Does Accutane Cause Weight Gain? A Dermatologist Breaks Down the Facts

Accutane, a widely recognized brand name for isotretinoin pills, is a medication that has taken the treatment of severe acne to a whole new level. It’s frequently regarded as a game-changer by patients—even A-listers—who’ve struggled tenaciously with stubborn breakouts.

Despite being around for decades, the drug continues to attract much attention on social media, where scientific facts often mix with health misinformation. One question that comes up often is, does Accutane cause weight gain?

The seemingly endless maze of truths and opinions can make it hard for new users to know what to believe. This article unpacks what research actually shows.

What Kind of Medication Is Accutane?

Accutane is a widely reputed brand name for isotretinoin, a vitamin A–like medication taken in pill form. It’s primarily prescribed for severe acne that hasn’t responded to other therapies.

The drug fights pimples by shrinking oil glands, preventing clogged pores, limiting acne-causing bacteria, and reducing inflammation. By addressing this skin condition at multiple levels, isotretinoin provides long-lasting improvements for difficult-to-treat blemishes.

However, oral medications like isotretinoin can impact various parts of the body. This is concerning, as many patients aren’t clear on the treatment’s possible snags.

Common side effects of isotretinoin typically affect the skin and moist tissues: red, tight, or dry skin, thinning hair and nails, chapped lips, dry eyes and mouth, sun sensitivity, and, sometimes, skin infections. Vulnerable individuals may report body aches, nausea, or stomach upset. Most of these symptoms are mild and may be managed with proper care. 

Your healthcare provider may also caution you that oral isotretinoin therapy can have serious but rare and mostly preventable side effects. The most important are pregnancy-related, including miscarriage and severe birth defects. That’s why female patients who can get pregnant are usually advised to use two forms of birth control—while male patients are counseled on condom use—to prevent pregnancy while on this acne treatment.

Other uncommon issues include liver stress, clotting problems, and changes in hearing or night vision. These symptoms may be managed by adjusting the dose or pausing treatment. Some patients report mood changes, though evidence linking isotretinoin to mental health concerns is limited.

As for the drug’s impact on weight, it helps to understand how it influences your body’s “metabolism,” meaning the way it handles nutrients, medications, and other substances you take. Does isotretinoin really make you heavier? The answer is more complex than it seems.

What Does Research Say About Accutane and Weight Gain?

Data show that isotretinoin can influence fat and sugar metabolism. Studies report increases in triglycerides, the main components of fat cells, along with higher LDL (“bad”) cholesterol and lower HDL (“good”) cholesterol.

Insulin resistance may also arise, meaning the hormone insulin becomes less effective at moving sugar into the liver and muscles. When this happens, excess sugar stays in the bloodstream and is more likely to be stored in fat tissue, which can contribute to weight gain.

In theory, these changes suggest that conditions such as obesity, diabetes, and metabolic syndrome—all risks for heart disease—could occur during isotretinoin therapy. However, what’s biologically plausible isn’t always observed in studies or clinical practice. 

The thing is, research hasn’t found a consistent connection between isotretinoin therapy and weight gain. Some report both weight loss in certain patients and weight gain in others, while a few detect weight gain alone. Notably, the FDA’s product information lists weight loss, but not weight gain, as a possible Accutane side effect.

Weight fluctuation during treatment can’t be explained by simple calorie math alone. Everyone’s body responds differently. Your genes, general health, hormonal balance, and other prescriptions can all shape how isotretinoin works for you.

Still, Why Is Weight Gain a Common Concern with Accutane Treatment?

Despite the lack of a strong correlation, certain features of isotretinoin therapy—and the way patients interpret them—can affect actual or perceived changes in body weight. Let’s examine these factors.

Tricky Tips on Eating Habits

Your healthcare provider may recommend taking isotretinoin pills with a fatty meal to improve absorption. While this strategy helps the drug work, the extra fats can raise your overall calorie intake, which may lead to weight gain.

Possibly Reduced Physical Activity

Body aches and fatigue, if they occur, can reduce motivation to exercise regularly. When present, vision changes, mood fluctuations, sun sensitivity, or nausea can also make staying active more difficult. Over time, lower overall activity levels can promote weight gain, especially if you’re already prone to a sedentary lifestyle.

Age as a Wildcard Factor

Most people taking isotretinoin for severe acne are older adolescents or young adults, still close to their peak growth. For example, in the United States, a study of nearly 20,000 female patients found a median age of 20.6 years. Other reports confirm a similar age range among isotretinoin users.

At this age, your body is still completing growth and naturally adjusting metabolism. Some changes in body weight can occur regardless of medication intake. This means that any pounds you put on during isotretinoin treatment may reflect normal development as much as the impact of the drug.

Medication Effect on Thyroid Function

Research indicates that isotretinoin can interfere with thyroid gland function. Reduced thyroid hormone levels may slow metabolism, increase fatigue, and influence body weight regulation. Over time, this metabolic slowdown can make gaining weight easier.

However, these effects are uncommon and typically seen only in susceptible individuals. Screening physically and monitoring thyroid hormone levels with a blood test help identify these changes early.

Water Retention

In rare cases, isotretinoin may lead to mild water retention, though the reason isn’t fully clear. This transient fluid shift can cause short-term increases on the scale that don’t reflect fat gain.

Signs of water retention include facial puffiness and swelling of the hands or ankles that often resolves on its own. In contrast, real weight gain tends to be gradual and persistent.

Gut Feelings That Miss the Mark

If you’re new to isotretinoin, it’s natural to have questions or misconceptions about weight loss or gain while on therapy. For example, a study in Saudi Arabia found that overall knowledge about isotretinoin’s side effects was low, with the highest score being only 4 out of 9. Even participants with university education, who scored highest by educational level, averaged just 2.28 out of 9.

Only 1 out of 4 reported getting counseling from a healthcare provider, while 1 out of 5 relied on the internet. Nearly half of the people surveyed said they hadn’t received any information about isotretinoin’s side effects. These results signify that misunderstandings about the drug can occur when patients don’t obtain proper guidance from a trusted source.

On a related note, research in women using both isotretinoin and oral contraceptives found only small, inconsistent changes in hormone levels, without causing significant side effects. Yet, hormonal birth control can make some patients feel their weight has changed, even when the scale shows no difference.

How Do You Keep a Healthy Body Weight While on Accutane Treatment?

Since this acne medication has no established effect on body weight, any changes during treatment remain under your control. Maintaining a healthy weight requires no magic tricks, just the same tried-and-tested measures discussed below.

Plan Your Meals

You only need one higher-fat meal each day—the one when you take your medication. Then eat lighter, lower-fat foods the rest of the time to balance your overall calorie intake. Pairing this approach with good hydration helps prevent drying of the skin and moist tissues, supports digestion, and allows your body to handle the treatment more easily.

Maintain an Active Lifestyle

Skipping your workouts might feel easier when your muscles or joints ache. But inactivity can actually worsen stiffness and soreness.

Instead, aim for a gradual return to movement with joint-friendly exercises like walking, gentle stretching, or any low-impact activity you enjoy. Regular exercise not only eases aches but also helps reduce water retention, improve circulation, and keep your body functioning optimally throughout treatment.

Destress

Stress can actually have a stronger influence on body weight than isotretinoin. When you’re constantly stressed, your body releases more cortisol, a hormone that can stimulate appetite, drive fat storage, and make it harder to manage calories.

Stress can also trigger emotional eating or cravings for high-calorie foods. Worse, it can spark an acne breakout or other skin problems. 

To counter these effects, focus on destressing with mindfulness exercises, meditation, getting enough sleep, and avoiding your stress triggers. Managing stress helps keep your body weight in check, boost the effectiveness of your acne treatment, and support your skin’s health.

See Your Acne Treatment Provider Regularly

Acne isn’t just an ordinary skin problem. For many people, it can affect emotional well-being and self-esteem, necessitating medical attention.

When you add isotretinoin to the equation, the need for physician oversight becomes even more important. Regular checkups ensure you get the full benefit of the treatment without unnecessary risks, such as abrupt changes in weight or metabolism.

Since acne is a skin condition, your best treatment partner is a board-certified dermatologist, as they’re experts in both medical and cosmetic dermatology. That means besides helping you clear pimples and prevent future breakouts, a board-certified dermatologist can take care of acne scars and other marks to restore your skin’s natural glow.

Accutane May Not Cause Weight Change… But Stay Vigilant

While research fails to reveal a direct relationship between isotretinoin therapy and weight gain, remaining cautious is still crucial. Indirect contributions to body weight may arise from certain aspects of the regimen, including some of the drug’s side effects, patient factors, and measures taken to ensure treatment success.

Preventing unwanted effects requires lifestyle adjustments, careful monitoring, and regular doctor checkups. Teaming up with a medical professional experienced in getting rid of acne with isotretinoin helps ensure you get safe and effective care for this skin issue.

Finally, the decision to start isotretinoin for acne is a huge one. Not all healthcare providers are trained to deal with this inflammatory skin condition or figure out when recommending isotretinoin is the right move.

There are many options for managing pimples, but only a board-certified dermatologist specializes in treating them effectively and gets lasting results. To achieve the best outcomes from your acne treatment, entrust your care only to a highly skilled board-certified dermatologist.

Curious about Accutane treatment? Ask LA’s top acne docs 

Unlike topical treatments, oral isotretinoin is highly effective against stubborn pimples. But therapy requires careful medical supervision due to potential side effects. Some patients experience minor reactions, while others may face a higher risk of developing worrisome complications. Since treatment responses vary from person to person, professional guidance is essential.

At BHSkin Dermatology, our acne specialists are among the best in Los Angeles. Our patients are truly impressed with the reliable, individualized skin care and thorough instructions they receive at every session. Visit our Glendale or Encino clinic, or use our telederm platform for your initial consultation.

Count on our team of experts for your skin health. Book your appointment today!

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Author: Don Mehrabi

Don Mehrabi, MD, FAAD, is LA's leading board-certified dermatologist is the president of BHSkin Dermatology and proud father of 3 wonderful children. He treats patients in both Encino-Tarzana and Glendale. This blog builds on medical studies combined with Dr. Mehrabi's first-hand experiences from his practice.