubbing, says Skotnicki, and wash your face at night. She also recommends using over-the-counter treatments with salicylic acid and benzoyl peroxide, 2.5 to 5% afterwards.

Richardson also suggests moisturizing, vitamin A-rich beauty products. “I recommend Blissoma Smooth A + Serum and a pure moisturizer for clients looking for alternatives to traditional acne treatments.

3. Be consistent with your routine

While the beauty aisle and candy-colored packaging may appeal to you, it’s best to stick to the same products for at least 28 days, and in some cases even 3 months (as with a topical retinoid).

28 days is roughly the time it takes for the outer layer of the skin to regenerate. “Consistency leads to great skin,” says Richardson.

4. Make changes to your diet

“Low-inflammatory diets can be beneficial,” Skotnicki says. Most people also report victories in limiting sugar and dairy products.

Surprisingly, there is evidence that low-fat dairy products can make acne worse, but these studies need stronger links before skim milk goes down the drain for good.

When it comes to chronic acne, a dermatologist and a prescription for isotretinoin may be a better acne army, especially if you have severe cystic acne or treatment-resistant rashes with scarring.

But if you’re worried about the potential side effects, don’t be afraid to keep asking questions, looking for alternatives, or getting a second opinion.

Ultimately, feeling empowered and confident in your choice means finding the right balance between your comfort and your needs.

Grace Gallagher is a writer living in Portland, Oregon. All his work can be found on

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