Accutane side effects

Accutane Side Effects: What They Are and How You Can Best Deal with Them

Updated on August 5, 2022, by Don Mehrabi

Accutane is a brand of oral isotretinoin. Its vitamin A-like actions make it an excellent acne medication. However, the wide range of Accutane side effects makes close medical supervision imperative throughout the regimen. The FDA classifies it as a prescription drug, though some websites sell it illegally, transacting even without a prescription.

You may have heard all sorts of bad about this medication despite many success stories and medical experts’ glowing recommendations. So if you’re taking Accutane for the first time, it’s understandable to proceed with caution.

Accutane Side Effects Before and After
The Dramatic Results of Accutane Treatment

What things should you watch out for while on Accutane treatment? What can you and your dermatologist do to control them? What happens when you stop intake?

Learning to navigate the downsides of this highly effective acne therapy helps patients make the most out of it. This article provides information that can help you reach that goal.

Presently, the primary FDA-approved indication of oral isotretinoin is “severe recalcitrant nodular acne.” In simple terms, that means the persistence of many inflamed pimples at least 5 mm in size despite conventional treatment. Nodular acne may bleed or have pus.

Oral isotretinoin may also be prescribed to individuals with milder forms of acne vulgaris if the condition is causing severe physical or emotional distress. Patients must be non-pregnant and 12 years or older when they take the medication.

Side Effects of Accutane
Severe Nodular Acne

The drug has  also been used off-label–or without FDA approval–for the following skin conditions:

  • Darier disease, presenting with greasy, malodorous, wart-like lesions in body areas with plenty of oil (sebaceous) glands
  • Inflammatory forms of rosacea, especially if accompanied by skin oiliness
  • Pre-surgical treatment of hidradenitis suppurativa or the inflammation of hair follicles in sweat gland-rich areas
  • Some stubborn lupus skin manifestations
  • Treatment-resistant seborrheic eczema, a clinical form of the disease notable for producing greasy scales

However, only licensed physicians, such as board-certified dermatologists, can ensure the safety of off-label treatments.

How Does Accutane Work?

Acne formation is the culmination of several processes triggered by various factors. The main site affected is the pilosebaceous unit, which is made up of the hair follicle and the sebaceous gland attached to it.

The Pilosebaceous unit

The following are the most important processes leading to acne formation:

  • Abnormal cellular growth inside the hair follicles, clogging the skin pores
  • Excessive production of oil or sebum, which may also have an abnormal composition
  • Increased bacterial activity
  • Inflammation

These events may be triggered by hormonal changes, stress, medications, unhealthy eating, poor hygiene, immunologic dysfunction and many others.

Accutane is one of the most effective acne remedies because it acts at the genetic level to reverse all the processes creating the inflamed lesions. Its ability to modulate the skin’s immune response makes it powerful against acne-causing bacteria that have become resistant to conventional antibiotics.

How Acne Forms

How Accutane Fights Acne

In the first month of treatment, you may experience what is known as the “Accutane purge,” which looks like acne aggravation. But this is a period when the skin removes the dysfunctional cells in the hair follicles and sebaceous glands and replaces them with normal ones. Expect significant improvement by the third month. Complete clearance occurs from the fourth month onwards. This is a common term found when researching symptoms of Accutane.

Oral isotretinoin therapy is typically 15 to 20 weeks long. But in most patients, the skin continues to improve until 2-4 months after stopping intake. If you have a good response, your dermatologist may shorten the regimen to limit your side effect risk.

You may learn more about how isotretinoin therapy works by checking out our Accutane before-and-after treatment guide.

What Are the Side Effects of Accutane?

Oral isotretinoin can penetrate cells throughout the body, so it may potentially result in a number of adverse effects. We discuss them below.

Common Accutane Side Effects

These symptoms stem from the suppression of skin cell growth and oil secretion. Skin cells are similar in many ways to mucosal cells, so mucous surfaces are affected, too.

Common Accutane Side Effects

Common Accutane side effects include the following:

  • Skin dryness, redness and tightness
  • Photosensitivity due to skin thinning
  • Skin fragility that may result in cracking and peeling
  • Thinning and other changes in the hair and nails
  • Mucosal dryness, e. g. on the lips and mouth
  • Dry eye
  • Proneness to boils and other manifestations of Staphylococcus aureus infection, which sebum’s antimicrobial properties normally control

These symptoms are easy to manage, as we shall explain later. Sebum production usually returns to normal 2-4 months after the regimen and up to a year in rare cases.

Uncommon and Preventable Accutane Side Effects

Isotretinoin penetrates various tissues, so it can potentially cause the following systemic adverse effects:

Pregnancy and Fetal Issues

Accutane can cross the placenta. Some of the most serious consequences of taking this medication are its detriments to the unborn, which include the following:

  • Severe birth defects, which may result in infant death
  • Miscarriage
  • Premature birth

The drug can also remain in sperm. Patients must not be pregnant or considering having children while on isotretinoin treatment and a few months after.

severe side effects of Accutane
Premature birth is a severe side effect of Accutane. Patients can prevent it by using contraceptives during therapy

Musculoskeletal Problems

Accutane patients may experience muscle cramps, joint pain and bone pain. Osteoporosis and abnormal bone formation have been reported following its use.

Breastfeeding mothers must also be aware that this medication may be excreted in human milk. It can cause bone and cartilage abnormalities in very young children.

Effects on the Nervous System

Isotretinoin patients may develop “pseudotumor cerebri,” a benign condition presenting with increased pressure inside the skull, visual blurring, nausea and headache. It is mostly associated with the concomitant use of tetracycline antibiotics.

Psychiatric adverse effects have also been reported among patients on oral isotretinoin therapy. They include the following:

  • Depression
  • Hallucinations
  • Suicidal thoughts
  • Aggressive behavior

However, large-scale studies have not been able to establish a clear link between isotretinoin intake and mental health issues. Meanwhile, acne vulgaris is a known risk factor for emotional and social distress.

Metabolic Problems

Elevated blood levels of a type of lipid called “triglycerides” is another potential side effect of Accutane. Triglycerides can build up in the skin and cause yellow lumps called “xanthomas.” They can also stiffen the arteries and increase a patient’s risk of developing pancreatitis.

Accutane may also cause blood sugar elevation, making it highly risky for people with diabetes mellitus.

Effects on the Digestive System

Intestinal disturbances during isotretinoin therapy are uncommon, but nausea, stomach pain, vomiting, severe diarrhea and rectal bleeding can occur. The drug may aggravate abdominal symptoms in patients with inflammatory bowel disease, notably ulcerative colitis.

The liver is the main metabolic site of isotretinoin and other vitamin A-like drugs. Susceptible patients may experience a temporary elevation of liver enzymes—a sign of mild liver damage. Overt liver disease—the earliest symptoms of which are yellowing of the skin and darkening of the urine—is rare.

Pancreatitis, signified by deep abdominal pain, may occur with or without triglyceride elevation. The manifestations range from mild to severe.

Accutane Side Effects

Effects on the Blood

Accutane may cause clotting disturbance and decrease platelet counts, making patients prone to bleeding, bruising or stroke formation. It may also reduce red and white blood cell counts, resulting in anemia and immunosuppression.

Allergic Reaction

Isotretinoin by itself has a low chance of inducing hypersensitivity. However, the preservatives used in manufacturing isotretinoin capsules, specifically parabens, are likely to cause allergies. The manifestations include rashes, shortness of breath, kidney problems, etc.

Abnormalities of the Senses

Hearing impairment is a possible side effect of Accutane treatment, the reasons for which are unclear.

Visual disturbances may result from injury to the front part of the eye (cornea) due to lack of lubrication, a condition known as “dry eye syndrome.” Reduced night vision may occur, presumably due to the drug’s interaction with the vitamin A molecules in the eyes’ retinas.

Respiratory Issues

People on isotretinoin therapy may experience breathing problems, vocal disturbances or respiratory infections. These are thought to be due to mucosal changes in the breathing passageways. Asthmatics are especially vulnerable.

Menstrual Problems

Female patients on Accutane may experience menstrual irregularities, particularly amenorrhea or the absence of menstruation.

Again, isotretinoin’s more serious side effects are either rare or preventable. But we should emphasize that you must be under the care of a licensed physician to make sure you’re safely taking this drug.

The table below summarizes Accutane’s potential side effects:

The Top 11 Risks of Accutane Treatment
Common Side Effects Rare and Preventable Side Effects

Changes in the skin, hair, nails and mucosal surfaces

  • Dryness
  • Thinning and fragility
  • Susceptibility to Staphylococcus aureus infections

Pregnancy and fetal issues

  • Severe birth defects
  • Miscarriage
  • Premature birth

Musculoskeletal problems

  • Muscle, bone or joint pain
  • Muscle, bone or joint abnormalities in both adults and very young children

Effects on the nervous system

  • Pseudotumor cerebri
  • Accutane’s link to psychiatric problems remains unestablished

Metabolic problems

  • Increased triglyceride or sugar levels in the blood

Effects on the digestive system

  • Nausea
  • Vomiting
  • Stomach pain
  • Severe diarrhea
  • Rectal bleeding
  • Aggravation of inflammatory bowel disease, especially ulcerative colitis
  • Liver damage
  • Pancreatitis

Effects on the blood

  • Clotting disturbance
  • Anemia
  • Immunosuppression
Allergic reaction

Abnormalities of the senses

  • Hearing impairment
  • Visual disturbances

Respiratory issues

  • Shortness of breath
  • Vocal changes
  • Respiratory infections
Menstrual problems

Accutane is very effective. So you should seriously consider it if you want to prevent further breakouts, acne scars and the hassles they could bring. But remember that it is not the first line of acne therapy because of its potential hazards. Doctors recommend it only if the benefits will surely outweigh the risks.

How Can You Reduce the Side Effects of Oral Isotretinoin?

The best way to deal with Accutane’s side effects is to work with your doctor. Once you’ve started the treatment, you must watch out for new symptoms that could be drug-related and seek medical attention immediately.

Here’s a list of what your physician will do to ensure your safety during the treatment:

1. Assess Your Fitness for Isotretinoin Therapy

Patient screening is essential before recommending Accutane. Your doctor will take your full medical history and physical examination to look for possible contraindications. A physician can find clues to many pre-existing conditions from the patient consultation alone. Hearing problems, visual impairment and mental disturbances are some examples.

Patients on tetracycline antibiotics, such as minocycline and doxycycline, may be prescribed an alternative that doesn’t interact with isotretinoin. But the doctor may recommend a different acne treatment to those requiring medications that can affect the liver.

2. Take Baseline Blood Tests

Blood testing can help detect conditions that are not obvious during consultation. It is particularly important to people at risk, such as overweight individuals, undiagnosed diabetics and those taking liver-metabolized medications. Examples of blood tests are fasting blood sugar, fasting blood lipids and liver enzymes.

3. Pregnancy Testing and Birth Control Prescription

Birth defects and other fetal problems may be avoided by screening out pregnant patients and keeping eligible ones on birth control.

For female patients of childbearing age, the doctor will order a pregnancy test before starting Accutane. They must use two forms of contraceptives beginning at least one month before the treatment course and until one month after. A monthly pregnancy test is required until one month after completing the therapy.

Male patients must also use effective contraception to prevent Accutane transmission through the semen.

Fertility Side Effects of Accutane

4. Address Minor Complications

Your doctor will start you on the lowest effective dose to minimize your complication risk. But they may advise the following for non-life-threatening side effects:

  • Use moisturizers on dry skin.
  • Apply lip balm on chapped, dry lips.
  • Use eye drops or artificial tears for eye dryness.
  • Start antibiotics for skin infection.
  • Take a lipid-lowering medication for mild triglyceride elevation.
  • Reduce your Accutane dose, e. g. for hair loss.

Most patients respond to these measures and finish the treatment uneventfully. However, you may talk to your doctor about stopping midway if even minor side effects become intolerable.

5. Avert Other Serious Complications

Meticulous screening saves many patients from isotretinoin’s potentially life-threatening side effects. However, as in any other form of therapy, there remains a small chance of “idiosyncratic” or unexpected reactions to the medication.

Vigilance is key to preventing severe side effects. So expect frequent doctor visits and, possibly, regular blood testing during Accutane therapy.

Diagnostics include but are not limited to the following:

  • Muscle enzymes for complaints of muscle pain
  • Calcium, vitamin D and parathyroid hormone levels in the presence of bone pain or fragility
  • Liver enzymes if the physician suspects liver damage
  • Blood lipids and glucose for at-risk patients
  • Pancreatic enzymes for possible pancreatitis
  • Complete blood count and clotting function tests to look for blood problems

A mild blood test abnormality may be addressed by lowering the dose and continuation of monitoring. But the physician may stop the treatment if they find large deviations.

Other reasons for discontinuing Accutane therapy include new hearing or visual problems, psychiatric changes, respiratory issues, severe gastrointestinal symptoms, hypersensitivity and other conditions needing emergency treatment. The physician may also refer the patient to another specialist if needed.

Visual problems
Accutane may cause visual problems—a reason for stopping the treatment early.

Aside from working closely with your doctor, Accutane therapy has its own set of dos and don’ts. These measures can help you ensure the success of your treatment while preventing its serious consequences. Avoidance of cosmetic procedures, alcohol and blood donation are some examples. We explain them further in our Accutane before-and-after treatment guide.

Do Accutane Side Effects Go Away After Treatment?

If you entrust your therapy to an Accutane specialist, you won’t likely see any of the drug’s severe side effects. You would also be able to control the minor ones easily.

Accutane’s effects are dose-dependent—high amounts increase the odds of complications. But once you stop the treatment, it takes days to weeks before the side effects diminish.

As previously mentioned, sebum secretion may not normalize until 2-4 months after therapy for most patients and up to a year for some. You may have to continue treating skin and mucosal symptoms during this time.

Hair and nail changes will disappear gradually. In female patients, menstrual periods will become regular again.

Severe complications affecting specific organs may improve but not heal completely. Examples are hearing and visual impairment. Spare yourself the trouble by trusting only a bona fide Accutane expert.

Does Acne Come Back After Accutane Treatment?

Acne disappears after one round of Accutane therapy in about 85% of patients. The rest will require a second course, usually starting at least eight weeks after completing the first. The waiting period is necessary because the skin may clear up completely during this time.

About one-third of isotretinoin patients see a relapse three years on average after finishing the regimen. Most respond to conventional acne remedies, while the rest benefit from starting another round of Accutane treatment.

People with high blood levels of testosterone and testosterone-like hormones, e. g. pubertal kids, males, and other patients with such hormonal imbalance, are at risk for relapse. Patients diagnosed with “acne conglobata”—a potentially disfiguring form of inflamed acne—are also more likely to see a recurrence after Accutane therapy.

After Accutane

Why Is It Important to Entrust Your Acne Treatment to a Board-Certified Dermatologist?

Acne is a multifactorial condition that can produce physical and emotional scars. The best thing about having a board-certified dermatologist solve this problem is that they are the authority on safe and effective skin care.

Dermatologists have a keen clinical eye for determining the best Accutane therapy candidates and screening out those who are not. They have extensive expertise in managing the drug’s minor downsides and preventing the more serious ones. They are also your most reliable source of medical advice for keeping your skin healthy and looking gorgeous for a long time.

Bottomline, the best healthcare provider to lean on for a complex skin issue like acne is a board-certified dermatologist.

Getting a Radical Acne Treatment Without Its Radical Side Effects

Accutane is a brand name for the vitamin A-like medication isotretinoin. It is highly effective against severe, treatment-resistant nodular acne. However, it may produce potentially disabling or life-threatening side effects if used inappropriately or without strict medical supervision.

Skin and mucosal changes are the most common of Accutane’s possible side effects, and they are treatable. Meanwhile, birth defects and other pregnancy problems are some of its worst complications. You may prevent them by taking a pregnancy test monthly and using effective birth control while on the regimen.

But as always, the best way to get rid of acne safely and effectively is to consult a board-certified dermatologist. They specialize in a vast array of acne treatments, including Accutane. They are your best hope for restoring your skin’s radiance and keeping it blemish-free.

Leave Acne to LA’s Most Trusted Skin Care Specialists

Acne lesions are more complicated than they look. The wrong treatment can cause permanent scarring that, if bad enough, can shatter people’s confidence. If multiple failed regimens are starting to frustrate you, it’s high time you let an acne expert help.

At BHSkin Dermatology, our skin doctors have years of experience getting rid of this problem safely and effectively. And Accutane treatment is one of their many specialties. Visit us at our Glendale or Encino office or use our virtual portal for a consultation.

Book your appointment today!


Author: Don Mehrabi

Don Mehrabi, MD, FAAD, is LA’s leading board-certified dermatologist who treats patients, builds the BHSkin clinics, and raises three kids. This blog builds on medical studies combined with Dr. Mehrabi's first-hand experiences from practicing in Encino-Tarzana, Glendale, and online

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