Almost everyone gets the same predictable set of effects, and almost all of them are easier to handle if you have already bought what you need.
Before starting, get:
- A good lip balm, and more than one — car, desk, bedside, coat pocket. Dry lips are effectively universal, and running out is the most avoidable misery of the whole course.
- A plain, fragrance-free moisturiser for face and body
- Preservative-free eye drops if you wear contact lenses
- High-factor sunscreen — sun sensitivity increases markedly
- A gentle, non-foaming cleanser. Your usual acne wash will be far too harsh.
The Common Effects
Dryness, everywhere
Lips first and worst, then face, hands, and the inside of the nose — nosebleeds are common. A little petroleum jelly inside the nostrils helps. Dry eyes make contact lenses uncomfortable; glasses are easier for the duration.
The initial flare
Acne frequently worsens around weeks two to six. It is expected and it is not a reason to stop, though it is worth being warned about rather than discovering.
Muscle and joint aches
Common, especially with exercise. Do not stop exercising, but expect to need more recovery, and mention it if it becomes limiting.
Sun sensitivity
Take this seriously rather than generally. Sunscreen daily, and reconsider sunbeds entirely.
What Needs Reporting Promptly
- Changes in mood — low mood, anxiety, irritability, or anything that people around you notice before you do
- Sexual dysfunction — prescribers are now expected to ask about this at follow-up, and it is a legitimate thing to raise unprompted
- Severe headache, particularly with visual changes or vomiting
- Severe abdominal pain, or persistent diarrhoea
- Significant vision changes, especially difficulty seeing at night
- Yellowing of the skin or eyes
The mental health point deserves emphasis. The MHRA's position is that patients should be asked about it at follow-up and that patients and those close to them should be alert to changes. Tell someone in your household that this is worth watching for — mood change is often more visible from outside.
Blood Tests
Liver function and blood lipids are monitored, because isotretinoin can raise both. This is routine, and the monitoring is why it is safe. Do not skip the appointments because you feel fine.
Pregnancy Prevention
Non-negotiable, and not a formality. Isotretinoin causes severe birth defects. The programme involves pregnancy testing before, during and after treatment, reliable contraception from a month before until a month after, and prescriptions limited in duration and dispensed within a short window.
The MHRA has clarified that medically supervised pregnancy testing may be performed remotely with appropriate oversight, and that while the first appointment should be in person, later follow-ups may be remote where appropriate.
Practical Things That Help
- Take it with food, ideally containing fat — absorption is much better, and an empty stomach wastes part of the dose
- Avoid waxing, laser hair removal and dermabrasion during treatment and for a period afterwards; skin is fragile
- Avoid vitamin A supplements, which compound the effect
- Be cautious with alcohol, given the liver monitoring
- Do not donate blood during treatment or for a month afterwards
It Is Finite
Unlike most acne treatment, isotretinoin is a defined course with the prospect of long-term remission afterwards. The side effects are largely dose-related and resolve after treatment ends. Knowing there is an end point makes the dry-lipped middle of it considerably easier to tolerate.