Celebrities may have used drugstore finds to treat acne (Constance Wu said in The New York Times).

Particularly, Isotretinoin was the “top-selling product […] with a sales volume of USD 1.2 million.” (This is the most current data on prescriptions for acne, as of 2016). It is also known as Accutane generic, which was discontinued in 2009.

The effectiveness of isotretinoin works by reducing the amount sebum on your skin. This eliminates a major factor in acne lesions.

“They will be found in the form of antibiotics, retinoids and anti-hormones”, says Jennifer Hollander is a board certified nurse practitioner with experience in both cosmetic and clinical dermatology.

While many people have had great success with the pill, there is still a lot of fear and stigma associated with oral isotretinoin. Here’s how you can decide if this is the right treatment for you.

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Do not believe that you must “suck it up”.

I was plagued by severe acne and wished there were a way to get rid of all my pimples. Acne can be very painful on the skin and affect self-esteem. There are also studies that show how it can lead to depression. Acne is more than just a cosmetic condition.

There’s nothing wrong with using prescription medications or antibiotics to treat acne. However, it is important to discuss side effects with your dermatologist.

Isotretinoin is good for anyone?

It is not possible to prescribe a single treatment for all cases of acne.

You will need to make a more complex decision. And if you’re tired of wasting money on products, you may be interested to hear that treatment-resistant acne usually actually requires prescription medication.

The closest thing we have to a cure for acne is isotretinoin. Everyone’s skin will improve with treatment.

Most people use isotretinoin to treat acne:

  • Acne sufferers who have acne scarring
  • Patients whose skin is resistant to OTC and/or more conservative prescription treatments
  • People with rosacea or other skin conditions
  • People with severe acne (nodulocystic)
  • “It is important that scarring acne sufferers see a doctor in order to receive effective medication. It’s not a waste of money or time using OTC treatments, while scarring continues,” Dr. Sandy Skotnicki (dermist) and author of  Beyond soap says.
  • “Patients suffering from severe cystic acne should be prescribed medication.”

What side effects should you be aware of?

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

During this time, you should avoid taking vitamin A supplements.

Psychiatric side effects of medication

Although side effects of isotretinoin on the mind are not well-known, they have been historically thought to include an increased risk of:

  • Suicidal thoughts and depression
  • Psychosis and Mania
  • Anxiety
  • Stress

 Physical side effects

Isotretinoin reduces the oil content of your skin and almost everyone will experience dry skin, chapped lips and dry nose. The dosage you are given may cause nose bleeding.

This increases your risk of sunburns/sun sensitivity. Very active people are more likely to experience joint pains or muscle aches.

It is possible for your acne to worsen during the first phase of treatment. This is normal and should not be considered a reason to stop treating. If it becomes severe, let your dermatologist know immediately.

You should also report any other side effects, if any, that occur while taking the medication.

  • Dizziness and headaches
  • Blurred vision or difficulty seeing in darkness
  • Nausea or vomiting

You may have heard about isotretinoin’s potential to cause inflammatory bowel diseases. However, studies have largely disproved this claim.

It is not recommended to be taken while you are pregnant.

Register for the iPLEDGE program before you can start isotretinoin. This program was created to prevent birth defects from isotretinoin.

  • Before you can get your prescription, you must use two forms or birth control.
  • You can still get pregnant even if you previously weren’t able to. Your prescription will not be filled until you have submitted proof of a negative pregnancy test.

How your journey with oral medication will look

1. To determine the right dosage, a derm will help you.

Hollander states that the standard dose of isotretinoine is administered in two equal doses with food for between 15 and 20 weeks. The dosage can be gradually increased during subsequent office visits.

A dermatologist will usually start you at 0.5 mg/kg every day, depending on your weight. If your body is able to tolerate the medication, they’ll increase your daily dosage to 1.0 mg/kg after one month.

Capsules should be swallowed whole. About 80 percent of people will have clear skin in 4 months. However, treatment is often based upon weight.

A treatment course can last anywhere from 120mg/kg up to 220mg/kg. A typical course lasts 4 to 6 months. Those who require more treatment will need to continue for 4 to 6 additional months.

2. Prepare for monthly check-ins.

You’ll need to visit your dermatologist every month after you start isotretinoin. Hollander says that liver function is monitored by drawing blood every month. You may also order a complete blood count and a lipid panel.

You may not be a candidate if your schedule doesn’t permit for regular appointments.

3. Keep hydrated during the entire process.

“I always advise patients to drink lots of water and to keep Aquaphor in their pocket,” Hollander states that patients should apply an SPF 30 or higher to their face and bodies, as they are more susceptible to sunburns.

Many dermatologists will recommend that you stop using any acne products, and instead prescribe a gentle face wash and moisturizing cream.

Oral isotretinoin is very drying and so hydrating skin products should be the focus of your skin care routine, instead of acne-fighting ingredients, which may cause extra irritation.

Are you thinking twice about oral medication? Have you’ve tried…

If you aren’t interested in taking isotretinoin, it doesn’t hurt to look at all options. The effectiveness of treatment will vary from person to person. It’s worth taking the time to soothe your fears.

1. Find out what lifestyle, environmental and dietary stressors you are.

Catherine Richardson, an esthetician who owns Holiday Organic Skin Boutique in Boston MA, says that “your esthetician will want you to dig into your diet and environmental stressors and lifestyle habits which may be exacerbating breakouts.”

“By identifying contributing factors, you can make small changes to get a skin you love.”

2. Make sure your products are hydrating. Keep it simple.

Skotnicki recommends that you avoid scrubbing your skin and instead wash it at night. Skotnicki also suggests OTC treatments with salicylic and benzoyl peroxide at 2.5-5 percent.

Richardson also recommends products that are rich in vitamin A, which can hydrate and moisturize. “I recommend Blissoma’s Smooth A+ Serum and Pure moisturizer to clients looking for alternatives to traditional acne treatments.”

3. Keep your routine consistent.

Although the beauty aisle with its candy-colored packaging might be tempting, you should stick with the same products at least 28 days or, in certain cases, 3 months.

28 days is the average time it takes for the skin’s outer layer to recover. Richardson states, “Consistency is the key to beautiful skin.”

4. Make diet tweaks.

“Low inflammatory diets may be beneficial,” Skotnicki says. People also report success when they limit sugar and dairy.

Surprisingly there are some studies that low-fat dairy may make acne worse. However, these studies require stronger links before we can pour skim milk down our drain.


A dermatologist and an isotretinoin prescription are two of the best options for chronic acne. This is especially true if you have severe cystic or other treatment-resistant breakouts.

If you are concerned about side effects, do not hesitate to ask questions, get alternative options, or seek a second opinion.

Feeling empowered and confident in your choices is about finding the middle ground between comfort and your needs.

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