The Ultimate Accutane Guide: Everything You Need to Know

by | Last Updated Apr 4, 2017 | Acne, Guides, Ingredients | 7 comments

Accutane, a.k.a. “The Nuclear Option.” The place where people go when literally nothing else works. If there was a “one-size-fits-all” product or pill to clear acne, this would be it. It’s powerful, effective, and… somewhat dangerous.

Why is it so effective? Because it basically stops your body from producing oil — like, at all. I know, that sounds intense. That’s because it is. Let’s be nerdy and get into the science!

What is Accutane?

Accutane (or isotretinoin) is a synthetic derivative of vitamin A primarily used to treat severe cases of acne which haven’t responded to anything else. It’s a prescription-only drug taken orally requiring dermatologist referral.

Dosage highly depends on the severity of acne, but ranges from 0.5 mg to 2 mg daily, with low-dose recommendations becoming the prioritized standard. Despite it having a very high success rate (about 90%) a course of Accutane can last anywhere from 3.5 to 10 months! (1)

  • Think About it.

I want you to pause and think about that for a second. We’re talking about a drug that dermatologist widely consider the most powerful acne medication in the world, yet it can take up to 10 months to eradicate blemishes completely (in fact, it’s not uncommon for people to do multiple “courses” of accutane (2)  — seriously, bless their souls).

If a red-flag hasn’t gone off in your head yet, let me explain why it should have.

How many times have you seen a skincare company, beauty guru, or website promising to get rid of your acne overnight? Answer: if I had a pimple for ever time I’ve heard that, not even Accutane would work.

Hint: if Accutane, the most powerful acne medication known to man (and women), takes a minimum of 3.5 months than what secret-magic-potion-holy-sauce are these people selling that apparently dermatologists worldwide don’t know about? Simple, they’re lying.

  • How to Navigate Through a World of Marketing.

The “overnight” claims go to show how much nonsense is behind the skincare market. The world can be a cruel place: don’t forget this. Skincare companies and websites will take advantage of your insecurities any chance they get to make a quick buck. I’m sure we’ve all fallen victim to that at one point or another.

I say all this because managing acne can no doubt be an overwhelmingly emotional experience, but it is our utmost important duty as intelligent and critically thinking people, to approach skincare logically and even somewhat scientifically before choosing what routes we take. Especially if we’re considering Accutane.

Often times, people don’t realize its their skincare products that are causing the problems. I can’t tell you how many people I’ve seen over the years resort to Accutane out of desperation before examining their skincare routine more closely.

I was very close to being one of them. I know how emotionally appealing “overnight” claims are, how desperately you want them to be true, but please please remember that by far and wide they’re completely bogus.

How does Accutane Work?

Isotretinoin works by limiting the amount of oil your body produces (about an 80% reduction). (3) Because acne in the most basic sense is simply an overgrowth of bacteria in a clogged pore, you can imagine why this is so effective — less oil means less room for bacteria to thrive.

It also significantly reduces oil gland size, regulates cell-turnover rate, and has anti-inflammatory properties. (4) In other words, it kicks some serious ass by addressing every possible cause of acne. This badassery however, doesn’t come without its share of side effects.

Side Effects of Accutane.

  • Long Term Side Effects

This part scares many people, but we’ll work through it together. A fair warning now though: this part isn’t pretty.

Isotretinoin is a “category X” drug, meaning it is known to cause birth defects if taken during pregnancy. (5) This safety concern has made it mandatory for females to take birth control while on Accutane to minimize the chances of unwanted pregnancy. And we’re just getting started…

You ever see those crazy commercials on T.V. advertising some new hip medication that has more side effects than problems it solves? Well, imagine that being Acctuane’s pansy little brother.

Long term side effects occur in 7.2% of patients and can include crohn’s disease (i.e. inflammatory bowel disease), abnormal bone growth, dry eye syndrome, arthralgia, xeroderma, and exacerbation of eczema — though all of these are considered mild in nature. (6789)

Fun-fact! There was actually an Accutane lawsuit in 2009 that temporarily banned it from the U.S. market under grounds of causing inflammatory bowel disease (okay, maybe that’s not so much a fun-fact).

  • Short Term Side Effects

Common side effects include dry lips, dry skin, nosebleed (caused by dry skin), eczema (dry rash), cheilitis (inflamed dry cracking lips), increased photosensitivity, and dry mouth. (10) You see a theme here? It’s called DRYNESS. Be warned, you will become a pruny raisin.

What to Expect on Accutane.

  • Medical Testing.

The process begins with your dermatologist. Since Isotretinoin is taken very seriously, there’s a lot of procedural stuff that goes on beforehand, particularly for woman. These include discussions about sexual and menstrual history, education about contraception, blood work, pregnancy tests, and follow up visits every 28 days. Males can expect similar protocols, without the pregnancy stuff.

  • Mood Change.

Mood change, especially depression isn’t unheard of while on Accutane. The science and research on this is all over the place, but one of the most reliable studies found that depression occurs in 0.4% of users, with a relative risk ratio of 2.68. (1112)

In other words, someone who takes Accutane is 2.68 times more likely to develop depression than someone who doesn’t. If you do find you fall into this category, please seek social support as soon as possible and talk to your health care professional.

  • Acne Flair-Up.

There’s a dreaded “purging period” during Accutane when acne gets worse initially. One study found it happens in 32% of patients and typically lasts 3-4 weeks. (13) If this happens to you don’t be discouraged, it simply means the medication is working its magic. These side effects will subside soon enough.

If you find it overbearing take a deep breath, listen to music, meditate, write in a journal, exercise — anything to destress and keep your mind off it. For most people, this is the hardest part about Accutane. Once you’ve gotten past this point your more than halfway through the battle, Acne-warrior.

Phew, now that the bad stuff is outta of the way let’s get into the good news.

  • Dramatic Results

Nearly all Accutane users destroy their acne! If this was a baseball game, the ball didn’t just go out of the park, it traveled into a black hole across the galaxy never to be seen again. Up to 95% of patients see excellent results, with results often being permanent. (14)

A reduction in anxiety and depression among cystic acne patients is very common after a successful bout of Accutane. (15) It goes without saying, but finally clearing acne has a huge and lovely impact on your confidence and wellbeing.

When your skin starts clearing and people notice.

How most girls react when complimented.

Skincare Routine on Accutane And Best Practices.

Your dermatologist will provide the best guidance here. Listen to them before taking any advice from me. Generally, they’ll recommend a barebones skincare routine that minimizes irritation. This means no harsh acne washes, active ingredients, chemical and physical exfoliates, or waxing.

Skin is very fragile and sensitive on Accutane, so baby it every chance you get. Use a gentle, pH-balanced cleanser and moisturize like there is no tomorrow. Start moisturizing before the skin is dry. Sunscreen is a must due to the photosensitizing properties Accutane causes, without it you will sunburn far more easily.

Not skincare related per-say, but avoid multivitamins, alcohol, and taking Accutane on an empty stomach. Research has shown that the absorption of Accutane is 1.5 to 2 time greater when consumed with a meal including high fat content. (16)

One final note, and I cannot stress this enough: your skin will become dry and sensitive, so pamper it like you would a newborn. And if you find that nothing is minimizing the dryness, use Aquaphor  — trust me, it will become your new best friend.

aquaphor for accutane

Support Groups and Resources.

Because doing a course of Accutane can result in many side effects and take its toll on you emotionally and mentally, it’s important to have a safe space to go when you need to vent or have concerns. I highly recommend joining an online support group. is a fantastic place filled with very caring and compassionate people. Their motto: “let’s go through this together.” is another rich source of information with supportive forums. We are all here to help.

Also watch youtube videos of people who have gone through Accutane themselves. There are a ton of them. Hearing about other’s experiences is an invaluable way of easing stress and preparing you for what to expect.

I hope knowing that hundreds of thousands of strangers have made this journey, gives you some peace of mind and sense of comfort: if they made it, so can you.

Final Words.

If you begin to lose hope, remember to have the longterm goal in sight. This is all temporary. The pain you’re experiencing now will be worth it in the end, and if it’s not — it’s not the end. Keep pushing, hold on, love yourself (you’re beautiful damn it!), and it’ll be better before you know it.

Update (10/1/16): If you’re considering going on Accutane, I highly recommend you try clearing your acne with my 3 step approach first. I put as much information into that guide as I possibly could, and I think it could realistically clear 90 to 95% of people.

Very warmly,

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