What Derms Want You to Know Before Starting Accutane

This acne treatment is highly effective, but do your research first.

Occasional breakouts are usually managed with over-the-counter products or a skincare regimen recommended by your dermatologist. Ongoing, severe cystic acne is an entirely different story, though, and often requires a more aggressive treatment approach. Enter: Accutane. The brand name for isotretinoin, Accutane is a powerful oral retinoid prescription that’s been given the FDA stamp of approval for treating acne.

“Ideal candidates are those with inflammatory acne, scarring acne, or acne that is not responsive to other treatments,” says Brendan Camp, MD, a board-certified dermatologist at MDCS Dermatology in Manhattan. “It reduces oil production and normalizes skin cell turnover to prevent the formation of acne lesions.”

He adds that what separates isotretinoin from other acne treatments is the durability of its acne-clearing effect even after you’ve finished the medication. In other words, it targets existing acne while preventing future episodes of extreme breakouts.

As mighty as Accutane is, there are a number of considerations to keep in mind. Your dermatologist will ultimately help you determine whether Accutane is right for you, but here are some things you should know before starting this medication.

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You Can’t Be Pregnant or Breastfeeding

Accutane is off limits if you’re pregnant, thinking about getting pregnant, or breastfeeding. It can cause birth defects, and can also get into your breastmilk and potentially harm your baby. Dr. Camp says, “Female patients on isotretinoin are required to document some form of contraception, including abstinence, throughout the course of treatment.”

He adds that you’ll also be registered in a risk evaluation and mitigation strategy (REMS) program to reduce the chance of a child being born with birth defects related to isotretinoin exposure.

Things Can Get Worse Before Getting Better

“Your cystic acne can actually flare up at the beginning of taking Accutane, and your doctor might prescribe a topical medication to take with Accutane to decrease the effect of purging,” says Julie Russak, MD, a NYC-based board-certified dermatologist. Try not to panic if this happens to you—it’s part of the process and a sign the medication is working.

Accutane Will Dry You Out

Accutane will make you dry. Not like a little dry, but the kind of dry where your lips are constantly chapped and you’re prone to nosebleeds. “Dryness can be intense, and this is due to the fact that the medicine is decreasing sebum production as its primary action,” says Lauren Penzi, MD, board-certified dermatologist. “Moisturizer and lip balm will be necessary to apply liberally when on Accutane.” The higher your dosage, the more extreme the dryness.

You’ll Be More Sensitive to the Sun

Along with drying you out, Accutane can make your skin much more sensitive to the sun. “The worst sunburn I’ve ever seen was a patient on Accutane who was skiing during the winter,” Dr. Russak says. “You have to be very on top of sunscreen while on Accutane.”

It Works Better When Taken With Food

Here’s your excuse to snack a bit more than usual. Dr. Penzi says, “Accutane works better when taken with food, particularly high fat foods. Taking Accutane twice daily with a high fat meal increases the absorption of the medication, and thereby increases its efficacy.”

Drinking Alcohol is a No-No

Accutane is metabolized by your liver, so it’s important to avoid anything that can put additional strain on this important organ, says Dr. Westbay. Alcohol can potentially interfere with the way your body metabolizes the Accutane, which puts you at an increased risk of alcohol poisoning.

Treatment Lasts About 6 Months

A typical course of isotretinoin treatment lasts around six months. Dr. Camp says, “The reason for this is to reach a cumulative dose based on the patient’s weight. Patients who do not reach the goal dosage range may have a greater risk of acne recurrence.” Some patients find that the side effects are very uncomfortable, which can make the six month period difficult to get through.

Your Doctor Will Want to Monitor Your Treatment

Getting on an Accutane treatment isn’t a “See you in six months” sort of deal. Your dermatologist will want to check in with you often to see how things are going and adjust treatment if necessary.

“Every provider has their own way of doing this,” says Rachel Westbay, MD, a board-certified dermatologist at Marmur Medical. “I check my patients' blood at baseline and then one month into therapy, as well as two months into therapy after I have doubled their dose to their maximum daily allowable dose (provided they tolerated the first month at half dose well).”

Dr. Westbay says this monitoring is crucial since Accutane can potentially affect liver function, white blood cell count and cholesterol.

You Really Should Complete The Course of Medication

In order to see and maintain Accutane benefits, it’s crucial to stay the course. “Many patients see improvement after a few months and want to stop, but I warn patients that if they stop prematurely, it is likely their acne will return,” says Dr. Penzi.

It’s Powerful, But Everyone Responds Differently

Accutane is very powerful, and many people see tremendous results with their treatment. However, every person responds uniquely and it’s not always a slam dunk right out of the gate. “While isotretinoin is not a cure for acne, it is thought to be the most effective form of treatment because the effects of treatment continue after the treatment has ended,” Dr. Camp says. “Some patients may require more than one treatment course, but most patients do well after only one.”

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