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Content warning: The following story contains a mention of suicide.
Have you experienced severe acne at any point in your life? It can be characterized as chronic, cystic bumps that form deep beneath the skin — and seem to stick around a while. Then you may already be familiar with Accutane.
Technically speaking, Accutane was a brand name (which is no longer manufactured) for an acne drug called isotretinoin, a derivative of vitamin A, NYC-based dermatologist Neal Schultz, MD, tells PS. This oral acne medication is still around today, but needs to be prescribed by a professional.
Robyn Gmyrek, a dermatologist at Union Derm in New York, adds: “It works by decreasing the amount of oil production released by the sebaceous glands in the skin, [and] has the potential to provide a long-term decrease in acne after a five-month course of medication.”
She says that the ideal candidate is someone with severe or scarring acne who has tried — without success — other at-home topical treatments, antibiotics, or hormonal agents such as spironolactone. If you’re curious about trying Accutane/isotretinoin, we spoke with both Dr. Gymrek and Dr. Schultz to learn the common side effects and risks. Here’s what you need to know.
Experts Featured in This Article
Robyn Gmyrek, MD, is a dermatologist at Union Derm in New York.
Neal Schultz, MD, is a dermatologist at Park Avenue Skincare and based in New York.
Mild Short-Term Isotretinoin Side Effects
Before you begin taking isotretinoin, you should know that a typical treatment plan lasts between three and six months. During those months, it’s common to experience the following mild, short-term side effects. The higher your dosage is, the more noticeable these side effects may be. For that reason, some doctors prescribe low dosages that are taken over a longer period of time.
- Dryness of the skin and especially the lips, possibly leading to eczema or dermatitis
- Dry eyes
- Acne can worsen before improving
- Nosebleeds from dry nasal mucosa
- Bone, muscle, or joint pain (may be mild or severe)
- Decreased night vision
- Increased sun sensitivity
- Increased muscle tenderness
- Increased triglyceride levels in the blood
Severe Short-Term Accutane Side Effects
It’s important to regularly talk with your dermatologist while taking Accutane/isotretinoin. They can offer guidance for how to make the above side effects more tolerable and can adjust your dosage (or cease treatment) if any severe side effects manifest. With that said, here are some things to be on the look out for:
- Pancreatitis: “This is a condition that occurs if lipids or fats, like triglyceride, increase in the blood and back up into the pancreas, causing pain and inflammation to the pancreas. Blood work is done to monitor lipids while on Accutane,” Dr. Gmyrek says. Pancreatitis presents as sudden or ongoing pain in your abdomen or back. You may also feel bloated, nauseated, or experience vomiting, loss of appetite, and indigestion.
- Liver damage and/or inflammation: “Patients are instructed not to drink alcohol while on the medication, and lab work monitors the liver during treatment,” Dr. Gmyrek says. Liver damage doesn’t often have obvious symptoms, but it’s possible you may feel fatigued, experience some pain in your abdomen, or lose weight unexpectedly.
- Changes in mood or behavior/possible depression
- Attempts at suicide or thoughts of suicide
- Bone, muscle, or joint pain (may be mild or severe)
- Severe malformations to a fetus if pregnancy occurs while taking the drug, or within four weeks of the last dose.
Severe Long-Term Side Effects of Accutane
While the above side effects typically cease after treatment, you may experience some side effects that linger, or are permanent. Again, talk to your doctor if you experience any of these symptoms, and she can help you. Every person is different, and all treatments vary accordingly. The dermatologists we spoke to say that severe long-term side effects include the following:
- Painful bone spurs
- Closure of bone growth plates, which stops you from growing
- Decreased vision in darkness, which may occur while on the drug and persist after the drug has been stopped
- Hair loss or alopecia may occur while on the medication and may persist after discontinuation
- Long-term malformations and effects to an infant born, if exposed in utero, to the drug via the mother’s ingestion of the drug
Longe-Term Side Effects of Accutane
Latent side effects refer to issues triggered by your medication that aren’t necessarily obvious to you. In fact, sometimes it can take months or years after treatment for these side effects to even be noticed. When we asked Dr. Gymrek about latent side effects of isotretinoin, here’s what she says:
“It is unclear, and more data and study needs to be done, but it seems that Accutane/isotretinoin can cause the appearance of or worsening of inflammatory bowel disease in people who are predisposed to this disease,” Dr. Gmyrek says. “I’m referring to patients who have a history of inflammatory bowel disease or a strong family history of inflammatory bowel disease.”
Final Note
The side effects of Accutane/isotretinoin, like many drugs, sound pretty scary. However, it has proven an effective treatment for those battling ongoing, severe acne who have run out of options. If you’re considering starting the drug, we recommend reading up on it and scheduling an appointment with a dermatologist for a more personalized review of what Accutane can do for you.
Wendy Rose Gould is a lifestyle writer and photographer. She is a former contributing editor at XoVain and has written for Refinery29, ModCloth, InStyle, The Klog, and others.