Acne can be persistent and challenging to treat, especially in severe cases where over-the-counter remedies and topical treatments fall short. For those suffering from moderate to severe acne, isotretinoin (commonly known by its former brand name, Accutane) is often recommended as a powerful solution. This medication, derived from vitamin A, targets the root causes of acne, offering significant and long-term improvements. In this article, we explore the isotretinoin treatment journey, highlighting what to expect from start to finish.
What is isotretinoin?
Isotretinoin is an oral medication used to treat severe acne that has not responded well to other treatments. It works by reducing the amount of oil (sebum) produced by the skin’s sebaceous glands. By shrinking these glands, isotretinoin helps prevent clogged pores that lead to acne formation. Additionally, it has anti-inflammatory properties and helps renew skin cells, promoting clearer skin over time.
Before starting isotretinoin: Consultation and considerations
1. Medical consultation
Before beginning isotretinoin treatment, you will undergo a thorough consultation with a dermatologist. During this visit, the dermatologist will assess your skin, acne severity, and medical history. Since isotretinoin has known side effects, it’s important to discuss any underlying health conditions and medications you may be taking.
- Blood tests: A blood test may be required to check liver function and cholesterol levels, as isotretinoin can affect both. These tests will be conducted periodically during your treatment.
- Pregnancy and contraception precautions: Isotretinoin is a potent teratogen, meaning it can cause severe birth defects. Patients who are prescribed this medication must take strict precautions to avoid pregnancy during treatment and for at least two months after completing the course. Effective contraception must be in place from one month before starting the medication and continue for two months post-treatment to ensure all traces of the drug are eliminated from the body. Regular pregnancy tests and close monitoring are essential throughout this period.
2. Setting realistic expectations
Isotretinoin is highly effective, but it’s not a quick fix. While many patients experience significant improvement, the treatment process requires patience. Results vary depending on individual skin types and acne severity, with visible improvements often taking months.
The treatment journey: What to expect at each stage
1. Starting treatment: Weeks 1-4
During the first few weeks of treatment, your body will begin adjusting to the medication. Most people start on a low dose to minimise side effects. Common experiences at this stage include:
- Worsening acne: It’s normal for acne to temporarily worsen before it improves. Known as the “purge phase,” this happens as the medication accelerates the turnover of skin cells.
- Skin dryness: Since isotretinoin reduces oil production, one of the earliest side effects is dry skin, lips, and eyes. Applying a gentle moisturiser and lip balm becomes essential.
Key tips:
- Hydrate often to combat dryness.
- Use a gentle, fragrance-free cleanser.
- Avoid harsh skincare products, like exfoliants, that can irritate sensitive skin.
2. Middle phase: Weeks 5-16
By this point, your body is accustomed to the medication, and some improvements in acne may be noticeable. Patients often see a reduction in new breakouts and overall skin texture.
- Continuing side effects: Skin and lips may remain dry, and some patients experience joint pain or muscle stiffness. Mood changes, though rare, can also occur, so it’s crucial to monitor your mental health and inform your dermatologist of any concerns.
- Managing flare-ups: While acne should be improving, occasional flare-ups may still occur. Stick with the prescribed routine, as long-term results will come with consistency.
Key tips:
- Continue moisturising to prevent skin damage.
- Protect your skin from the sun by using a broad-spectrum sunscreen daily, as isotretinoin increases sun sensitivity.
- Attend all follow-up appointments to track progress and adjust dosage if needed.
3. Final phase: Weeks 16-52
The duration of isotretinoin therapy is highly individualised, often depending on factors like dose tolerance, patient weight, and the degree of acne clearance. While a typical course lasts around 5-8 months, treatment can extend up to 52 weeks (12 months) in some cases to achieve optimal results. Dermatologists adjust the duration and dose to ensure acne is fully managed, taking into account each patient’s unique response to the medication.
As the treatment progresses, most patients see a substantial reduction in acne. By the end of the treatment, clear or nearly clear skin is common for those who stick with the full course.
- Reduced oil production: By now, your skin will produce significantly less oil, leading to a noticeable decrease in acne severity and frequency of breakouts.
- Fading scars: While acne scars may remain, isotretinoin helps reduce redness and inflammation. For deeper scars, dermatologists may recommend treatments such as laser therapy or microneedling post-isotretinoin.
Key tips:
- Continue avoiding harsh skincare products and treatments during the final phase.
- Stick with sunscreen protection, as sun exposure can worsen scarring or pigmentation.
Post-treatment: What happens after isotretinoin?
Once the course is completed, most patients experience long-lasting acne relief. A proper course of isotretinoin should bring long-term remission of acne in 80% of patients. It does, however, have multiple side effects, especially mucocutaneous effects. These are frequently minor but, for some individuals, they can be quite problematic. The post-treatment phase requires ongoing care to maintain results and manage potential side effects.
1. Post-isotretinoin skincare
While acne may not return, your skin may remain sensitive for several months after treatment. Continuing with gentle skincare products and avoiding aggressive treatments will be crucial for skin healing.
2. Possible relapse and retreatment
Though isotretinoin offers long-term benefits, some patients (particularly those with severe or cystic acne) may experience a relapse. In such cases, your dermatologist might prescribe a second, shorter course of isotretinoin or other treatments to maintain clear skin.
3. Monitoring side effects
Your dermatologist will continue to monitor your skin health and any lingering side effects post-treatment, such as dry skin, which should gradually improve. Women of childbearing age need to maintain contraception for at least one month after discontinuing isotretinoin.
Common side effects of isotretinoin
Isotretinoin is a powerful medication, and its side effects can vary in intensity. While many of these diminish after the treatment course, here are some common ones:
- Dry skin and lips
- Nosebleeds due to dry nasal passages
- Joint and muscle pain
- Mood changes (rare but serious)
- Sun sensitivity
Is isotretinoin right for you?
The isotretinoin treatment journey can be life-changing for those with severe acne. While it requires dedication and careful management of side effects, the long-term benefits often outweigh the challenges. Clearer, healthier skin awaits many who complete the journey.
If you’re considering isotretinoin or are currently on medication, maintaining an open line of communication with your dermatologist is essential. Regular monitoring, patience, and proper skincare practices will help ensure the best outcome on your path to clearer skin.
If you’re seeking personalised acne treatment, Acne Express offers expert online consultations tailored to your needs. Located in the Northern Territory of Australia, Acne Express specialises in managing various acne conditions, including those requiring isotretinoin.
With our teledermatology service, you can access professional advice and treatment plans from the comfort of your home. Our dermatologists are dedicated to helping you achieve clear, healthy skin—no matter where you are in Australia. Start your journey to better skin today by booking a consultation with Acne Express!
