Dispatch · February 5, 2026 · 8 min · By Emeka Balogun
When to consider isotretinoin
The most effective acne drug we have, the realities of taking it, and who it is for.
Isotretinoin (still widely called by its original brand name) is the only acne treatment that can produce lasting remission rather than ongoing control. For severe, scarring, or stubbornly treatment-resistant acne, nothing else compares.
It works by shrinking oil glands dramatically and resetting the conditions that allow acne to form. A standard course runs several months. The trade-offs are real and require monitoring: dryness of skin and lips is universal; bloodwork tracks liver and lipid levels; and because the drug causes serious birth defects, anyone who can become pregnant enrolls in a strict pregnancy-prevention program with monthly check-ins.
Those requirements scare people off, sometimes unnecessarily. For the right patient, someone scarring, or exhausted by years of partial fixes, isotretinoin is frequently life-changing and, taken under proper supervision, well-tolerated. It is a decision to make with a dermatologist who treats it routinely, not a reason to keep suffering through regimens that are not working.
Related reading: Acne scarring: what can and cannot be fixed and How to treat acne without wrecking your skin barrier.