As a skincare girlie who cruised through her teens without a single blemish on her skin, you can imagine how a sudden outbreak of adult acne was my worst fear, realised. I was in my late 20s, with severe breakouts—painful cystic eruptions followed by scarring that no antibiotics or topical treatment seemed to fix. It left me with one last option: isotretinoin.
What is it, you ask? Isotretinoin is a powerful oral medication primarily used to treat severe acne. While known to be highly effective, it comes with significant side effects and requires close medical supervision. "Isotretinoin works by shrinking the sebaceous (oil) glands and significantly reducing oil production," explains Dr Mikki Singh, medical director at Bodycraft Clinics.
This stops pores from getting clogged, prevents new acne from forming and also promotes skin cell turnover to keep pores clear. However, consistency is key—my own experience only revealed noticeable improvement after six months on the medication. Before you consider starting the treatment, here are some things to keep in mind.
The immediate risks of isotretinoin Dr Neha Khuraana, founder of House of Aesthetics, advises that after taking isotretinoin, it's common for the skin to remain dry for a long time. It may even become more sensitive and prone to irritation. I personally noticed dry, flaky skin, cracked lips that would sometimes bleed, and increased skin sensitivity, especially to the sun.
More severe but rare side effects like liver enzyme elevation and increased cholesterol aren’t unheard of either. However, these effects generally go away after discontinuing the medication. Isotretinoin or “Tret” can alter your gut microbiome too, potentially leaving you vulnerable to inflammatory bowel diseases, especially if you have pre-existing gastrointestinal disorders like ulcerative colitis or Crohn's disease.
Isotretinoin and pregnancy The drug is a big no-no during pregnancy because it is known to cause severe issues for the baby, like problems with the nervous system, heart, and face. "Isotretinoin usage is highly unsafe in pregnancy , there is a risk of the fetus developing adverse birth defects if it's consumed in any dose, for even a short duration of time," cautions Dr Khuraana. If you do want to get pregnant while on the medication, make sure to consult your doctor on when it will be safe to do so.
Precautions to consider Tret was difficult on my system, but with a few lifestyle changes, I could commit to the journey and was taken off it in less than eight months. "To minimise side effects of isotretinoin, make sure you're using a good moisturiser and sunscreen, even on cloudy days," says Dr Singh. Steer clear of vitamin A supplements and harsh or drying skin products like alcohol-based toners and exfoliants.
She explains that while rare and still under research, mood changes like anxiousness and depression can occur too. So, monitor your health, and if you observe any signs of mood swings or emotional instability, talk to your doctor immediately. It also might be a good idea to avoid any abrupt changes in the medication routine and get regular liver function tests and lipid panels for overall health monitoring.
Isotretinoin and diet If this sounds too overwhelming, Dr Khuraana recommends alternative options like topical application of retinoids (retinoic acid or adapalene) with fewer side effects. "Acne with hormonal background needs hormonal therapy such as oral contraceptive pills (spironolactone)," she adds. Going on Tret is a decision that's entirely your own, guided by a medical expert you trust.
So, make sure to carefully weigh the benefits and potential side effects before committing to a treatment that requires at least six months of dedicated care to heal your skin from within. Also Read: Everything you need to know about the hormonal condition polycystic ovary syndrome 6 foods to eat when you're on an anti-inflammatory diet 10 dermatologist-approved acne scar treatment products that will help even out skin texture.
