What is Accutane and why I refused to take it: Breaking down the clinical research

How it works, if it’s risky, and why I chose to skip it

First things first - thank you so much for such a great response on my acne story. It’s wonderful to see the support and even see some of you relating with my experience.

Acne really gave us hell, huh?

Out of all the questions I got DM’d - these 3 were the most common and stood out:

#1 Why 1 am?

#2 I am a skincare novice - what routine should I follow?

#3 Why did you warn against accutane?

I do plan to answer all but the third question felt the most urgent - given a lot of you wrote in saying you’re on Accutane right now.

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I remember reading a lot of clinical research on Accutane - and the more I read the more I was convinced I wanted to be far away from this “miracle drug”. As someone who was told to get on Accutane but refused to - here’s me coming clean on why I never took it.

What is Accutane and what does it do?

Accutane is a branded version of the drug Isotretinoin in its oral form. (Going forward you might see me using Accutane and oral Isotretinoin interchangeably). It is a potent derivative of Vitamin A and is strictly prescription only.

Isotretinoin was authorised by the FDA in 1982 and is considered to be one of the most efficient treatments for acne. It is usually the last resort for acne treatment. It is highly effective but comes with a set of drastic side effects.

Many dermatologists recommended that I get on a course of Accutane. Most times with very little to no warning, context or literature about its adverse effects.

What tipped me off the most was when they would ask me the loaded question - “Are you planning to get pregnant in X number of years?” (The number varied dermat to dermat).

The second I answered with a “no” — the prescription would get signed.

Call me an overthinker but this was my cue to research the sh*t out of this miracle drug before any (undesired) miracles happened…

I eventually never took Accutane. I know many people have and it’s worked for them. But to me, the risks felt too scary (call me a coward, it’s cool).

You don’t need to take my word for it (I don’t know your diagnosis, or have the complete context - and I’m not a doctor). But let me take you through all the published scientific research I read about Accutane (oral Isotretinoin) which made me skip it.

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1. Pregnancy and Isotretinoin don’t go hand in hand

If you are someone who is currently pregnant or is trying to get pregnant, Isotretinoin is a complete no-go. This isn’t a ‘be careful’ situation but a ‘don’t even think about it’ one.

Effect of Isotretinoin on fetal development | Source: NCBI

Exposure to Isotretinoin can cause severe fetal abnormalities affecting the brain, heart, craniofacial development (bones of the skull and face). It’s not just risky, it is truly catastrophic.

In fact the risk is so great that in some countries “pregnancy prevention programs” are mandatory during isotretinoin treatment - to manage the risk of isotret’s teratogenicity and to minimise fatal exposure.

Source: iPLEDGE program

Teratogenecity and side effects of Isotretinoin; Teratogenicity refers to the capacity of a substance to cause birth defects in a foetus or embryo. | Source: NCBI

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2. Dry Skin is a common side effect

Cracked lips caused by Isotretinoin

Isotretinoin works by reducing oil production in the skin to treat acne. However, this can also lead to widespread dryness - particularly on the lips, where the skin is thinner and more prone to irritation.

A majority of people who take isotretinoin experience dry skin, especially on parts of the body that are regularly exposed e.g. the face, hands, lips. The most common and prominent side effect is chapped or cracked lips, which usually appears early in the treatment.

Side effects of Isotretinoin concerning the skin | Source: NCBI

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3. Hello muscle pain and weakness

Isotretinoin can cause muscle aches, stiffness, or weakness, with lower back pain being the most common. The risk often increases with higher doses. Some studies link it to sacroiliitis, possibly because the drug weakens joint cell membranes, making them more prone to irritation (although this theory is not conclusive yet).

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4. Impact on blood markers

Oral Isotretinoin can cause changes in certain blood markers, including:

• Increase in Triglycerides (TG) – a type of fat in the blood

• Increase in Liver enzymes like ALT and AST – markers of liver function

• Higher LDL – "bad" cholesterol

• Lower HDL – "good" cholesterol

Hence, regular blood tests are essential during treatment to monitor their normal levels and liver function. The good news? Most of these changes seem to reverse after stopping the medication.

Effect of Isotretinoin on blood markers | Source: NCBI

There are a few side effects which are often linked to Isotretinoin but so far, current research hasn’t been able to prove the correlation. For now, they remain in the ‘maybe’ category.

For example, the impact on mental health - like mood swings and depression - is not proven yet. Or the impact on IBS, which is often spoken about but not actually proven.

My final thoughts

Accutane (oral Isotretinoin) can and has been a saviour for some. But I believe no one should be pushed into it without having all the facts first.

We’ve looked at isotretinoin holistically - what it is, how it works, the proven side effects and the ones still being debated. Why some people choose to use it while others like me have steered clear. The point here isn’t to scare you away - it is to ensure you know exactly what you’re saying yes to.

Your skin is unique, and so are the choices you make to treat it. All I’m saying is: ask questions, get the full picture, and then decide if this miracle is worth the fine print.