Acne: Treatment with Isotretinoin

Deciding About Isotretinoin

Isotretinoin (such as Amnesteem, Claravis, or Zenatane) is a powerful medicine that's usually prescribed for severe acne that can't be cleared up with other medicines. It's typically taken for 4 to 6 months. If acne returns after treatment, you may be able to take another round of medicine.

This medicine unclogs skin pores, shrinks oil glands, and decreases bacteria and inflammation. It can reduce the scarring caused by acne. It may also help if acne is causing distress. There's a link between acne and depression and other mental health concerns.

But isotretinoin can cause side effects. And it has serious risks, especially during pregnancy.

What are the serious risks during pregnancy?

Taking isotretinoin even for a short time during pregnancy can cause severe birth defects or miscarriage.

Before anyone can start treatment with isotretinoin, they have to enroll in a program called iPLEDGE. Your doctor can explain this program to you. Among other things, it may require you to:

• Use two forms of birth control before, during, and after your treatment if you're able to get pregnant.
• Take pregnancy tests before, during, and after treatment.
• Have monthly doctor visits while you're taking this medicine. These may be in-person or virtual care (telehealth) visits.

What are some possible side effects?

Other side effects include dry skin, nose, mouth, eyes, and lips. Some people also feel more tired than usual, sunburn more easily, have problems with night vision, or lose more hair than usual.

These side effects can usually be treated with over-the-counter products like moisturizers, sunscreen, and artificial tears. If you have dry eyes while taking this medicine, you may have to wear glasses instead of contact lenses.

This medicine may also cause headaches, muscle pain, or changes in your liver or blood. You'll have blood tests to see how it's affecting your liver and to check your cholesterol and triglyceride levels.

There may be a link between this medicine and depression or other serious mood problems. Your doctor will want to know if you have mood changes.

Some reports suggest that isotretinoin may increase the risk of inflammatory bowel disease. But experts don't have enough information to know if this is true.

How can you decide if you should take this medicine?

You may want to take isotretinoin if:

• You have acne that doesn't get better after several months of treatment with other medicines.
• You have acne that's causing scarring.
• Acne causes you to have anxiety, low self-esteem, or depression.

You may not want to take this medicine if:

• You can control your acne with other medicines or treatments.
• There is any chance that you could get pregnant.
• You want to avoid the side effects.

Your doctor can help you weigh the pros and cons of this medicine so you can decide what's right for you.