Almost everyone experiences acne at some point, but for some, it’s more serious than the occasional bout of adolescent blemishes. If you’ve been through cycles of prescription topical and oral treatments and over-the-counter cleansers, then wondered what comes next when painful breakouts keep returning despite your best efforts, it’s natural to start seeking out stronger solutions.

, or isotretinoin, is one of the most well-established treatments for severe or treatment-resistant acne. While it is true that this prescription-only medication has offered life-changing outcomes for some people, it does come with side effects that deserve honest discussion.

How Accutane Works

Accutane is classified with medications called retinoids, which are derived from vitamin A. Other retinoids include , adapalene, and tazarotene, all topical treatments you may already be familiar with. However, unlike those that you apply directly to your skin, Accutane is an oral medication that lets its active ingredients work systemically throughout your body. Because it works from the inside out, the medication can target multiple contributing factors that lead to acne: Oil production, cellular turnover inside the pore, and inflammation.

First, it targets your sebaceous or oil glands, causing them to shrink and become less active, reducing the amount of oil your skin can produce. Because there is less oil, your pores are less like to become clogged, creating the conditions that lead to bacterial overgrowth.

Second, it helps your skin shed dead cells more efficiently. The lining of your pores are made up of skin cells that grow and shed regularly. In acne-prone skin, these cells tend to shed unevenly, clumping together due to the excessive oil, and forming “plugs” that block pores. Accutane reduces the tendency of cells to build up inside the follicle, so you’re less likely to develop painful forms of blemishes like comedones and cysts.

Finally, this medication helps address the inflammation that acne causes. When pores get clogged with the combination of bacteria, dead skin cells, and oil, your immune system causes an inflammatory response, resulting in the painful swelling and redness that accompanies blemishes. Accutane does double-duty to keep that inflammatory response under control: indirectly, it limits that pore buildup that sets off your immune system in the first place. Directly, it reduces pro-inflammatory cytokines within your skin.

What You Can Expect During Accutane Treatment

Accutane changes how your skin functions, so you’ll notice some predictable side effects over the course of your treatment, the most common of which is dryness. Your lips may chap easily, your skin can feel tight, and even the inside of your nose can feel dry. This happens because your sebaceous glands are less active, so your skin doesn’t have a consistent source of natural oils. As with all retinoids, you’ll also be more sensitive to sunlight, so wearing your SPF every day is an absolute must.

Apart from these common side effects, some people also notice muscle or joint aches because isotretinoin affects the way your body processes fats and interacts with musculoskeletal tissue. For most, the discomfort is mild and manageable, but it’s something to be aware of and to mention at follow-up visits.

Your dermatologist will also order routine blood tests throughout your course of Accutane to monitor your liver function and cholesterol levels. The liver metabolizes isotretinoin, and it can lead to changes in blood lipids, such as triglycerides. If anything comes up as abnormal, your dermatologist can adjust your dosage or provide additional guidance to help you stay healthy throughout treatment.

Keeping Your Skin Comfortable While Using Accutane

The best thing that you can do for your skin during a course of Accutane is creating routine that protects your moisture barrier from day one. Here’s an example of what our providers might suggest:

Morning

  1. Cleanse gently with a non-foaming, fragrance-free cleanser to remove oil without stripping further hydration from the barrier. We recommend products such as:
  2. Apply a non-comedogenic moisturizing cream rich in ingredients like ceramides, cholesterol, fatty acides, glycerin, and hyaluronic acid to replace barrier lipids. You can find some of the industry’s most trusted, clinician-approved products at Advanced Skin Therapeutics, including:
  3. Apply a broad-spectrum SPF 30+ mineral sunscreen. Reapply every two hours and  after sweating to prevent sunburns and post-inflammatory hyperpigmentation.

Throughout the Day

  1. Keep a petrolatum or lanolin-based lip ointment with you, and reapply frequently. You should avoid strong flavors like menthol or camphor. We’re also fans of Dr. Dan’s Cortibalm, the only truly hypoallergenic lip balm with 1% hydrocortisone.
  2. Drink as much water as you can and, if possible, use a cool-mist humidifier to reduce trans-epidermal moisture loss (TEML). It will also help prevent nosebleeds.
  3. Use isotonic saline mist as directed by your dermatologist. Consider this list of recommended brands from the American Academy of Allergy, Asthma, & Immunology. You can also use a water-based nasal gel like Ayr Saline Nasal Gel to refresh the mucus membranes.

Evening

  1. Take short, warm showers. Hot water can further strip essential lipids from your skin barrier.
  2. Apply moisturizer within a few minutes of toweling off, all over your body. For very dry areas, like the knees and elbows, seal in the moisturizer with a thin layer of occlusive petrolatum afterwards.

Other Considerations

  • Stop using retinoids, benzoyl peroxide, acids, and exfoliating scrubs unless your dermatologist specifically advices otherwise.
  • Skip waxing, laser hair removal, dermaplaning, microneedling, and chemical peels, all of which can cause injuries or irritation to already fragile skin.
  • If your skin is itchy, use bland emollients like colloidal oatmeal to soothe it.
  • Some people find that their eyes feel dry and uncomfortable, particularly when wearing contact lenses. Switch to daily disposables or glasses, and keep lubricating drops nearby.

Considering replacing your acne topicals with Accutane? Start with a consultation with Dr. Elizabeth Briden of Advanced Dermatology & Cosmetic Institute.

She brings decades of dermatological experience to the table, so you can be confident knowing that your progress is closely monitored and that she can help make the day-to-day aspects of taking the medication more tolerable.