Last Updated on November 7th, 2021
By Dr. Jaggi Rao, MD, FRCPC, Double board-certified dermatologist
Roaccutane (generic name: isotretinoin) is one of the world’s most commonly prescribed acne treatments. This oral medication and vitamin A derivative is prescribed to treat severe forms of acne, such as conglobate acne, nodular acne or acne that has a high risk of leaving permanent scars. It’s usually recommended as an extreme and last-resort method after commonly used topical treatments and oral antibiotics don’t work.
Roaccutane is very potent with high risk of side effects and, unfortunately, it often doesn’t work. Usually the dermatologist tells the patient to keep trying, and sooner or later, Roaccutane does deliver the benefits it promises. However, a lot can go wrong and prevent isotretinoin from doing its job.
Before we get started, let’s make one thing clear: Medications and antibiotics should not be your first line of defense against acne. The risks of Roaccutane are high, as you will learn. If you haven’t already tried a scientifically proven and simple 30-day skincare routine to get your acne under control, such as the Exposed Skincare Basic Kit, then that’s where you should start. If you don’t see results with this kit, you can return it with the company’s money back guarantee. It’s important to try all of your other options before resorting to antibiotics or medication for your acne, which can have serious and long-lasting consequences on your health.
Here is what you should understand about Roaccutane, along with seven reasons you might not have had success with Roaccutane and what you can do about them.
This information also applies to other brand names of the same drug, including Amnesteem, Claravis, Isotroin, and Sotret. Before 2009, Roaccutane was known as “Accutane” in the USA.
First, understand how acne normally forms. Acne is basically the result of too much sebum. Too much sebum blocks sebaceous glands, leading to a buildup of sebum under the skin. Acne bacteria love this and swarm to the area, leaving fatty acids and waste products that irritate and inflame the sebaceous glands (oil glands).
Isotretinoin (aka Roaccutane) minimizes how active sebaceous glands are, so they don’t produce as much sebum. Within six weeks, sebum excretion can be decreased by as much as 90%. Less sebum reduces the likelihood of the glands being blocked, so there’s less of an ideal environment for the bacteria to flourish and less inflammation.
1. Roaccutane has to “build up” to a certain level before it can knock out acne and keep it away for good.
To force acne into remission, it is necessary to take a dose of Roaccutane equivalent to 125 to 150 mg of the drug for every kilogram of body weight. This is roughly 60 or 70 mg per pound of body weight before you have taken “enough” Roaccutane. Doctors prescribe higher or lower doses depending on weight, usually coming out to 1 or 2 mg of Roaccutane per kilogram of body weight per day.
If you weigh a little over 100 pounds, or a little under 50 kilos, you need to have taken about 7,500 mg of Roaccutane before you can quit. Your doctor will probably prescribe a dose 50 to 100 mg of Roaccutane a day, so you’ll need to take Roaccutane consistently for 75 to 100 days, around 3 months, before the benefits are noticeable and permanent. If you skip pills, you haven’t been taking it long enough, or you don’t get your refills, the drug won’t work. Or, it will work for a while, but then acne will come back.
2. Substitutes for Roaccutane just don’t work.
There are plenty of pills you can take for acne, but there isn’t any other FDA-approved oral medication in the same class as Roaccutane. Switching to antibiotics, vitamins, or (if you are a woman) birth control pills just won’t give you the same results as Roaccutane. There are other topical medications that you can apply to your skin that work the same way as Roaccutane (Retin-A, for instance), but Roaccutane (including its brand-name equivalents) is the only retinoid available in the USA in pill form.
3. Lower doses of Roaccutane will relieve symptoms, but only temporarily.
Often due to concerns about Roaccutane’s side effects, Doctors sometimes prescribe low-dose Roaccutane. In practice, this looks like just 0.1 to 0.2 mg of the medication per day per kilo of body weight, instead of the 1 to 2 mg of the medication per day per kilo of body weight. If you take a low-dose version of the drug, your face may clear up in 2 or 3 months, but you might have problems once you quit the drug.
4. Roaccutane is supposed to be taken with food.
Taking Roaccutane on an empty stomach almost guarantees it will not work. You don’t have to eat a full meal every time you take the drug, but you do need to eat a snack with it, at least. Food keeps the pill from irritating the lining of the esophagus, and also slows down the passage of the pill through your digestive tract , allowing more medication to absorb into your bloodstream.
5. Using alcohol-based products (such as toners) on your skin cancels out some of the benefits of Roaccutane.
Roaccutane “dries up” the production of oily sebum from the inside out. But, if your skin dries up from the outside in, like when you splash alcohol-based products on your face, or when you spend too much time in the sun, the skin protects itself by producing more sebum. The healing impulse to produce more sebum cancels out Roaccutane’s effect on sebaceous glands to make them produce less sebum.
6. Taking Roaccutane and antibiotics at the same time sometimes reduces the effects of Roaccutane.
One of the ways Roaccutane clears up acne is by “normalizing” the immune system’s response to acne bacteria. In small numbers, acne bacteria are actually helpful. They eat excess sebum. It’s only when they multiply to large numbers and the immune system tries to attack them with inflammation that blackheads and whiteheads turn into pimples.
Roaccutane helps the immune system “remember” that acne bacteria aren’t deadly, so it does not produce as much inflammation. But if you zap all the bacteria with antibiotics, the immune system doesn’t get the message that acne bacteria (at least on the skin) aren’t deadly. If you use antibiotics, the immune system “skips class” when Roaccutane is the teacher.
7. Dieting interferes with the action of Roaccutane.
Roaccutane is best absorbed when it is taken at the same time one eats a high-fat, high-calorie meal. The fat in a meal slows down the rate at which the stomach empties to the small intestine, and in turn this leaves the drug in contact with stomach acid longer so that the pill is more completely broken down. Researchers have found that teenagers who diet tend to get poorer results from taking Roaccutane (taking longer to clear up acne, having to go back on treatment faster), presumably because their bodies don’t completely absorb the pill.
This doesn’t mean your choices are having zits or gaining weight. But you do need to be sure that you absolutely, positively always take Roaccutane with food. And if you are on a low-fat diet, make a point of taking Roaccutane when you consume sour foods, like pickles, lemon juice, or anything with vinegar, at least a tablespoon (15 ml). Acid foods also slow down the passage of food and medications from your stomach, allowing more of the drug to enter your system and bring acne to bay.
First and probably the most important thing to know is that Roaccutane is a form of isotretinoin, well known to be dangerous for unborn babies. Do not use it if you’re pregnant or even think you might be. There’s a very high risk of birth defects or miscarriage. Don’t use while breastfeeding and it shouldn’t be used by anyone under the age of 12.
Most people will experience some form of side effects. There are many potential side effects, so make sure you talk to your doctor about them. Some side effects of taking oral isotretinoin include:
Your skin may get worse during the first 7-10 days. This is normal and can normally improve after this period when your skin is adjusting to it. Your skin will also probably be dryer than usual, so stay hydrated and don’t forget to moisturize.
For some people, Roaccutane is worth the risk. Others err on the side of caution and choose treatments that are reliable, safe and more simple. For these reasons, Roaccutane should not be your first choice in acne treatment. For most types of acne, treatment kits like the Exposed Skin Care will yield the desired results without all the risk involved with many prescriptions.
Looking for a place to start? This pre-made routine includes three steps, completed twice a day, and is proven to clear skin within 30 days. This Basic Kit gets results because it combines low levels of powerful acne-fighting ingredients, such as salicylic acid and benzoyl peroxide, with natural and calming ingredients like green tea extract to calm and soothe while clearing skin.
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