TREATMENT FOR SEVERE ACNE: Is Isotretinoin Right for My Teen?

The vast majority of teenagers experience some degree of acne. Many families seek the help of dermatologists, who begin treatment with skincare regimens, topical medications and/or antibiotics. Severe and persistent forms, however, may be unresponsive to these treatments and lead to debilitating physical and emotional scars alike.

When nothing else works, dermatologists consider a prescription for isotretinoin. Often still referred to as “Accutane” despite the brand’s discontinuation in 2009 as generic forms became available, isotretinoin is a vitamin A derivative that can permanently clear severe acne in 4-7 months.

“If you are a parent considering isotretinoin for your child, there are pros and cons to consider,” says Dr. Eleanor Braun at South Louisville Pediatrics. “The most obvious benefit is clear skin and a boost in self-esteem during crucial years of social and personal development. As a caregiver, however, remember that treatment will be demanding for you as well.”


It is not a first resort. If your child has never received professional treatment for acne, do not expect an isotretinoin prescription right away. Due to the possible side effects and responsibility required to take it, dermatologists will nearly always start with less severe options, especially if the patient is 14 or under.

The possible side effects are numerous and may be severe. Most people already know that the #1 risk of taking isotretinoin is pregnancy. If a patient taking isotretinoin becomes pregnant, severe birth defects are extremely likely. Beyond this risk, new or worsening depression has been linked to isotretinoin treatment, so patients taking it should monitor their mental well-being and be prepared to answer questions during check-in appointments. They must also complete monthly fasting blood tests to monitor liver function and metabolism. If results come back abnormal, your doctor may want to repeat the test, adjust or halt treatment.

Less severe but common side effects include: skin dryness/itching; chapped lips (nearly guaranteed); increased susceptibility to sunburn; headaches; joint, muscle or back aches; dry or irritated eyes; nose bleeds.

The commitment is strenuous. A number of steps are required before your dermatologist can administer the first dose. Patients of any age and gender must be enrolled in the mandatory iPledge program, completing requirements which vary according to whether the patient is capable of pregnancy. No one using isotretinoin may donate blood during treatment or for one month afterward. Don’t forget the monthly blood tests.

Patients who are capable of getting pregnant: Must have two negative pregnancy tests at least 19 days apart (if not 30 depending on menstrual cycle and/or birth control) prior to receiving their initial prescription. They must also attest to using two forms of birth control each month of their treatment, and these forms must match what is reported to the prescribing physician.

This may be frustrating for patients who are not sexually active or don’t identify as female, but your prescriber and pharmacist are bound by the FDA to follow these rules. The prescriber must continue to run and report a monthly pregnancy test regardless of the patient’s age, stage of development, sexual activity, or gender identity. Once iPledge requirements and monthly blood work are complete, the prescription must be obtained within 7 days.

Patients who are NOT capable of getting pregnant: Once iPledge requirements and monthly blood work are complete, the prescription must be obtained within 30 days. If they are sexually active with an isotretinoin-using partner who is capable of pregnancy, they should adhere to that person’s chosen forms of birth control.

Beyond these medical requirements, there are time and financial demands to consider. The monthly appointments are time-sensitive, must be completed in person, and may incur co-pays for office visits. The cost of the drug itself may also vary depending on brand, insurance coverage, and pharmacy.

There are downsides. A teen suffering from acne may welcome the side effects or risks as long as their skin clears up, but they should consider a few stipulations:

  • It may not be curative. Despite isotretinoin’s success record, it doesn’t work permanently for everyone. Female patients in particular may experience hormone fluctuations later in life that cause acne to return.
  • Some side effects may linger after treatment concludes. Temporary hair loss has been reported after taking isotretinoin. Hair density typically returns with time, but patients should be prepared for extra shedding and regrowth of “baby hairs.”
  • Needles are part of the program. If your teen is averse to needles, they should know that monthly blood draws are required for isotretinoin prescriptions. If the blood work isn’t completed, they can’t get a refill.
  • IPledge requirements are subject to gender at birth. Patients and caregivers should maintain open communication about the demands, which may be uncomfortable if you’ve never talked about birth control or your child doesn’t identify with their birth gender.

“If isotretinoin is the right choice for your teen, please inform your pediatrician of treatment and any hormonal birth control they may be starting,” says Dr. Braun. “This lets us know which drugs not to prescribe, including some antibiotics, and whether we should look out for any red flags during or after treatment. Our priority is to be a supportive partner in your child’s health and well-being.”