Accutane side effects: common, serious and lasting

Isotretinoin, the drug many people still call Accutane, clears severe acne that other treatments cannot, and it has a long list of possible side effects. The FDA label reserves it for severe acne that has not cleared with standard treatment because of the side effects linked to its use. This guide sorts those side effects into three groups: the common ones many people get, the serious ones that mean you stop and call, and the ones that can last after treatment. For the drug itself, see the Accutane guide.

Skinli gives general education and is not a doctor. Isotretinoin is prescribed and monitored by a doctor, who checks for side effects at a visit every 30 days. If you are considering it, read when to see a dermatologist for severe acne first.

The common side effects

The August 2026 FDA label lists the side effects seen in 5 percent or more of patients: dry lips, dry skin, back pain, dry eyes, joint pain, nosebleeds, headache, cold symptoms, chapped lips, skin rash or irritation, a raised muscle enzyme in blood tests, inflamed lips, muscle discomfort, upper airway infections and reduced sharpness of vision.

A 2022 review pooled 30 trials, 25 of them randomized, with 3,274 patients to count how often each effect was reported. These are its figures across the trials that reported each one:

Side effect	Share of patients who reported it
Dry lips	58.2 percent
Dry skin	49.1 percent
Cracked, inflamed lips	41.5 percent
Dry nose	40.2 percent
Dry or irritated eyes	26.9 percent
Nosebleeds	23.8 percent
Back pain	19.6 percent
Changes to hair	17.9 percent
Headache	10.5 percent
Mood changes	10.2 percent

The review's authors wrote that the side effects mainly concerned mild skin and lining changes and that severe cases were rare. A 2018 systematic review in the British Journal of Dermatology found side effects twice as often with isotretinoin as with the comparison treatments, and more than half of them were related to dryness.

The label says the lip inflammation and the rise in blood fats are linked to dose. The dry lips guide covers lips, nose and eyes in detail.

Easing the dryness

The American Academy of Dermatology (AAD) gives these tips for patients taking isotretinoin:

• Wash with a gentle cleanser no more than twice a day, and after sweating.
• Apply an oil-free moisturizer while skin is still damp.
• Use lip balm with SPF 30 or higher outdoors, and petroleum jelly on the lips indoors and at bedtime.
• For a dry nose, a moisturizing nasal spray or a small amount of petroleum jelly just inside the nostril.
• For dry eyes, saline drops or artificial tears.

The AAD also lists products to avoid during treatment: vitamin A supplements, retinol, benzoyl peroxide or sulfur, vitamin C skin care, exfoliating acids and scrubs, fragrances, dyes and toners. The NHS says the same about salicylic acid and benzoyl peroxide products.

Serious side effects: stop and call

The Medication Guide, the FDA-approved leaflet that comes with every fill, tells patients to stop isotretinoin and call their prescriber right away for these signs. For hives, a swollen face or mouth, or trouble breathing, it says to get emergency help.

Warning signs	What they can mean
Feeling sad, loss of interest, sleep changes, irritability, thoughts of self-harm, seeing or hearing things that are not real	Depression or psychosis. See the Accutane and depression guide
Bad headache, blurred vision, dizziness, nausea or vomiting	Raised pressure inside the skull, which can lead to permanent loss of eyesight
Rash with fever, blisters, sores in the mouth or eyes, peeling skin	A severe skin reaction
Severe upper belly pain, nausea and vomiting, fever	Inflammation of the pancreas
Yellow skin or eyes, dark urine, pain on the right side of the belly	Liver problems
Severe stomach or bowel pain, diarrhea, bleeding from the rectum, painful swallowing	Inflammation of the gut or food pipe
Worse hearing or ringing in the ears	Hearing loss, which may be permanent
Any change in vision	Eye problems, including poor night vision
Muscle weakness	Serious muscle damage

Blood test changes

The label reports that in clinical trials, triglycerides (a type of blood fat) rose sharply in 25 percent of patients, "good" HDL cholesterol fell in 15 percent, and total cholesterol rose in 7 percent. These changes reversed after the drug was stopped. Liver enzymes rose to a mild or moderate level in an estimated 15 percent of patients. This is why the label calls for fasting blood tests before and during treatment. Blood sugar problems, including new cases of diabetes, have also been reported.

Bones, muscles and growth

The label reports that 29 percent of teenagers in one trial developed back pain, which was severe in 14 percent of those cases. It warns that isotretinoin may stop long bone growth in teenagers who are still growing. In a trial of 217 teenagers, bone density at the lower spine fell by more than 4 percent in 8 percent of them, and at the hip by more than 5 percent in 11 percent. It also warns that teenagers in sports with repeated impact may face a higher risk of certain bone injuries. Hard exercise can raise a muscle enzyme, and rare cases of serious muscle breakdown have been reported. Tell your prescriber before starting a hard training program.

Sun, waxing and skin procedures

Isotretinoin can make skin burn faster. The label says to avoid long sun exposure and tanning beds. It also says to avoid waxing and skin resurfacing, such as dermabrasion and laser, during treatment and for at least 6 months after, because of a possible risk of scarring. The microneedling guide explains what the waiting period means for scar treatment.

Eyes, hearing and night driving

Dry eyes are common, and the label says people who wear contact lenses may have trouble wearing them during treatment and afterwards. Night vision can drop, sometimes suddenly, so the label warns patients to be careful when driving at night until they know how the drug affects them. Clouding of the clear front of the eye has been seen; in trials it cleared or was clearing 6 to 7 weeks after the drug was stopped. Hearing loss and ringing in the ears have been reported, and the label says to stop the drug and see a specialist if they happen.

Allergic reactions

The label reports severe allergic reactions, including swelling of the face or mouth and trouble breathing, and allergic inflammation of blood vessels that can show as red patches or bruises on the legs. People allergic to vitamin A or to an ingredient in the capsules must not take isotretinoin. Some capsules contain soybean oil, and the NHS says isotretinoin may not be suitable for people with a soya or peanut allergy.

Side effects that can last

The label says most reactions in trials reversed when the drug was stopped, and some persisted. These are the effects it describes as continuing in some people after treatment ended:

• Hair loss
• Reduced night vision
• Hearing loss
• Inflammatory bowel disease
• Bone changes, including lower bone density in some teenagers
• Sexual problems, including erectile dysfunction, low sex drive and vaginal dryness

The AAD says the dryness clears once you stop, and that thinning hair, trouble seeing at night and muscle or joint pain tend to go away. The label's own wording covers both sides: most reactions in trials reversed, and some persisted. The hair loss and weight guide covers hair in detail.

Medicines and supplements to avoid

The label lists two things to avoid during treatment. Vitamin A supplements add to the drug's effects, because isotretinoin is closely related to vitamin A. Tetracycline antibiotics raise the risk of pressure inside the skull; the NHS names tetracycline and doxycycline. MedlinePlus adds St. John's wort, which can make hormonal birth control fail. Tell your prescriber about every medicine, vitamin and supplement you take. The alcohol guide covers drinking during treatment.

How often serious problems happen

The trial data are limited. A 2018 Cochrane review of 31 randomized trials with 3,836 people found that most trials had a high risk of bias. In the trials comparing isotretinoin with antibiotic pills plus creams, one serious side effect was reported, a severe skin reaction. The review found more minor side effects, such as dry lips and skin, with isotretinoin. None of the trials it included reported a birth defect, and the pregnancy risk is described on the Accutane and pregnancy page.

Most side effects are easier to manage when reported early. Write them down between visits, and bring the list to each monthly check-in.