Isotretinoin (Roaccutane / Accutane) | Everything you need to know

Created: 09.01.2025

Updated 09.01.2025

Approved by: Consultant Dermatologist, Dr James Denny

Deciding to embark on a course of Isotretinoin (Roaccutane / Accutane) can be scary, especially since there are a lot of mixed messages on the internet and at times, the scientific evidence can appear a bit patchy, conflicting or simply hard to find. Whether you're considering treatment, looking into a prescription or simply searching online for information, understanding the full scope of the medication's effects is crucial.

That’s why we wrote this guide which compliments the most recent British Association of Dermatologist’s patient information leaflet and should give you all the information you need to make an informed decision as to whether or not you think isotretinoin (Roaccutane/Accutane) is the right medication for you.

What is isotretinoin (Roaccutane / Accutane)?

Isotretinoin is a prescription-only medication used for acne and some other similar skin conditions. It is a type of medication called a retinoid and can only be prescribed by doctors who are experienced in using it, usually a Consultant Dermatologist. As such, your GP is not authorised to prescribe nor monitor its use.

Roaccutane and Accutane are the brand names for the drug isotretinoin and how it is more often referred to. It has been available for use in the UK for approximately 40 years and, as such, we have a lot of experience prescribing it.

Isotretinoin is usually prescribed as a capsule but is also available as a topical cream and gel. This guide does not focus on the topical versions, but they are useful to know of as they can be helpful for mild acne.

How effective is isotretinoin?

9 out of 10 (90%) of people report a significant improvement in their acne after their treatment course has been complete (i.e after approximately 5-6 months).

There is no other available acne treatment that can produce such consistently positive results.

Although highly effective, it is important to remember that while some people will get complete control of their acne, most people will still develop the odd spot here and there while on treatment, but the number will be far fewer in number, size, severity and will also disappear faster.

Does isotretinoin cure acne?

Studies have shown that approximately 70-90% of people will see either a complete cure or only a minor reoccurrence of their acne, so mild that only topical treatments are required.

In those unlucky few who do see a complete return of their acne, there is evidence to show that a second course, often at a higher dosing schedule, is enough to finally put their acne to rest.

How will isotretinoin help my acne?

1. Reduces greasiness (seborrhoea) – Isotretinoin shrinks sebaceous glands and so reduces grease production in the skin, by up to 90%. This is why dry skin is the main side effect and why many people will notice their skin and hair become less shiny while on treatment.
2. Reduces bacteria – Grease can cause bacteria to grow. Isotretinoin reduces grease production but also inhibits the growth of bacteria on skin which reduces the chance of them causing infections, pus spots and cysts.
3. Reduces blocked pores (comedones) – Isotretinoin stops comedones from forming and is also effective at clearing existing comedones that may be open (blackheads) or closed (whiteheads). However, large closed comedones might not clear with Isotretinoin and are best treated before starting a course of Isotretinoin. Examples of treatment including hyfrecation and manual extraction which are best performed by a skilled clinician.
4. Reduces inflammation – Isotretinoin has an anti-inflammatory effect and clears inflamed spots like papules, pustules and nodules. Isotretinoin stops new inflamed spots from developing and causes existing inflamed spots to flatten and resolve.
5. Reduces cysts – Isotretinoin is good at reducing cysts that arise in acne.

What will isotretinoin not help with?

1. Pigmentation – When skin becomes inflamed it often reacts by producing more pigment in that area. This is called post-inflammatory hyperpigmentation and is often more pronounced in skin of colour. Isotretinoin does not treat this hyperpigmentation although there are several other treatment options available for this.
2. Scarring – Although isotretinoin can soften scars, it does not get rid of them. The main aim of isotretinoin is to prevent scarring which is why seeking treatment early often leads to better results.
3. Redness – Isotretinoin will reduce inflammation but occasionally persistent redness at the site of healed very inflamed spots can occur. If this occurs, then laser treatment may be indicated.
4. Pores – Isotretinoin will reduce pore size while you are on treatment, but this is temporary, and the pores will return to their normal size within a few months of stopping treatment.

Roaccutane / Accutane side effects and how to control them

Almost everyone who is treated with isotretinoin will experience at least one side effect during their treatment course. However, for the vast majority of people these are tolerable and easily managed. The side effects also tend to be greater as the dose is increased (see next section for more information on dosing) and if too much the dose can be reduced to find the best fit for you.

The aim is to keep side effects to a minimum whilst simultaneously improving your acne. With appropriate Consultant-led monitoring and management almost 100% of people will be able to complete a full course.

Common side effects

Dryness (Lips) – This is the first side effect that is noticed and experienced by 95% of people. It can easily be managed by applying a lip balm regularly throughout the day and to try avoiding licking your lips and picking any flaked skin. Recommendation for good lip balms can be requested during your consultation.

Dryness (Inside your nose) – This can cause itching, discomfort and occasionally small nose bleeds. Apply a greasy ointment like petroleum jelly to the inside of the nose at least 3 times per day or more if they are very dry. Recommendation for good ointments can be requested during your consultation.

Dryness (Skin) – You should also apply a non-comedogenic moisturiser (one that does not block pores) regularly throughout the day. You may also need to stop some of the topical products you normally use as they may be too harsh for your skin while on isotretinoin. A big no-no is if you are already using a topical retinoid and you continue to use it while using isotretinoin (which is also a retinoid). The two together will make your skin extremely dry. We would also advise that you avoid soaps, exfoliators, and cosmetic acids. Recommendation for good emollients, cleansers and soap alternatives can be requested during your consultation.

Dryness (Eyes) – This side effect does not often require treatment but if you wear contact lenses try to avoid where possible. Some people may benefit from the use of artificial tears. Recommendations for good lubricating eye drops can be requested during your consultation.

Dryness (Vaginal) – This side effect does not often require treatment but can be improved by using vaginal hydrating products and lubricants during sexual intercourse.

Muscle aches and pains – Isotretinoin can cause stiffness, aches and pains. Lower back pain is particularly common. This side effect is usually mild but may require the occasional use of paracetamol. It is often exacerbated by intense or strenuous exercise includes weight-lifting and cardiovascular work-outs.

In rare events some people have reported severe inflammation of their lower back (sacroiliitis) and in some tendons e.g. Achilles tendon, plantar fascia and tendons around large joints like the knee and shoulder.

Headaches – Mild headaches are very common at the start of a course of Isotretinoin.

Severe headaches that are worse in the morning, worse when coughing and sneezing and accompanied with nausea and vomiting is a rare side effect of isotretinoin (1 in 10,000 chance). If this occurs treatment must be stopped immediately.

Tetracycline medications such as Doxycycline, Oxytetracycline and Lymecycline must be stopped a week before starting Isotretinoin to reduce the chance of this rare side effect.

Temporary flaring – It is common to experience a slight worsening in your acne during the first month of treatment. This is occasionally referred to as ‘purging’. If severe, a short course of oral steroids can be administered alongside the isotretinoin. Occasionally it will be given prophylactically to reduce the risk of this side effect.

Infections and healing – As a result of the skin becoming dry while on isotretinoin, the risk of skin infection is increased as the skin becomes cracked at a microscopic level. Any skin wounds you experience may also take longer to heal and your skin may feel more fragile.

Photosensitivity – Isotretinoin can make you much more sensitive to the sun, and so you may find you burn more easily. Protect yourself while outside, even when its is cloudy, by considering hats, long sleeved shirts/trousers and using SPF30 (at least). You should also avoid sun beds and tanning salons.

Uncommon side effects

Liver injury – Your liver is the organ that processes isotretinoin and stops it building up in your body. Occasionally, isotretinoin makes the liver work a little too hard and temporarily upset it. This is why blood tests are required (see section below on blood tests). If this occurs the dose may need to be reduced or in some cases stopped altogether.

Alcohol is also processed by the liver and so we advise avoiding its consumption during your treatment period or at least minimising it.

Raised triglycerides – Cholesterol and triglycerides are found in your blood. Isotretinoin can temporarily raise both but more so for your triglycerides. High triglyceride levels can be a problem in the short term for your pancreas or liver and in the long term for you blood vessels. This is why blood tests are required (see section below on blood tests).

Hair thinning – This is uncommon and almost always temporary. It is normally only seen at high doses and does not mean treatment needs to be stopped unless affecting you severely.

Reduced libido and erectile dysfunction – There are rare reports of reduced libido in both men and women. There are also rare reports of men struggling to establish and maintain an erection.

Decrease in night vision – This is rare (1 in 10,000 chance) but if you notice it then you should stop Isotretinoin. It is usually temporary, but very rarely can be permanent. Some professions may be impacted, such as drivers, airline pilots, people in the military, and those who operate heavy machinery. If any of these are the case, you should not take isotretinoin.

Calcification – There is an unproven yet possible risk of tendon calcification if isotretinoin is taken for prolonged periods of time (~over one-to-two years). Most isotretinoin courses last no longer than 5-6 months and so this side effect is very rarely reported.

Mental health

This is a tricky one as the link between isotretinoin and low mood, self-harm and suicide has yet to be fully proven, but it has gathered a lot of media attention. By and large, the vast majority of people feel much happier after their course of treatment has been completed as they can visibly see an improvement in their skin. Unfortunately, there have been rare reports of depression/mood-disturbance (between 1 in 1,000 and 1 in 10,000 chance) with some people also developing suicidal ideation while on treatment (less than 1 in 10,000 chance).

It is not clear if it is the medication that causes this or that individuals themselves already had underlying or undiagnosed mental health issues. It is a rare but important concern and normally, if you have a history of mental health illness or have previously attempted suicide then you must discuss this with your dermatologist before starting treatment. You may be required to contact a Psychiatrist or Psychologist for assessment before being considered eligible for isotretinoin. If you feel like your mood is deteriorating on treatment you must stop treatment immediately and contact your Dermatologist.

Pregnancy, Breastfeeding & Fertility

Pregnancy – Women must not get pregnant while on isotretinoin or for one month after completing their course. This is because isotretinoin is highly teratogenic i.e. it causes severe birth defects. Isotretinoin also increases the risk of miscarriage.

Before starting isotretinoin women of childbearing potential should use at least one, and preferably two, forms of contraception for at least one month before starting treatment. This includes the intra-uterine coil (Mirena or Copper), the implant or combined oral contraception pills (COCP). Barrier contraception (condoms and caps) should be used in conjunction, not on their own.

Despite the effective use of contraception, there remains a very small risk of pregnancy. If you do fall pregnant, you must inform your dermatologist immediately, stop taking the medication and seek help from a family planning clinic.

During your consultation, your dermatologist will discuss the Pregnancy Prevention Programme (PPP) with you. This is a programme established to minimise the risk of pregnancy while taking isotretinoin. You can either opt in or opt out. It’s your choice.

Breastfeeding – You should not breastfeed while taking isotretinoin and for a month after completing treatment. Isotretinoin is found in the breastmilk of people who are taking it.

Fertility – Isotretinoin does not affect fertility. One month after finishing a course of isotretinoin, you may get pregnant with no additional risk to the unborn baby.

There are no risks to a pregnancy if a man taking isotretinoin fathers a child even though small amounts of isotretinoin are found in semen.

How does the whole process work and what will it cost?

Despite what you may have heard, isotretinoin treatment does not have to be complicated, it just needs to be safe. Below are the main aspects to be aware of during your treatment, followed by a summary and our pricing structure.

Roaccutane / Accutane Online Appointments

Appointments – Every patient will require an initial video consultation to assess if isotretinoin is the right medication for you. If so, a ‘follow up’ schedule will be devised by you and your doctor.

The exact length of a course of isotretinoin varies between people and depends upon a few factors but everyone must be seen 3-4 weeks after they start treatment. Further follow up appointment are dictated by 2023 MHRA regulations and how much medication (the dose) you can tolerate each day taken over a length of time up to a maximum amount. The higher the daily dose you can tolerate the more ‘cumulative’ doses you build up meaning you reach the maximum quicker, thus shortening your course. It is important to note that dose increases need to be gradual as your body needs to get used to higher doses. You cannot simply start at a high dose. Furthermore, not everyone can tolerate high doses.

The way a course will run is specific to you but most courses of isotretinoin last approximately 5-6 months.

As per UK Guidelines, and due to the issues around pregnancy monitoring, women usually require more regular reviews and are typically seen monthly, whereas men are normally reviewed on alternate months.

Our current rates are £189 for an initial consultation and a reduced rate of £149 for follow up appointments.

Pregnancy Tests (female only) – Women require a pre-treatment pregnancy test within a week of commencing isotretinoin and typically require a repeat test every 4-8 weeks and 4 weeks after completing their treatment. Women who are unable to bear children (e.g. post-menopausal, have had a hysterectomy etc. are exempt from this). This monitoring is required even if you are on contraception.

We send you a complementary skindoc monitoring pack for your entire treatment course and have an online reporting service too. We don’t believe women should have to pay extra for pregnancy tests just because you have ovaries!

Blood Tests – Everyone will require a ‘screening blood test’ before they commence isotretinoin. This involves a Liver Function Test (LFT) and a Fasting Lipid Profile (LP). If you have known kidney problems you may be asked to book a Renal Function, also known as Urea & Electrolytes (U&E).

These blood tests will then need to be repeated 4-6 weeks into your treatment course and every three months thereafter, while on treatment.

Blood tests are available via a few routes:

1. Home blood test kits (over 18s only) - We can arrange for these finger-prick style tests to be delivered to you. We use a laboratory called Forth to run all our tests. These are priced at only £74.99. They also have an option where you can have your blood test taken by a healthcare professional in a clinic near you for only £119.99.
2. Private Clinic - You may decide to have a healthcare professional perform these for you in a designated clinic. Most clinics will charge £200-300 but if you live near Fulham, London we can do them for you for just £95.
3. Your GP - we can request your GP undertake your blood tests on your behalf although they are under no obligation to perform these as your treatment is being delivered in the private sector and not via the NHS.

Medication – The cost of the medication itself depends on the dose that is prescribed to you. The higher the dose, the greater the cost. This is because more capsules are required. We are fortunate enough to have partnered with Phlo Online Pharmacy. They are not part of skindoc but they handle the majority of our prescriptions and have one of the lowest costs for Roaccutane in the UK. They also deliver your medication directly to you and depending on where you live, they can even courier it to you in a matter of hours.

The cost per pack of medication varies greatly between Pharmacies so it is always worth ringing around to compare prices. Expect to pay £25-100 per month of treatment depending on the dose you are taking.