Isotretinoin (Accutane®)

Oral Retinoid
Compare To Other Treatments

What Is It?

Isotretinoin is a vitamin A derivative called a retinoid that is taken orally and is approved only for severe acne. It is thought to clear acne primarily through its ability to permanently reduce skin oil (sebum) production.


Strength of Evidence
Average 87% reduction in acne after 18 weeks
  1. Ye, D. et al. A prospective, randomized, split-face study of concomitant administration of low-dose oral isotretinoin with 30% salicylic acid chemical peeling for the treatment of acne vulgaris in Asian population. Int J Dermatol 61, 698–706 (2022).
  2. Li, Y. et al. Efficacy and safety of low-level light therapy by delicate pulsed light combined with low-dose oral isotretinoin for the treatment of acne vulgaris: a randomized split-face study. Lasers Med Sci 37, 3221–3229 (2022).
  3. Van, T. N. et al. Efficacy of oral isotretinoin in combination with desloratadine in the treatment of common vulgaris acne in Vietnamese patients. Open Access Maced J Med Sci 7, 217–220 (2019).
  4. Pandey, D. & Agrawal, S. isotretinoin and antihistamine versus isotretinoin alone in the treatment of moderate to severe acne: a randomised control trial. Kathmandu Univ Med J (KUMJ) 17, 14–19 (2019).
  5. Zaenglein, A. & Del Rosso, J. An open-label study evaluating the long-term efficacy, quality of life, and safety of lidose-isotretinoin (absorica) capsules administered without food in patients with severe recalcitrant nodular acne: Interim analysis of 20-week active treatment period. SKIN The Journal of Cutaneous Medicine 2, (2018).
  6. Tan, J. et al. A treatment for severe nodular acne: a randomized investigator-blinded, controlled, noninferiority trial comparing fixed-dose adapalene/benzoyl peroxide plus doxycycline vs. oral isotretinoin. Br J Dermatol 171, 1508–1516 (2014).
  7. Rademaker, M., Wishart, J. M. & Birchall, N. M. Isotretinoin 5 mg daily for low-grade adult acne vulgaris--a placebo-controlled, randomized double-blind study. J Eur Acad Dermatol Venereol 28, 747–754 (2014).
  8. Lee, J. W. et al. Effectiveness of conventional, low-dose and intermittent oral isotretinoin in the treatment of acne: a randomized, controlled comparative study. Br J Dermatol 164, 1369–1375 (2011).
  9. Strauss, J. S. et al. A randomized trial of the efficacy of a new micronized formulation versus a standard formulation of isotretinoin in patients with severe recalcitrant nodular acne. J Am Acad Dermatol 45, 187–195 (2001).
  10. Gollnick, H. P., Graupe, K. & Zaumseil, R. P. Comparison of combined azelaic acid cream plus oral minocycline with oral isotretinoin in severe acne. Eur J Dermatol 11, 538–544 (2001).
  11. Prendiville, J. S., Logan, R. A. & Russell-Jones, R. A comparison of dapsone with 13-cis retinoic acid in the treatment of nodular cystic acne. Clinical and Experimental Dermatology 13, 67–71 (1988).
  12. Pigatto, P. D. et al. Isotretinoin versus minocycline in cystic acne: a study of lipid metabolism. Dermatologica 172, 154–159 (1986).
  13. Lester, R. S., Schachter, G. D. & Light, M. J. Isotretinoin and tetracycline in the management of severe nodulocystic acne. Int J Dermatol 24, 252–257 (1985).
  14. Strauss, J. S. et al. Isotretinoin therapy for acne: results of a multicenter dose-response study. J Am Acad Dermatol 10, 490–496 (1984).
  15. Cörlin, R., Maas, B. & Mack-Hennes, A. 13-cis-retinoic acid. Low dosage oral use in acne papulopustulosa. Results of a multicenter study. Hautarzt 35, 623–629 (1984).
  16. van der Meeren, H. L. et al. Dose-response relationship in isotretinoin therapy for conglobate acne. Dermatologica 167, 299–303 (1983).
  17. Jones, D. H., King, K., Miller, A. J. & Cunliffe, W. J. A dose-response study of I3-cis-retinoic acid in acne vulgaris. Br J Dermatol 108, 333–343 (1983).
  18. Peck, G. L. et al. Isotretinoin versus placebo in the treatment of cystic acne: A randomized double-blind study. Journal of the American Academy of Dermatology 6, 735–745 (1982).
  19. Goldstein, J. A. et al. Comparative effect of isotretinoin and etretinate on acne and sebaceous gland secretion. J Am Acad Dermatol 6, 760–765 (1982).
  20. Farrell, L. N., Strauss, J. S. & Stranieri, A. M. The treatment of severe cystic acne with 13-cis-retinoic acid. Evaluation of sebum production and the clinical response in a multiple-dose trial. J Am Acad Dermatol 3, 602–611 (1980).

Side Effects

High side effects and adverse reactions's Real World Take

The nuclear option. It works reliably and provides long-term remission of acne, and even severe acne, in about ⅔ of people who properly take an adequate dosage. However, it permanently and irreversibly changes the skin and the body forever and users may experience long-term side effects for the rest of their lives. It’ll nuke it, but there is no going back.


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