Isotretinoin: Who It Suits and Its Side Effects
Part of: Acne
When isotretinoin is the right treatment, how long a course lasts, how to manage dryness and sun sensitivity, why blood tests and mood checks matter, and the strict pregnancy-prevention rules and why.
Acne · 2 min read · August 22, 2026
Written and medically reviewed by Dr. Yousef Abo Zarad · German board-certified dermatologist · Last reviewed: September 2026
Key takeaways
- Isotretinoin is a prescription medicine for severe acne: deep, painful cysts and nodules, or acne that scars or doesn't respond to treatment.
- A course usually lasts 4 to 5 months, with a follow-up visit every 30 days.
- It often gives long-lasting clearance, which can be permanent for some patients.
- Dryness is the most common side effect and is managed with simple steps.
- It causes serious birth defects, so the pregnancy-prevention rules are strict, with no exceptions.
Who is isotretinoin for?
- Severe acne with deep, painful cysts and nodules.
- Acne that leaves scars.
- Acne that hasn't improved despite appropriate treatment taken as directed.
- Acne that clearly affects mood and quality of life.
The decision doesn't rest on how many spots you have on one day, but on severity, scarring and response to earlier treatment.
How long does treatment last?
One course usually takes 4 to 5 months, sometimes a little less or more. Each prescription covers 30 days, with a monthly follow-up visit in person or by telemedicine.
Acne may get worse for the first 1 to 2 months before it starts to clear; this is temporary.
Common side effects and how to manage them
| Effect | What to do |
|---|---|
| Dry, chapped lips | Petroleum jelly throughout the day and at bedtime, and lip balm with SPF 30 or higher outdoors |
| Dry skin | An oil-free moisturizer on the face, neck, shoulders and back |
| Dry eyes | Saline drops or artificial tears |
| Dry nose and nosebleeds | A moisturizing nasal spray or a very small amount of petroleum jelly inside the nose |
| Sun sensitivity | Broad-spectrum, water-resistant sunscreen with SPF 30 or higher, reapplied every 2 hours |
Side effects to report right away
- Mood changes, depression, anxiety, or any thoughts of self-harm.
- Signs of bowel inflammation, such as severe stomach pain or bloody diarrhea.
- Any chance of pregnancy.
If thoughts of self-harm appear, stop the medicine and contact your doctor or emergency services right away.
Why are blood tests needed?
Isotretinoin can raise triglycerides, cholesterol and liver enzymes, so blood tests are done before and during treatment to monitor them. Changes are usually mild and return to normal, and your doctor decides what's needed based on the results.
Pregnancy: rules with no exceptions
Isotretinoin causes serious birth defects. So anyone who can become pregnant must:
- Have two pregnancy tests before the first prescription, then a pregnancy test every 30 days.
- Use two forms of birth control together, or remain abstinent.
- Keep this up for one month before starting, throughout treatment, and for at least one month after the last dose.
What to avoid during treatment
- Vitamin A supplements.
- Topical retinol, benzoyl peroxide and sulfur.
- Exfoliants of any kind: acids and scrubs.
- Fragranced and dyed products.
- Don't share your medicine with anyone, and don't donate blood during treatment.
Common questions
- Does acne come back after isotretinoin? Skin often stays clear for a long time, permanently for some patients, though some need further treatment later.
- Does it cause depression? It can change mood in some people, and severe acne itself can cause depression, so mood is checked at every visit.
- When can I treat my scars? Your doctor will advise the right time for laser or microneedling after the course ends.
Key numbers
- One month before and after: birth control around the treatment period.