A definitive guide to Isotretinoin (Roaccutane / Accutane) by a Dermatologist

Making the decision to go on a course of Isotretinoin can be difficult, especially as there is a lot of opinion about this medication on the internet and on the media. It is important to consider the benefits of this medication, along side the risks and the costs. If you have had a consultation with one of our acne specialist doctors  and have been advised to consider Isotretinoin, then you will be asked to read this information page before reaching the decision to take Isotretinoin so that you are fully informed.

Acne dermatologist in Birmingham and London

Whilst all dermatologists will be familiar with the conventional Isotretinoin doses, we have a specialist interest in all aspects of acne management. Being an ‘acne’ dermatology practice, we have extensive experience helping patients, particularly adults in their 20’s and 30’s and older, with chronic acne, hormonal acne, cystic acne and other types of acne. Because of this, patients are offered highly bespoke treatment regimes and combinations of therapy.

What is Isotretinoin (Roaccutane / Accutane)?

Isotretinoin is a prescription medication used for acne. It can only be prescribed by doctors who are experienced in using this drug, usually a Consultant Dermatologist.
Roaccutane is the brand name for the drug Isotretinoin in tablet form. Roaccutane is made by Roche and has been available in the UK since 1983. In the USA, Isotretinoin was branded as Accutane by Roche and approved in 1982.
Many other companies make Isotretinoin in capsules using exactly the same recipe as for Roaccutane. However, when other companies manufacture isotretinoin, the package will only have the label ‘Isotretinoin’. This is called a generic version of the medication and is identical in every way to the branded versions of Roaccutane and Accutane.
Isotretinoin is also available as a cream and gel. This article does not include further information on the cream or gel version of Isotretinoin.

How does Isotretinoin help acne?

Isotretinoin is the most effective treatment available for acne. Isotretinoin is very good for:
  • Inflamed (red) spots. Isotretinoin clears inflamed spots like red papules, pustules and nodules. Isotretinoin stops new inflamed spots from developing and causes existing inflamed spots to flatten and resolve.
  • Cysts. Isotretinoin is good at reducing cysts that arise in acne.
  • Comedones. Isotretinoin is also effective for comedones that may be open or closed. However, very large closed comedones might not clear with Isotretinoin and are best treated with hyfrecation before starting a course of Isotretinoin. Find out more about the hyfrecation of comedones.
  • Greasiness. Isotretinoin reduces grease production in the skin and many people will notice their skin and hair become less shiny.

How does Isotretinoin work?

Isotretinoin works by reducing grease (sebum) production in the skin by shrinking the sebaceous glands. This is why dry skin is the main side effect.
Grease in the hair follicles causes overgrowth of Cutibacterium acnes bacteria (formerly known as Propionibacterium acnes). This leads to inflammation and acne spots. By dropping grease production by as much as 90%, there is far fewer C. acnes bacteria in the skin and much less inflammation.
Isotretinoin also stops the hair follicle cells from being so sticky. This means it stops hair follicles from getting clogged up by skin cells. Because cells are slightly less sticky, they are also prone to shearing with trauma. Many people will find their skin is more fragile on Isotretinoin for this reason. This is also why waxing and threading must be avoided, as it could pull off the skin as well as hair.
Isotretinoin also probably directly reduces inflammation in the skin too and helps control acne this way.

How effective is Isotretinoin for acne?

Studies show that about 80 to 90% of people will find that their inflamed acne counts improve by 95% after 5 months of treatment (Straus 1984). What does this actually mean?
Well, someone who has 20 inflamed (raised and red) spots on their face at the beginning of treatment may expect to have 1 or 2 inflamed spots at the end of 5 months of treatment.
Or someone who gets 20 new spots per week can expect to get 1 or 2 new spots per week after 5 months of treatment.
While some people will get complete control of their spots, many people will still develop occasional spots while on Isotretinoin – but these are far fewer in number and usually much smaller and shorter-lived.

When is Isotretinoin used for acne?

Isotretinoin is used when

  • Acne is very severe – such as nodular and cystic acne
  • Acne is very extensive – such as extensive acne on the trunk
  • Acne is causing scarring
  • Acne is causing post-inflammatory hyperpigmentation
  • Acne that does not clear with antibiotic treatment
  • Hormonal acne that is difficult to treat with other means
  • Acne that causes a lot of psychological distress

What is Isotretinoin not good for?

It is important to appreciate that there are limitations to Isotretinoin. Isotretinoin does not work for:

  • Scars. Isotretinoin does not work for scars. It also does not stop inflamed spots from causing scars either.
  • Redness. Redness, where spots have healed, is extremely common with acne. This is called post-inflammatory erythema. Isotretinoin does not clear redness that is left by inflamed spots once they have flattened and the inflammation has gone. If post-inflammatory erythema is a concern then vascular laser treatment can be used while on Isotretinoin.
  • Hyperpigmentation. Isotretinoin does not clear hyperpigmentation from acne.
  • Pores. Isotretinoin will reduce pores while you are on treatment as it shrinks sebaceous glands, but the pores will return to their normal size within a few months of stopping Isotretinoin.

Does Isotretinoin cure acne for good?

Most dermatologists agree that Isotretinoin is one of the few medications that can give prolonged control of acne even after the treatment course for many years, and in some instances, it is a permanent cure. It is hard to have an exact figure as to how many people are cured as the very long term studies to show this are lacking.
As a very general rule of thumb, in the long term, after a course of Isotretinoin in adults over the age of 18 our experience shows:
  • 1 in 3 can expect their acne not to come back
  • 1 in 3 can expect their acne to come back at some point, but at a much milder level that can be controlled with topical treatments
  • 1 in 3 can expect their acne to come back to a level that is similar to how it was before Isotretinoin

How does Isotretinoin cause long-term relief from acne?

Isotretinoin is able to damage sebaceous gland cells. In fact, it can severely shrink sebaceous glands and damage the stem cells so that it takes many months or years to recover sebaceous gland activity. This is thought to be the main mechanism of how Isotretinoin produces long term relief from acne

How long will a course of Isotretinoin be?

A standard course of Isotretinoin will last between 5 to 7 months. We usually start on a low dose to get your body used to the medication. The dose is increased every 4 weeks until the maximum dose you can manage for your body weight is reached. If you are able to reach a dose of 1mg of Isotretinoin per kg of body weight per day (so if you weigh 60kgs, then a dose of 60mg of Isotretinoin per day) by the 12th week, then the course will last about 5 to 7 months. The course can last longer than 7 months if:
  • Your acne is slow to come under control
  • We elect to stay on a low dose regime
There is a suggestion that reaching a total dose of Isotretinoin of at least 120mg per kg of body weight by the end of the course will reduce the chance of the acne reoccurring. There is some data to suggest that a total dose of 159mg/kg is better at preventing relapses than 128 mg/kg, as is continuing Isotretinoin for 65 days after acne has cleared (Tran et al, 2020).
This broadly described the standard course, which is one that is licensed and officially advocated by the health care regulators in the UK and in Europe.
While a standard course is very effective, the downside is that there can be more side effects compared to a low-dose course.

Low dose Isotretinoin course

Many studies have shown that lower doses of Isotretinoin per day can bring acne under good control as well.
One study showed that a dose of 10mg per day for 6 months reduced inflamed spots by 87% and non-inflamed spots by 81%. 20mg per day for 6 months reduced inflammatory spots by 94% and non-inflammatory spots by 88 (Plewig 2004).
Personal experience has shown that low dose Isotretinoin also causes fewer Isotretinoin-induced flares (and possibly less hypertrophic scarring), especially in nodulocystic acne and acne with many macrocomedones.
The big attraction for lower-dose Isotretinoin is that there are fewer side effects. At higher doses (1mg per kg per day) 98% of patients get side effects, while at lower doses, 50% experience side effects and the side effects are much milder.
Low dose Isotretinoin courses need to be longer in order to achieve enough sebaceous gland shrinkage that the chance of recurrence after stopping are reduced.
Piquero et al. showed that 0.2-0.3mg/kg of Isotretinoin per day for 12 months followed by topical treatment created an excellent level of clearance for 80% of people with moderately severe acne.

Personalised Isotretinoin dosing

Our Dermatologists are extremely experienced with Isotretinoin and understand the needs of patients who require improvement in their skin while balancing side effects. We prefer to offer a flexible dosing approach for each patient based on their personal goals, other conditions they may have such as eczema, and their proneness to develop side effects. The aim is to control the acne as best as possible whilst keeping the side effects to their lowest levels possible. For some, this will mean a dose of 10mg three times per week, and for others, this will mean more conventional dosing, with many variations in between. When using low-dose Isotretinoin, treatment is continued until the acne has become controlled and is extended to 3 or 4 months beyond that. A flexible dosed course may last anywhere from 4 months to 18 months.
It is important to note that low dose and personalised dosing is not in the product licence for Isotretinoin, and so it is provided for on a case-by-case basis after consultation with a doctor.

Costs of Isotretinoin

These are the costs to consider when embarking on a course of Isotretinoin. The following can provide a rough idea of the costings:
  • The cost of the medication will depend on the dose prescribed to you. This can range from £35 per month for those on a low dose to £135 per month for those on a higher dose. The cost of medicines will vary according to market forces at the time of your course.
  • The cost of blood tests. A blood test is required before starting every time there is a dose change and every 2 or 3 months when there is no dose change. A blood test costs £85-£95 per time though up to date prices will be provided at consultation.
  • Follow-up consultations. These are charged at the prevailing rate and required monthly and can be remote or face to face. Prescriptions for women are  30 days in duration.
  • Females of childbearing age will be required to carry out a urinary pregnancy test before and every 4 weeks during treatment and 4 weeks after the completion of treatment.
  • For a typical 6 to 7-month conventional course, a cost estimate of between £1900 to £2700 is suggested. Please note this may vary and will fluctuate depending on individual circumstances.
  • Please note there are additional costs of tests or specialist opinions in case these are required along the way. For example, you may be referred to a psychologist, psychiatrist, liver specialist, eye specialist or lipid specialist. You may require specialised eye assessments, ultrasound scans, blood tests etc. if you develop side effects or a complication of treatment.

How are blood tests for Isotretinoin done?

Blood tests can be done at the Clinic. We are unable to instruct your GP to carry out blood tests while you are receiving private care.

If you are unable to have tests and appointments on time

The monitoring and clinic appointments while undergoing a course of Isotretinoin are pretty ‘strict’. We let all our patients know that if there are interruptions in the monitoring plan that you have been given, then we cease treatment and further prescriptions of Isotretinoin are not offered.

Side effects from Isotretinoin and how to keep them under control

Isotretinoin can cause side effects and these are greater as the dose is increased. With our Personalised Dosing Plan, the goal is to keep side effects minimal and under control whilst improving acne. The key here is to prevent side effects as much as possible right from the beginning. With good management, out of 100 people starting Isotretinoin, only 1 or 2 may need to discontinue it.
Here are the main side effects, and how to control them

Common side effects

  • Dryness of the lips. This is the first side effect that is noticed. This can be managed by applying a lip balm every 2 or 3 hours (or more often if they become very dry) and avoiding licking the lips. Saliva makes the lips paradoxically more dry and prone to chaffing. Lip balms worth looking at are Vaseline, Blistex Intensive Moisturiser, Burt’s Beeswax Lip Balm and Dr Lipp’s Original Nipple Balm for lips. Other recommended products include O’Keeffe’s Lip Repair Balm, Carmex and Aquaphor Soothing Skin Balm.
  • Dryness of the nose. This can cause itching and nose bleeds. Apply Vaseline or Aquaphor Soothing Skin Balm to the inside of the nose at least 3 times per day and more if they are very dry. If you suffer from dust allergy or hay fever that gives you an itchy nose anyway, then control this by minimising your exposure to dust and pollen, and taking an antihistamine daily.
  • Dryness of the skin. You will need to stop all topical treatments for acne as your skin will become too sensitive to these while on Isotretinoin. Avoid using anything harsh on your skin such as soaps, gels, bubble baths, scrubs and loofas. Use a gentle soap substitute to was with such as Cerave Moisturising Lotion for Dry Skin, Cetaphil Lotion (note – not the cleanser, the lotion) or Dermol 500. While these products will not later or bubble, they will hydrate your skin as they cleanse. Use Dermol 500 to wash your hands unless your hands are visibly soiled or you need to wash them for virus prevention in which case you should use soap first then Dermol 500. You should also apply a non-comedogenic moisturiser three times per day. Use a light product in the daytime such as Cerave Moisturising Lotion for Dry Skin Cetaphil Lotion, Aveeno Lotion or Cerave Lotion, and a heavier product at night such as Epaderm Ointment or Cerave Moisturising Cream for Dry Skin. If your skin becomes very dry then you will need to use the heavier product in the day too. If you are seeking a Vegan product then consider Sukin Oil-Free Moisturiser.
  • Dryness of the eyes and red eyes. Try to avoid wearing contact lenses and use artificial tears at least four times a day and more if required. Products to consider for regular use during the day are Thealoz Duo Eye drops or Visu XL drops and for nighttime use are Xailin Night lubricating eye ointment. If you are encountering persistent redness you should let your doctor know and you may need to be seen at a specialist eye clinic.
  • Vaginal dryness. This can be improved by using vaginal hydrating products such as YES VM regularly – from once every three days to daily (or more) depending on the level of dryness.
  • Aches and pains. Isotretinoin can cause stiffness, and aches and pains. Low back pain is particularly common. These are usually mild and can be managed with occasional Paracetamol use. If they are severe then let your doctor know. You will need to avoid strenuous exercise or starting fitness training for the first time while you are on Isotretinoin. Strenuous exercise includes weight lifting and intense cardio such as rowing for 30 mins. Intense exercise can cause muscle breakdown.  If you are very athletic then plan to have Isotretinoin when out of season.
  • Headaches. Mild headaches are very common at the start of a course of Isotretinoin. Severe headaches that are worse in the morning, associated with nausea and vomiting, and worse with coughing and sneezing is a rare side effect of Isotretinoin and means treatment must be stopped immediately, and a neurological review is required. Medications such as Doxycycline, Oxytetracycline and Lymecycline must be stopped before starting Isotretinoin to reduce the chance of this rare side effect.
  • Severe damage to an unborn baby. Women can not get pregnant while on Isotretinoin or for one month after completing a course of Isotretinoin. This is because Isotretinoin causes severe birth defects and increases the risk of miscarriage. Women who are of childbearing age need to use one form of highly effective birth control such as the intra-uterine coil device or the hormonal implant, or 2 complementary forms of less effective birth control such as the pill and condoms. It is important to appreciate that even with these methods in place, there is a very small risk of pregnancy as any contraceptive method can fail. You should seek advice on contraception from your GP, a private gynaecologist or a private family planning clinic in order to ensure you are using appropriate methods before starting Isotretinoin.

Uncommon side effects

  • Liver strain. Strain on the liver can be caused by Isotretinoin and if this occurs the medication needs to be reduced or stopped. This is why regular liver blood tests are required. Alcohol is also toxic to the liver and should be minimised to no more than 2 units per week for the course of Isotretinoin. If your liver blood tests are abnormal before starting Isotretinoin, you may be asked to see a liver specialist for an assessment.
  • Elevated triglycerides. There are two main fats in the blood. Cholesterol and Triglycerides. Isotretinoin does not really affect the Cholesterol levels very much but it can raise triglyceride levels. If Triglyceride levels become very high then they may cause serious inflammation of the pancreas. This is why Triglyceride levels are tested before and during a course of Isotretinoin. Blood tests for Isotretinoin are done when fasting in order to be able to assess the Triglyceride levels properly. Fasting means nothing to eat or drink other than water or black tea or coffee for 8hrs before the blood test.
  • Depression and self-harm. Overall patients who take Isotretinoin feel happier at the end of a course because their acne is clear. However, very rarely, depression can be worsened and suicidal ideas can occur with Isotretinoin such that suicide attempts and death by suicide have very rarely been reported. If you have a history of depression or bipolar disorder or have previously attempted suicide then it will be required for you to see a Psychiatrist or Psychologist for assessment before being eligible for Isotretinoin and to keep in touch with the mental health care professional during the course of treatment. It is best to let your close friends and family know you are starting Isotretinoin and to ask them to let you know if you appear different or low compared to your normal self. If you feel a lowering in mood or ideas of harming yourself on treatment, you should stop Isotretinoin straight away and let your GP know so you can be seen by a mental health professional.
  • Decrease in nighttime vision. This is rare but if you notice this then stop Isotretinoin. You will need to see an Ophthalmologist for evaluation. If you are a pilot or plan to become a pilot then you should not take Isotretinoin as sometimes a decrease in nighttime vision can be permanent.
  • Skeletal changes. If adults take Isotretinoin for more than two years continuously, there is a possibility they may be prone to calcification of tendons, causing stiffness. This has not been categorically proven though there are concerns.
  • Sacroiliitis. While low back pain is very common on Isotretinoin, severe low back pain caused by inflammation in the sacroiliac joints can occur.
  • Tendonitis. Isotretinoin can also cause inflammation of tendons leading to pain such in the Achilles tendon, the plantar fascia, and tendons around the knee and shoulder.
  • Erectile dysfunction and reduced libido. There are rare reports of men having problems getting or maintaining an erection, and both men and women suffering from a lower libido.
  • Inflammatory bowel disease. There are cases of Inflammatory Bowel Disease flaring and it is important you discuss this with your Dermatologist.

FAQs

When should I take Isotretinoin?

You should take Isotretinoin at the same time every day with a meal, preferably a meal that has 20g or more of fat. Try and select healthy fats such as avocado, olive oil and nuts. Isotretinoin is better absorbed in fatty food.

Should I take all my medication in one go?

Yes, it is safe to take your full day’s dose all in one go. If you are experiencing a lot of side effects, then it is advisable to take half the dose in the morning and half the dose at night.

What should I do if I miss a day by accident?

Do not take extra on the next day to make up for the missed dose. You will just take that day’s worth at the end of the course.

I have run out of Isotretinoin – what should I do?

We advise you to plan your appointments for blood tests and consultations in good time, so you do not run into this problem. Interim prescriptions are not available. Gaps of 1 and 2 weeks will not affect your treatment as the Isotretinoin remains in the body for at least 2 weeks before it is washed out.

I am not experiencing any side effects on Isotretinoin, is this normal?

Some people have very few side effects, and this is not a concern providing the acne is improving. If the acne is not improving, then it may be that Isotretinoin is not being absorbed properly – so make sure you have a fatty meal with it. There are some people who do not metabolise Isotretinoin to the active drugs in the body very well and just need a higher dose.

Can I take vitamins and supplements with Isotretinoin?

It is perfectly OK to take a standard multivitamin that contains no more than your recommended daily allowance of Vitamin A of a maximum of 5000 units per day. Amounts of vitamin A that exceed this should not be taken. You should avoid St John’s Wort if you are on the oral contraceptive pill.

How much alcohol am I allowed on Isotretinoin?

You should keep alcohol intake to an absolute minimum, and preferably none if possibly. A maximum amount of 4 Units is recommended.

If I have depression, can I have a course of Isotretinoin?

Many people who have depression have successfully taken a course of Isotretinoin. You will be asked to have an Isotretinoin mental health assessment from an HCPC-registered practitioner psychologist or a GMC-registered Consultant Psychiatrist who is familiar with Isotretinoin to establish if it would be safe to proceed with this treatment. Your mental health practitioner should also be able to make arrangements for regular checkups and emergency access for any change in mental health.

I am about to start my exams. Should I still start a course of Isotretinoin?

Some people have complained about fatigue, irritability, poor concentration and forgetfulness – but these are not terribly common. If you are very concerned, you should wait until after the exams.

Can I take Isotretinoin if I am vegetarian or vegan?

The capsules contain gelatin, so you may wish to avoid Isotretinoin. There are no gelatin free alternatives

Can I take Isotretinoin if I am peanut-allergic?

Isotretinoin capsules contain soya bean oil. We would advise you to see an allergist to establish that you are not allergic to soya by having a pinprick test and IgE levels. Please bring these with a report to your appointment.

I would like treatment for acne scarring – how long should I wait?

The current guidance is to wait 6 months before having fully ablative laser treatment. It is possible to have vascular laser treatment while on Isotretinoin and subcision 2 months after stopping Isotretinoin. A good rule of thumb is to wait at least until your skin and lips start feeling back to normal. It is also possible to have fractional laser treatments, Tixel, TCA cross and chemical peels two months after stopping Isotretinoin.

I am worried I will flare after stopping Isotretinoin

Once you complete your course of Isotretinoin, you will be given a bespoke skincare programme containing prescription skin products that will reduce the chance of your skin flaring.

I am noticing more facial redness while I am on Isotretinoin.

There are four reasons why there may be more facial redness. The first is that Isotretinoin can cause redness and flushing as a direct effect, and this will go when you stop treatment. The second is that Isotretinoin can cause dry skin and eczema which can lead to redness. Use plenty of moisturisers to reduce this. The third is that inflamed, red spots will settle to leave flat areas of redness which are called post-inflammatory erythema – these will look redder when you are hot or exercise. Finally, Isotretinoin makes you prone to catching the sun, and this can cause sunburn and redness. It is important to avoid the sun and wear a high-factor sunblock.

I am noticing hair shedding since I started Isotretinoin

This is a well-known side effect because Isotretinoin causes some hairs to enter the shedding phase sooner than they would otherwise. The good news is that any hair changes should recover within 6 to 18 months of stopping Isotretinoin.

Can I go in the sun?

Isotretinoin can make you much more sensitive to the sun, and you may find that you burn very easily. It is best to stay out of bright sunlight. If you must go out, wear a hat and long sleeves, and apply a factor 50 sunscreen to the exposed areas.

Products you might like to consider are (these are all Factor 50):

Lighter – La Roche Possay Anthelios Ultra-Light Fluid Factor 50 (Tinted version also available), Heliocare 360 Oil-Free Gel

Slightly Heavier – Cetaphil Daily Defence Moisturiser SPF50+, La Roache Possay Anthelios Hydrating Sun Cream

For the body – Sun Sense Ultra SPF 50, Nivea Protect & Moisture SPF 50

Remember the following rules about sunscreen:

  • You need to put enough – about 1/4 teaspoon for the face and 2 teaspoons for the face, neck and arms
  • You need to reapply every 2 hours that you are out and about
  • You still need to wear a wide-brimmed hat and avoid direct sunlight where possible

How should I remove make-up when I am taking Isotretinoin?

It is perfectly OK to apply make-up while undergoing a course of Isotretinoin. A non-comedogenic make-up is better for your skin. Try and select a mineral-based product if possible. To remove makeup, you can consider using Micellar water and once all the make-up is off, washing the face with a moisturising lotion such as Cerave  Moisturising Lotion for Dry Skin, as described above. This two-step process is sometimes called a double cleanse but it will ensure your skin remains hydrated.

It has been two months, and I still haven’t seen any improvement.

Sometimes it can take quite a while before improvement is seen. In some people, this can be 8 weeks, and for others, it can be even 12 or 16 weeks. It is important to remain positive in the early stages while the medication is still taking effect.

My skin is flaring on Isotretinoin.

A mild flare in the first few weeks is very common and this is usually because your previous acne treatments have been stopped, and Isotretinoin has not yet kicked in. Severe flares in acne are also possible from Roaccutane. One theory is that the sebaceous glands all shrink at once, causing the immune system to act strangely and start causing inflammation against them. This can be treated with steroids. You may also be advised to temporarily stop or cut down the dose of Isotretinoin for severe flares. The other time is if you have a lot of untreated macrocomedones. It is best to get these dealt with before starting Isotretinoin treatment.

Can I donate blood?

Blood donation is not allowed while on Isotretinoin or for one month after you have stopped.

Can I breastfeed on Isotretinoin?

No, as the medication will be transmitted in breast milk.

Can Isotretinoin cause impaired fertility in women?

Isotretinoin does not affect the ability to have children in women, but they must only consider a pregnancy one month after stopping treatment.

Does Isotretinoin affect male fertility?

There is no evidence that Isotretinoin affects male fertility or causes any issues for those who conceive while the male parent is on Isotretinoin.

When do I need to have pregnancy tests?

You can purchase urinary pregnancy tests from a pharmacy or supermarket. A pregnancy test must be carried out before starting treatment and every month thereafter, usually on the day before your  appointment. You will be asked to take a photograph that you have dated and testified to be true, and send this using a special form.  You will also need to do a pregnancy test one month after stopping treatment because the drug stays in the body for one month and could damage a developing baby.

What should I do if I am worried I could have become pregnant?

If you have unprotected sex, miss your period, become pregnant or suspect you have become pregnant, you should contact our practice and your GP urgently. Our clinic will refer you to a private Obstetric and Gynaecological service.

I am not sexually active and do not intend to get pregnant

In certain cases, after discussion with your Dermatologist, it may be possible to opt-out of the requirement for contraception. However, monthly appointments and pregnancy tests will still be required, and prescriptions will be limited to 30 days.

Which blood tests do I require?

You require a blood test for liver function and fasting lipids which should include Triglycerides and Cholesterol. Blood tests must always be taken while you are fasting – this means you must not eat or drink anything other than water, black tea or black coffee for 8 hours before your test.

Can I get a tattoo or microblading when taking Isotretinoin (Roaccutane/Accutane)?

It is generally best to avoid any procedure that causes trauma to the skin while taking Isotretinoin. Therefore it is best to wait at least 3 to 6 months after you have completed the course.

Can I get an ear piercing or a body piercing when I am taking Isotretinoin (Roaccutane/Accutane)?

It is generally best to avoid any procedure that causes trauma to the skin while taking Isotretinoin. Ear piercing and body piercing are best avoided for 6 months until after completing your Isotretinoin course. This is because of a possible increased risk of getting thickened, raised or keloid scars.

Can I get eyelash extensions or false eyelashes when I am taking Isotretinoin (Roaccutane/Accutane)?

You would be advised to avoid eyelash extensions and false eyelashes while taking Isotretinoin. There is a possibility that the glue which is used may cause irritation that can lead to blepharitis.

My eyes are very dry, red and sore despite using eye drops regularly. What should I do?

Please contact the office so that you can be referred to a local specialist Eye clinic that is familiar with our patients on Isotretinoin for further evaluation. Following evaluation by an eye specialist, you will be advised if you have additional reasons for your dry eyes, such as blepharitis, eyelashes irritating the eye, an unstable tear film and Meibomian gland dysfunction. You will be advised whether you require medicated eye drops, punctum plugs to help tear retention or other eye treatments. It is important to have this symptom addressed sooner rather than later in order that you may remain on Isotretinoin.

Appointments for Acne and Isotretinoin

If you are interested in discussing Isotretinoin as a treatment for acne, then please contact us on 0121 285 4540 to organise an appointment or click here to make an enquiry.

Medications are only prescribed during a consultation once your doctor has adequate knowledge of your health and condition. A particular medication is only prescribed if the medication is suitable for a person in their current situation.

We ask that you do not assume that a particular medication will be prescribed at a consultation, as this will be down to the medical assessment made by your doctor. Further, we also do not necessarily continue prescriptions for medications you may have been prescribed elsewhere, including from overseas or from online providers, as the same criteria for prescribing are applied.

Important additional reading materials

Please ensure that you read this information as well:

Isotretinoin (Roaccutane) checklist

  1. Read this page thoroughly. Consider reading it together with a friend, partner or parent.
  2. Read the additional materials that are referred to in the links above
  3. If you are female and of childbearing potential, then you should ensure you are on appropriate contraception
  4. You will need the following – a daytime moisturiser, a nighttime moisturiser, a soap substitute, lip balm, eye drops (artificial tears), and vaseline for the nostrils. Remember, all your other skincare will need to be stopped.
  5. You will need to stop all topical treatments for acne and any tetracycline antibiotics – at least 48 hours before starting Isotretinoin.
  6. You will need a hat with a wide brim and factor 50 sunblock

References

    • Oral isotretinoin for acne. Cochrane Database Syst Rev. 2018 Nov; 2018(11): CD009435. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6383843/
    • Strauss JS, Rapini RP, Shalita AR, Konecky E, Pochi PE, Comite H, et al. Isotretinoin therapy for acne: results of a multicenter dose‐response study. Journal of the American Academy of Dermatology 1984;10(3):490‐6.
    • Plewig G, Dressel H, Pfleger Met al. Low dose isotretinoin combined with tretinoin is effective to correct abnormalities of acne. J. Dtsch Dermatol. Ges.2004;2: 31–45.
    • Is oral isotretinoin treatment contraindicated for patients with known peanut allergies?JAAD Case Rep. 2020 Feb; 6(2): 75. Published online 2020 Jan 16. doi: 10.1016/j.jdcr.2019.02.016
    • Piquero-Martin J, Misticone S, Piquero-Casals V, Piquero-Casals J. Topic therapy-mini isotretinoin doses vs topic therapy-systemic antibiotics in moderate acne patients. Ann Dermatol Venereol. 2002;129:S382.
    • Tran P, Berman H, Leavitt E et al. Analysis of factors associated with relapse in patients on their second course of isotretinoin for acne vulgaris. J Am Acad Dermatol. 2020 Oct 20;S0190-9622(20)32842-5. doi: 10.1016/j.jaad.2020.10.030.

Author Details

Author: Dr Sajjad Rajpar

Date last reviewed: 1 Aug 2022

Conflict of interest and disclaimer

This information is based on the views of a UK Consultant Dermatologist (a doctor who is on the specialist register for Dermatology, the equivalent of which is ‘Board certified’ in the USA) who has supervised many patients successfully on Isotretinoin over almost 20 years of practice. This information is intended for patients of this Clinic and under our care only. No part of this document should be construed as medical advice to those not under the care of this Clinic and under our care. Practices vary nationally and internationally, and we do not wish to contravene advice you have been provided by your own physician.