Why Isotretinoin is Safe and Encouraged for Severe Acne Treatment

Isotretinoin, often recognized under its former brand name Accutane, is a powerful and effective medication used to treat severe nodular acne that has not responded to other treatments. This drug offers hope to many who have struggled with persistent and debilitating acne, and despite its potential side effects, its benefits often outweigh the risks when properly managed.  “When my patients have tried all other acne treatments and the condition still persists, there is often hesitation about starting isotretinoin,” Dawn Baird, PA-C, who often has these conversations with her patients. “However, after completing the treatment and achieving clear skin—sometimes for the first time in years—their only regret is not starting isotretinoin sooner. Our goal as your healthcare provider is to ensure you achieve the best possible outcome. This information is intended to help you understand why we strongly support the use of isotretinoin.”

Understanding Isotretinoin and Its Benefits 

Isotretinoin is unique because it targets all the major factors contributing to acne. It works by:  

  1. Shrinking Oil Glands: Isotretinoin reduces the size of sebaceous glands, decreases oil production and reduces blocked pores.  
  1. Preventing Clogged Pores: By influencing cellular processes that normalize cell shedding, it helps prevent the formation of comedones (clogged hair follicles that cause blackheads and whiteheads).  
  1. Decreasing Bacteria: It reduces the growth of Propionibacterium acnes (P. acnes), the bacteria associated with acne.  
  1. Anti-Inflammatory Effects: The medication has properties that reduce inflammation, helping to calm the redness and swelling associated with severe acne.  

These combined actions make isotretinoin the only treatment that addresses all underlying causes of acne, providing a comprehensive solution where other treatments may fail.  

The Course of Treatment 

Most patients continue isotretinoin treatment until their acne clears, typically 4.5 to 6 months. While some might experience a relapse and require a second course, the majority achieve significant long-term improvement. Remarkably, 95% of patients see a complete remission of severe acne within the first 6 months of treatment, with 85% becoming virtually clear by 16 weeks when dosed appropriately. 

Side Effects and Monitoring 

Like any potent medication, isotretinoin has side effects, which range from common, manageable ones to rare, serious ones. The most common side effects include:  

  • Dry nose and nosebleeds  
  • Dry, chapped, or peeling lips  (Dawn recommends consistent use of Aquaphor)
  • Dry eyes  
  • Dry skin  
  • Initial, temporary (short term) worsening of acne, known as “purging” 

More serious side effects can include high triglycerides, mental health changes, birth defects, and liver damage. However, these are much less common and are closely monitored by dermatologists through regular check-ins, blood tests, and, for female patients, mandatory pregnancy tests.  

The Cost of Ineffective Treatments 

One of the most frustrating aspects of dealing with severe acne is the financial burden of ineffective treatments. Many patients spend thousands of dollars on various skincare products, topical treatments, and over-the-counter remedies, trying to find a solution without understanding the root cause of their acne, which is often hard to pinpoint.  

For instance, some people use antibiotics to treat what they believe to be bacterial acne, only to find out later that their acne is hormonal. Antibiotics can offer temporary relief, but they are not a sustainable long-term solution and can lead to antibiotic resistance and disturbance of the gut microbiota. Other treatments, like hormonal therapies or dietary changes, might not address the true underlying cause of the acne, leading to further frustration and expense.  

Psychological Benefits 

Beyond physical improvement, isotretinoin can have significant psychological benefits. Severe acne is not just a skin condition; it is also a psychosomatic disorder that can lead to:  

  • Low self-esteem  
  • Social withdrawal  
  • Stress, anxiety, and depression  
  • Body shame  
  • Family and relationship problems  

While isotretinoin has been associated with rare mental health side effects, the psychological distress caused by untreated severe acne is a critical factor. Many patients experience a significant improvement in their quality of life and mental health once their acne is treated effectively.  

The Ultimate Solution for Persistent Acne 

Isotretinoin is often the last resort for patients who have tried numerous treatments without success. Unlike antibiotics, which are temporary and have long-term use implications, isotretinoin offers a more permanent solution. It addresses acne’s root causes, whether bacterial, comedonal, or otherwise, making it a versatile and highly effective treatment.


Isotretinoin, when prescribed and monitored correctly, is a safe and life-changing treatment for severe acne. Its ability to target all causes of acne and provide lasting results makes it an invaluable option for those who have exhausted other treatments. The rigorous monitoring and patient education associated with isotretinoin use ensure that the benefits significantly outweigh the risks, offering a pathway to clear skin and improved mental health for many individuals.  

If you are struggling with severe acne and have not found relief through other treatments, consult with your dermatologist to discuss whether isotretinoin could be the right option for you. The journey to clear skin and improved self-confidence might be closer than you think.  Click to book online with Dawn Baird, PA-C in our Ayer office.

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