6 Things That Happened to My Body When I Went on Isotretinoin

If you're thinking about going on isotretinoin, the high-dose vitamin A pill that treats acne, you've probably already done some research. Before I started the medication—more widely known by its former brand name Accutane—I scrolled through online forums, diligently reading first-hand accounts of the pros and cons of the drug.

Pros: It cures acne for many people. Others see a significant lifelong improvement in their acne. Some see acne resolve for a few years and may require additional courses of treatment.

Cons: It comes with annoying side effects. It's also hard to get a hold of. According to the Food and Drug Administration, a government program called iPLEDGE REMS tightly controls prescriptions for isotretinoin since the drug can cause severe birth defects if a person gets pregnant while taking it.

Once my healthcare provider wrote me a prescription, I began the very involved process that accompanies taking isotretinoin. Spoiler alert: It includes blood work, pregnancy tests, and monthly check-ups with your dermatologist

The good news is that I'm on month three—about halfway through my treatment course—and my side effects haven't been all that bad so far. Still, I figured I'd share my experience in case you're frantically searching around on Google, looking for answers like I was.

I asked experts to weigh in on my side effects. Just keep in mind that my experience won't necessarily be the same as yours. How you respond to isotretinoin depends on your body and the dosage you take—mine was a 30-milligram dose. 

Here's what you should know the six things that happened to my body when I went on isotretinoin.

Dry Skin

Dry skin is a very common effect of isotretinoin. 

"Almost everyone experiences it," said Arielle R. Nagler, MD, associate professor of dermatology at the NYU Grossman School of Medicine in New York. That's because the drug reduces the production of sebum—the oily secretions from the sebaceous glands in your skin.

"Sebum is what's necessary to create acne," explained Dr. Nagler. "By decreasing oil production, isotretinoin is one of the only medications we have that can cure acne in many cases."

I typically have combination skin that's both oily and dry at the same time. Since I started on isotretinoin, the dryness has definitely won out—but not as much as I expected it to. 

Applying a generous swath of moisturizer in the morning and night has been enough to keep my skin hydrated. I've also been serious about applying my favorite sunscreen to my face every day since isotretinoin increases your sensitivity to the sun.

Peeling Lips

While the dryness hasn't been horrible on my face, it has done a number on my lips. That is expected, according to Dr. Nagler. Though isotretinoin can induce dryness anywhere on the body, it often dehydrates the lips because of its high cell turnover rate. 

If you're thinking of going on the drug, I recommend stocking up on lip balms, especially those that contain cortisone. Also, the dryness can extend to the nasal passages, causing nose bleeds. Ointment and a humidifier can help.

Breakouts (Sort Of)

About a month into my isotretinoin treatment, I started to feel tiny bumps on my chin and along the top of my nose. When I studied myself in the mirror, I saw that my pores seemed to be pushing out whatever gunk—no better word for it, sorry—they could, almost like spontaneous extractions. The bumps didn't look like pimples, and nobody could see them except me, but the texture of my skin was noticeably different.

"This can happen because the drug brings out all the acne that's underneath the skin," Debra Jaliman, MD, a New York-based dermatologist, wrote in an email. 

I'd read a few patient testimonials online that warned about that possibility. People wrote that their acne actually got worse in the first month or so as the isotretinoin worked to "purge" their skin. Mine was a mini purge, if that, and only lasted a week or two.

Stiffness

Almost immediately after starting isotretinoin, I woke up with a stiff neck that stuck around for four days. Annoying? Yes. Unheard of? No.

"Isotretinoin can affect the muscles and cause tenderness and soreness," noted Dr. Jaliman.

Patients may feel aches and pains in other body parts, too: "I see isotretinoin patients with joint pain and some with headaches too," added Dr. Nagler. "But if you are getting headaches on the medication, you definitely want to be seen by your [healthcare provider] since, in rare cases, the drug can cause an increase in pressure in the brain."

Sore Throat

Two days into taking the medication, I woke up with a sore throat. Dr. Nagler hadn't heard of that symptom before but thought it might have just been another part of my body that was experiencing dryness. The scratchy throat didn't last more than three days.

Better Hair

Yep, you read that right. I'm someone who needs to lather, rinse, and repeat daily in order to keep my locks looking fresh. Yet once I started taking isotretinoin, my hair required way less maintenance. I noticed that it wasn't getting greasy by the end of my workday, nor did it need to be shampooed nightly.

That is fortunate because, according to a study published in 2022 review in the Journal of The American Academy of Dermatology International, about 3.2% to 5.7% of people on isotretinoin experience hair loss, with a higher frequency at higher doses. The review noted that there's no evidence that hair loss may persist after discontinuing the medication.

"People say their hair gets less oily, and they have to wash it less," said Dr. Nagler. "That's likely related to the decrease in sebum production on the scalp." 

A Quick Review

Per the American Academy of Dermatology Association (AAD), there are several myths and misconceptions regarding the side effects of isotretinoin. Although experiences using the acne treatment may vary from person to person, side effects of isotretinoin include:

• Dry skin, mouth, and lips
• Sensitivity to the sun (use an SPF of at least 30 daily to protect yourself against sun exposure)
• Worsening acne
• Vision problems at night
• Thinning hair
• Muscle or joint aches and pains

However, those side effects are usually temporary and subside over time. They will also go away if you stop taking isotretinoin.

Consult your healthcare provider before starting or stopping isotretinoin. And do not use the acne treatment if you are pregnant or plan to become pregnant since isotretinoin may cause birth defects, miscarriage, or stillbirth.