Also contributing to its staying power is the matter of cost: Isotretinoin is often covered by insurance. For a cycle of 30 pills, there may be a small co-pay (usually under $20) or you could pay roughly $120 out-of-pocket, depending on your plan and whether you’ve met your deductible. Some promising new acne treatments, however, including lasers, may not be covered, says John Barbieri, MD, a board-certified dermatologist and director of the Advanced Acne Therapeutics Clinic at Brigham and Women’s Hospital in Boston. (A series of three sessions with the buzzy new AviClear laser, for example, can cost $3,000.) “So even if there’s something that might be an alternative, from a practical standpoint, many patients can’t afford it,” he adds. 

And isotretinoin can streamline your acne regimen. “What I love so much about isotretinoin is that you don’t have to use any more creams. You don’t need to go on an antibiotic,” says Dr. Marchbein. In other words, it’s the only medication you need, versus having to combine oral antibiotics or birth control with topical formulas, like prescription retinoids.

The 2023 Risks of Isotretinoin

Isotretinoin, though, isn’t always harmless. Because it works by shutting down your sebaceous glands, it can cause severe dryness on the lips and face. One systematic review found that this dryness affects more than half of isotretinoin patients. The same review also reported other less-common side effects including elevated liver enzymes, headache, decreased appetite, and depressed mood impacting 12 out of 760 patients enrolled in the studies. That’s less than two percent of participants, but the side effects were serious enough that patients withdrew from trials. Other purported side effects (not mentioned in this study) include the risk of inflammatory bowel disease and heightened cholesterol levels. 

A key word here, though, is purported. At present, there does not actually appear to be any link between inflammatory bowel disease and isotretinoin. And according to research, isotretinoin may in fact improve mental health. “We have good studies that show us that it usually makes people less depressed and happier because they’re not breaking out with bad cystic acne anymore,” says Dr. Marchbein.

One side effect that’s undisputed, however, is isotretinoin’s potential to cause severe birth defects, which research has shown to include both congenital defects and cognitive impairments. It’s categorized as a teratogenic drug, which describes any agent that causes abnormality after a fetus is exposed to it. “The data that we have for isotretinoin [shows] that it is absolutely not safe in pregnancy at any amount,” says Kavita Shah Arora, MD, a board-certified ob-gyn and bioethicist in Chapel Hill, North Carolina.