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Acne: Should I Take Isotretinoin for Severe Acne?

You may want to have a say in this decision, or you may simply want to follow your doctor's recommendation. Either way, this information will help you understand what your choices are so that you can talk to your doctor about them.

Acne: Should I Take Isotretinoin for Severe Acne?

Get the facts

Your options

  • Take isotretinoin to clear up severe acne.
  • Use other treatments for your acne. This may include over-the-counter or prescription medicines.

Key points to remember

  • Acne will improve over time for most people. For some people, though, acne is harder to treat.
  • You may want to take isotretinoin if:
    • You are bothered by severe acne that doesn't get better after several months of using other medicines.
    • A parent or sibling had severe acne with scarring.
    • Your acne causes anxiety, low self-esteem, or depression.
  • You may not want to take isotretinoin if:
    • You can control your acne with other medicines or treatments.
    • There is any chance that you could become pregnant.
    • You or members of your immediate family (parent, brother, or sister) have a history of severe depression.
FAQs

What is isotretinoin?

Isotretinoin (Amnesteem, Claravis, or Sotret) is a powerful medicine for severe acne that cannot be cleared up with other medicines. It is related to vitamin A. Most people need to take it for 3 to 6 months.

This medicine unclogs skin pores and shrinks oil glands. It can reduce the scars and emotional pain of severe acne. But this medicine can have severe side effects.

What are the risks of taking this medicine?

Isotretinoin can cause side effects. The most serious side effects occur in women who are pregnant or get pregnant while taking it. They may have a miscarriage, or their infant may be born with severe birth defects. Other serious side effects are rare.

The U.S. Food and Drug Administration (FDA) warns that this medicine has been linked with depression, psychosis, and, in rare cases, suicidal thoughts or suicide attempts. The link between this medicine and depression is not clear, and it is being watched very closely. Talk with your doctor to decide if this medicine is right for you or your child. See your doctor if you or your child takes isotretinoin and has signs of depression.

Most people who take this medicine have some of the less serious side effects. These include dry skin, dry mouth, chapped lips, nosebleeds, dry eyes, and trouble wearing contact lenses. These side effects usually are not a big problem and can be treated with moisturizers, artificial tears, and other products. If you have dry eyes while taking this medicine, you may have to wear glasses instead of contact lenses. Your skin also could sunburn more easily, so make sure to use sunscreen.

This medicine can raise the level of certain fats (triglycerides) in your blood. So you may be more likely to get health problems such as heart disease. For this reason, you need to have your triglyceride levels checked before you start this medicine and every 4 to 6 weeks while you are taking it. You also need blood tests to make sure that the medicine isn't harming your liver.

Headaches and muscle or joint pain are less common side effects that most people can treat with over-the-counter pain medicine. Muscle and joint pain are more common in people who exercise often.

Why might your doctor recommend this medicine?

Your doctor might recommend this medicine if:

  • You have severe acne that has not improved with other treatments.
  • You feel bad about yourself because of your acne.
  • You are not pregnant or planning on getting pregnant soon.

Compare your options

Compare

What is usually involved?









What are the benefits?









What are the risks and side effects?









Take isotretinoin Take isotretinoin
  • You take a pill every day for 3 to 6 months.
  • You have blood tests every 4 to 6 weeks to check your liver enzymes and the level of certain fats.
  • Because the medicine can cause birth defects or miscarriage, women must use two forms of birth control while they are taking it and for at least 1 month after they stop taking it.
  • Your acne may get much better or go away. In most people, this medicine clears up severe acne or makes it much better.
  • It can prevent scarring from severe acne.
  • If acne comes back, it may be much less severe than before you took the medicine.
  • You may feel better about how you look if the medicine clears up your acne.
  • It may not work for you. For some people, this medicine doesn't clear up severe acne or make it much better.
  • You cannot take it if you are pregnant or want to get pregnant soon. It can cause birth defects and miscarriages.
  • It has been linked with depression and suicidal thoughts.
  • Less serious side effects are dry skin, dry eyes, and chapped lips. You may get sunburned more easily than before if you don't wear sunscreen.
  • It can raise the level of fats in your blood.
  • This medicine is expensive.
Don't take isotretinoin Don't take isotretinoin
  • Keep washing your face with soap or other cleansers. You also may use over-the-counter acne lotions.
  • You can use other prescription pills or creams.
  • You don't have the risk of the medicine's serious side effects, such as depression and birth defects and miscarriage.
  • You don't have less serious side effects, such as dry skin, dry eyes, and chapped lips.
  • You don't have to use two forms of birth control, which is required for women who use this medicine.
  • Home care might not control your acne.
  • Your acne could get worse, causing more scarring.

Personal stories

Are you interested in what others decided to do? Many people have faced this decision. These personal stories may help you decide.

Personal stories about taking isotretinoin (such as Amnesteem, Claravis, or Sotret) for acne

These stories are based on information gathered from health professionals and consumers. They may be helpful as you make important health decisions.

I didn't think I needed to worry too much about my acne. So far it is mostly whiteheads and blackheads. But my dad has bad acne scars. I figure I am heading the same way if I don't do something about it, so I'm going to talk to my doctor about taking medicine.

Jason, age 16

My doctor said that it would be reasonable for me to try a medicine like Sotret for my acne. But my husband and I are thinking of having kids, and taking the medicine would mean putting that off for about 6 months or so. I'm going to take some time to think it over and talk to my husband, then decide.

Anne, age 24

I have had bad acne ever since I was 13. It was really embarrassing, and it was hard to make friends. It was like people only saw my acne. A couple years ago, my doctor put me on isotretinoin. It has changed my life. My acne is so much better and I don't feel so self-conscious. I am more outgoing, and I have made some really good friends. I even have a girlfriend. When I see old pictures of myself, it's like looking at a different person.

Steve, age 18

I've noticed that my daughter has become a lot more withdrawn and shy since she became a teenager. I think it might be related to her acne. She has quite a few pimples, and sometimes she gets a really severe one. I know that it bothers her, because she has asked me several times if she will outgrow it soon. I'm going to ask her if she wants to read up on isotretinoin and then we can see what the doctor says.

Barb, age 37

What matters most to you?

Your personal feelings are just as important as the medical facts. Think about what matters most to you in this decision, and show how you feel about the following statements.

Reasons to take isotretinoin

Reasons not to take isotretinoin

I want to do everything I can to treat my acne.

I want to take medicines that are not as strong as isotretinoin for my acne.

More important
Equally important
More important

I don't mind using two forms of birth control while I'm taking this medicine (women only).

I'm not willing to use two forms of birth control (women only).

More important
Equally important
More important

I'm not concerned about the side effects of this medicine.

I'm very concerned about the side effects of this medicine.

More important
Equally important
More important

I feel bad about how I look because of my acne.

I don't feel bad about how I look because of my acne.

More important
Equally important
More important

My other important reasons:

My other important reasons:

More important
Equally important
More important

Where are you leaning now?

Now that you've thought about the facts and your feelings, you may have a general idea of where you stand on this decision. Show which way you are leaning right now.

Taking isotretinoin

NOT taking isotretinoin

Leaning toward
Undecided
Leaning toward

What else do you need to make your decision?

Check the facts

1.

How bad does your acne have to be before you consider taking isotretinoin?

  • MildSorry, that's wrong. Washing with soap and using over-the-counter products could help with mild acne. Isotretinoin is a strong medicine that is recommended only for severe acne that can't be cleared up with other medicines.
  • ModerateNo, that's not right. Other prescription medicines might help average or moderate acne. Isotretinoin is a strong medicine that is recommended only for severe acne that can't be cleared up with other medicines.
  • SevereThat's right. Isotretinoin is a strong medicine that is recommended only for severe acne that can't be cleared up with other medicines.
  • I'm not sureIt may help to go back and read "Get the Facts." Isotretinoin is a strong medicine that is recommended only for severe acne that can't be cleared up with other medicines.
2.

Which of the following are side effects of isotretinoin?

  • BunionsSorry, that's wrong. Isotretinoin can cause birth defects and miscarriage. It also can cause dry skin, dry eyes, nosebleeds, and chapped lips. And it has been linked to depression.
  • Tooth decaySorry, that's wrong. Isotretinoin can cause birth defects and miscarriage. It also can cause dry skin, dry eyes, nosebleeds, and chapped lips. And it has been linked to depression.
  • Birth defects and miscarriageThat's right. Isotretinoin can cause birth defects and miscarriage. It also can cause dry skin, dry eyes, nosebleeds, and chapped lips. And it has been linked to depression.
  • I'm not sureIt may help to go back and read "Get the Facts." Isotretinoin can cause birth defects and miscarriage. It also can cause dry skin, dry eyes, and chapped lips. And it has been linked to depression.
3.

How long does a woman have to use two forms of birth control if she takes isotretinoin?

  • The first month of taking itSorry, that's not right. Women who take isotretinoin must use two forms of birth control while they are taking the medicine and for at least 1 month after they stop taking it.
  • While they are taking itNo, that's not right. Women who take isotretinoin must use two forms of birth control while they are taking the medicine and for at least 1 month after they stop taking it.
  • While they are taking it and for 1 month after they stop taking itThat's right. Women who take isotretinoin must use two forms of birth control while they are taking the medicine and for at least 1 month after they stop taking it.
  • I'm not sureIt may help to go back and read "Compare Your Options." Women who take isotretinoin must use two forms of birth control while taking the medicine and for at least 1 month after they stop taking it.

Decide what's next

1.

Do you understand the options available to you?

2.

Are you clear about which benefits and side effects matter most to you?

3.

Do you have enough support and advice from others to make a choice?

Certainty

1.

How sure do you feel right now about your decision?

Not sure at all
Somewhat sure
Very sure
3.

Use the following space to list questions, concerns, and next steps.

Your Summary

Here's a record of your answers. You can use it to talk with your doctor or loved ones about your decision.

Your decision 

Next steps

Which way you're leaning

How sure you are

Your comments

Your knowledge of the facts 

Key concepts that you understood

Key concepts that may need review

Getting ready to act 

Patient choices

Credits

Credits
Credits Healthwise Staff
Primary Medical Reviewer Kathleen Romito, MD - Family Medicine
Specialist Medical Reviewer E. Gregory Thompson, MD - Internal Medicine
You may want to have a say in this decision, or you may simply want to follow your doctor's recommendation. Either way, this information will help you understand what your choices are so that you can talk to your doctor about them.

Acne: Should I Take Isotretinoin for Severe Acne?

Here's a record of your answers. You can use it to talk with your doctor or loved ones about your decision.
  1. Get the facts
  2. Compare your options
  3. What matters most to you?
  4. Where are you leaning now?
  5. What else do you need to make your decision?

1. Get the Facts

Your options

  • Take isotretinoin to clear up severe acne.
  • Use other treatments for your acne. This may include over-the-counter or prescription medicines.

Key points to remember

  • Acne will improve over time for most people. For some people, though, acne is harder to treat.
  • You may want to take isotretinoin if:
    • You are bothered by severe acne that doesn't get better after several months of using other medicines.
    • A parent or sibling had severe acne with scarring.
    • Your acne causes anxiety, low self-esteem, or depression.
  • You may not want to take isotretinoin if:
    • You can control your acne with other medicines or treatments.
    • There is any chance that you could become pregnant.
    • You or members of your immediate family (parent, brother, or sister) have a history of severe depression.
FAQs

What is isotretinoin?

Isotretinoin (Amnesteem, Claravis, or Sotret) is a powerful medicine for severe acne that cannot be cleared up with other medicines. It is related to vitamin A. Most people need to take it for 3 to 6 months.

This medicine unclogs skin pores and shrinks oil glands. It can reduce the scars and emotional pain of severe acne. But this medicine can have severe side effects.

What are the risks of taking this medicine?

Isotretinoin can cause side effects. The most serious side effects occur in women who are pregnant or get pregnant while taking it. They may have a miscarriage, or their infant may be born with severe birth defects. Other serious side effects are rare.

The U.S. Food and Drug Administration (FDA) warns that this medicine has been linked with depression, psychosis, and, in rare cases, suicidal thoughts or suicide attempts. The link between this medicine and depression is not clear, and it is being watched very closely. Talk with your doctor to decide if this medicine is right for you or your child. See your doctor if you or your child takes isotretinoin and has signs of depression.

Most people who take this medicine have some of the less serious side effects. These include dry skin, dry mouth, chapped lips, nosebleeds, dry eyes, and trouble wearing contact lenses. These side effects usually are not a big problem and can be treated with moisturizers, artificial tears, and other products. If you have dry eyes while taking this medicine, you may have to wear glasses instead of contact lenses. Your skin also could sunburn more easily, so make sure to use sunscreen.

This medicine can raise the level of certain fats (triglycerides) in your blood. So you may be more likely to get health problems such as heart disease. For this reason, you need to have your triglyceride levels checked before you start this medicine and every 4 to 6 weeks while you are taking it. You also need blood tests to make sure that the medicine isn't harming your liver.

Headaches and muscle or joint pain are less common side effects that most people can treat with over-the-counter pain medicine. Muscle and joint pain are more common in people who exercise often.

Why might your doctor recommend this medicine?

Your doctor might recommend this medicine if:

  • You have severe acne that has not improved with other treatments.
  • You feel bad about yourself because of your acne.
  • You are not pregnant or planning on getting pregnant soon.

2. Compare your options

  Take isotretinoin Don't take isotretinoin
What is usually involved?
  • You take a pill every day for 3 to 6 months.
  • You have blood tests every 4 to 6 weeks to check your liver enzymes and the level of certain fats.
  • Because the medicine can cause birth defects or miscarriage, women must use two forms of birth control while they are taking it and for at least 1 month after they stop taking it.
  • Keep washing your face with soap or other cleansers. You also may use over-the-counter acne lotions.
  • You can use other prescription pills or creams.
What are the benefits?
  • Your acne may get much better or go away. In most people, this medicine clears up severe acne or makes it much better.
  • It can prevent scarring from severe acne.
  • If acne comes back, it may be much less severe than before you took the medicine.
  • You may feel better about how you look if the medicine clears up your acne.
  • You don't have the risk of the medicine's serious side effects, such as depression and birth defects and miscarriage.
  • You don't have less serious side effects, such as dry skin, dry eyes, and chapped lips.
  • You don't have to use two forms of birth control, which is required for women who use this medicine.
What are the risks and side effects?
  • It may not work for you. For some people, this medicine doesn't clear up severe acne or make it much better.
  • You cannot take it if you are pregnant or want to get pregnant soon. It can cause birth defects and miscarriages.
  • It has been linked with depression and suicidal thoughts.
  • Less serious side effects are dry skin, dry eyes, and chapped lips. You may get sunburned more easily than before if you don't wear sunscreen.
  • It can raise the level of fats in your blood.
  • This medicine is expensive.
  • Home care might not control your acne.
  • Your acne could get worse, causing more scarring.

Personal stories

Are you interested in what others decided to do? Many people have faced this decision. These personal stories may help you decide.

Personal stories about taking isotretinoin (such as Amnesteem, Claravis, or Sotret) for acne

These stories are based on information gathered from health professionals and consumers. They may be helpful as you make important health decisions.

"I didn't think I needed to worry too much about my acne. So far it is mostly whiteheads and blackheads. But my dad has bad acne scars. I figure I am heading the same way if I don't do something about it, so I'm going to talk to my doctor about taking medicine."

— Jason, age 16

"My doctor said that it would be reasonable for me to try a medicine like Sotret for my acne. But my husband and I are thinking of having kids, and taking the medicine would mean putting that off for about 6 months or so. I'm going to take some time to think it over and talk to my husband, then decide."

— Anne, age 24

"I have had bad acne ever since I was 13. It was really embarrassing, and it was hard to make friends. It was like people only saw my acne. A couple years ago, my doctor put me on isotretinoin. It has changed my life. My acne is so much better and I don't feel so self-conscious. I am more outgoing, and I have made some really good friends. I even have a girlfriend. When I see old pictures of myself, it's like looking at a different person."

— Steve, age 18

"I've noticed that my daughter has become a lot more withdrawn and shy since she became a teenager. I think it might be related to her acne. She has quite a few pimples, and sometimes she gets a really severe one. I know that it bothers her, because she has asked me several times if she will outgrow it soon. I'm going to ask her if she wants to read up on isotretinoin and then we can see what the doctor says."

— Barb, age 37

"My son is 13, and he has had acne for a year. He keeps asking me if he can go on isotretinoin, but I just think he's too young. I'm not sure that he would remember to take it every day, and I keep hoping that he will outgrow the acne as he gets a little older."

— Hakim, age 38

3. What matters most to you?

Your personal feelings are just as important as the medical facts. Think about what matters most to you in this decision, and show how you feel about the following statements.

Reasons to take isotretinoin

Reasons not to take isotretinoin

I want to do everything I can to treat my acne.

I want to take medicines that are not as strong as isotretinoin for my acne.

             
More important
Equally important
More important

I don't mind using two forms of birth control while I'm taking this medicine (women only).

I'm not willing to use two forms of birth control (women only).

             
More important
Equally important
More important

I'm not concerned about the side effects of this medicine.

I'm very concerned about the side effects of this medicine.

             
More important
Equally important
More important

I feel bad about how I look because of my acne.

I don't feel bad about how I look because of my acne.

             
More important
Equally important
More important

My other important reasons:

My other important reasons:

   
             
More important
Equally important
More important

4. Where are you leaning now?

Now that you've thought about the facts and your feelings, you may have a general idea of where you stand on this decision. Show which way you are leaning right now.

Taking isotretinoin

NOT taking isotretinoin

             
Leaning toward
Undecided
Leaning toward

5. What else do you need to make your decision?

Check the facts

1. How bad does your acne have to be before you consider taking isotretinoin?

  • Mild
  • Moderate
  • Severe
  • I'm not sure
That's right. Isotretinoin is a strong medicine that is recommended only for severe acne that can't be cleared up with other medicines.

2. Which of the following are side effects of isotretinoin?

  • Bunions
  • Tooth decay
  • Birth defects and miscarriage
  • I'm not sure
That's right. Isotretinoin can cause birth defects and miscarriage. It also can cause dry skin, dry eyes, nosebleeds, and chapped lips. And it has been linked to depression.

3. How long does a woman have to use two forms of birth control if she takes isotretinoin?

  • The first month of taking it
  • While they are taking it
  • While they are taking it and for 1 month after they stop taking it
  • I'm not sure
That's right. Women who take isotretinoin must use two forms of birth control while they are taking the medicine and for at least 1 month after they stop taking it.

Decide what's next

1. Do you understand the options available to you?

2. Are you clear about which benefits and side effects matter most to you?

3. Do you have enough support and advice from others to make a choice?

Certainty

1. How sure do you feel right now about your decision?

         
Not sure at all
Somewhat sure
Very sure

2. Check what you need to do before you make this decision.

  • I'm ready to take action.
  • I want to discuss the options with others.
  • I want to learn more about my options.

3. Use the following space to list questions, concerns, and next steps.

 
Credits
By Healthwise Staff
Primary Medical Reviewer Kathleen Romito, MD - Family Medicine
Specialist Medical Reviewer E. Gregory Thompson, MD - Internal Medicine

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