7 side effects of isotretinoin (Accutane)

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Overview

When other acne treatments don’t work, many dermatologists turn to medications, specifically isotretinoin.

You may know this best by its former brand name, Accutane. It’s a form of vitamin A that’s been shown to relieve severe acne. It’s thought to work by reducing how much oil your skin produces, slowing down the growth of skin cells that can clog pores. This creates an environment that makes it difficult for acne-causing bacteria to thrive.

But just because it can be very effective doesn’t mean every dermatologist will prescribe it to everyone. It can have some strong side effects, ranging from back pain and headaches to pregnancy-related issues.

With that in mind, it’s helpful to know more about the common side effects of isotretinoin and how to manage them.

1. Dryness

According to the National Institutes of Health (NIH), the most common side effect of isotretinoin is dryness. In fact, dry, chapped lips affect up to 90% of people taking this drug. Other dryness-related effects include:

• dry skin
• dry mouth
• sun sensitivity
• nasal dryness, which can lead to nosebleeds

Isotretinoin can also dry out your eyes. That can be especially uncomfortable if you wear contact lenses. Using artificial tear drops may help keep your eyes moist and lower the risk of infection, according to the American Academy of Dermatology (AAD).

Dryness of your skin, eyes, nose, and mouth should go away when you finish your course of isotretinoin, which usually lasts 15 to 20 weeks. Until then, there are some strategies you can use to manage dryness. This includes:

• staying hydrated by drinking plenty of water each day
• using moisturizer on your skin
• applying petroleum jelly to chapped lips
• applying petroleum jelly inside your nose or using a nasal spray
• practicing sun safety to avoid the negative effects of sun sensitivity

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2. Joint, back, and muscle pain

According to a small 2020 study, low back pain is one of the most common complications of isotretinoin. Of the 94 people in the study who took isotretinoin, 66 of the participants experienced low back pain. This side effect seemed to be more likely in people who took higher doses of isotretinoin.

According to the same 2020 study, joint pain and muscle aches affected about 20% of people who took isotretinoin.

So, why does isotretinoin cause joint pain? Researchers don’t quite know why this happens. But it may have to do with isotretinoin’s effects on the cells that line your joints.

If you have joint or muscle pain while taking isotretinoin, it’s a good idea to talk with your doctor. Typically, the pain should go away once you stop taking isotretinoin.

3. Headaches

According to the American Osteopathic College of Dermatology (AOCD), 5% of people who take isotretinoin experience headaches while taking this drug. In most people, headaches are not a cause of concern, but the drug can increase the pressure in the head. In rare cases, this may lead to vision loss or serious brain issues.

Be sure to tell your doctor if you have:

• persistent headaches
• blurred vision
• dizziness
• nausea
• vomiting
• seizures

4. Worsening acne

Sometimes, acne symptoms can worsen before they get better. This can be the case with isotretinoin.

At the beginning of your treatment, it’s possible you may notice more breakouts and your acne may seem worse than before. This is common, but know that it’s usually temporary. According to the AAD, it can be around 1–2 months before your skin starts to clear up.

5. Problems with fetal development

Taking isotretinoin while pregnant can cause severe fetal development issues, pregnancy loss, and stillbirth. It has a black box warning from the Food and Drug Administration (FDA). This is a warning on the medication to inform people and healthcare professionals of a very serious adverse effect.

According to the AAD, if you’re of reproductive age, you will need to take two pregnancy tests to show you’re not pregnant before a doctor can prescribe the medication. You’ll also have to take monthly pregnancy tests and use two forms of birth control for as long as you’re taking the medication.

6. Thinning hair

According to the AOCD, 10% of people experience thinning hair while taking isotretinoin. The same effects that help curb acne, such as slowing cell growth and oil production, may also affect hair growth. This is especially true if you’re taking a very high dose of isotretinoin. This side effect should stop once you stop the medication.

7. Depression

Some people may experience depression while taking isotretinoin. More research will help determine whether depression is due to isotretinoin.

According to some research, acne may have links with an increased risk of depressive symptoms. Treating it may help reduce these symptoms.

Isotretinoin benefits

While these side effects may seem daunting, it’s important to remember that they go away after your course of treatment. Also, dryness, the most manageable side effect, is typically the most common reaction.

The main benefit of isotretinoin treatment is its effectiveness.

After a round of treatment, or 2 pills per day for 4 to 5 months, 85% of people who take isotretinoin have clear skin.

Most people won’t need any more treatment for their acne, although some may need a second round of isotretinoin.

Research also suggests that treating acne can improve your quality of life by lowering symptoms of depression and distress.

Summary

Isotretinoin, formerly known as Accutane, is a strong medication that’s prescribed to treat acne. It’s known for being a highly effective acne treatment, but it’s also known for having certain side effects.

Some of these side effects can be mild, but they include dry skin and lips, worsening acne before it improves, and joint pain. These usually go away after finishing treatment. It’s important that you not take isotretinoin if you’re pregnant, as it can cause pregnancy loss, stillbirth, or fetal development issues.

If you have any concerns about isotretinoin side effects, be sure to talk with your doctor or healthcare professional.

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