What are potential long-term effects of Accutane?
The Long-Term Impact of Accutane: What You Need to Know
First off, let me say—I’m not here to demonize Accutane (isotretinoin). For many people, it works, and I’m genuinely happy for those who have found relief through it.
In fact, I took it myself. Just before graduating college at 22, after years of battling acne with little to no real improvement, I decided to give it a shot. I had tried it all—Proactiv, antibiotics (both oral and topical), birth control—but nothing seemed to work for my stubborn case of cystic acne. Of course, knowing what I know now, I understand that thinking I had “tried everything” was limited to my understanding of medicine and health at the time— and I can’t fault myself for that. In reality, had I “tried everything”, my acne would have cleared, because there is always a reason for health issues.
Cystic acne is a painful issue that is rooted deep within the body— it’s hardly a “skin” condition. It’s impacted by the gut, nutrient deficiencies, the body’s detoxification system (liver, kidneys & lymph), the body’s immune system, hormones and unfortunately, genetics.
Regardless of whether Accutane clears your skin, it undeniably has a significant impact on your body—effects that may not be immediately obvious. And that’s where my biggest concerns lie.
The Reality: Accutane’s Long-Term Effects
Beyond the long list of side effects and black box warnings, one of the most overlooked facts is that acne relapse is incredibly common—affecting up to 52% of users post-treatment.
With less than a 50% success rate, is a black box warning drug really worth it?
Accutane works by binding to retinoid receptors in your cells, acting as retinoic acid (the active form of vitamin A). This allows it to regulate cell growth, differentiation, and even cell death. It shrinks sebaceous glands (reducing oil production— the impacts of this may be permanent and detrimental— more on that later), decreases keratinization (preventing dead skin cell buildup), and suppresses inflammation. This rapid shift in cellular activity impacting the skin is why many people experience an initial “purge” before their skin clears—either temporarily or permanently.
But here’s the catch: when a synthetic compound binds to receptors, it blocks natural substances from doing so that would otherwise. In this case, Accutane takes up the receptor spots meant for natural vitamin A, retinol.
Why This Matters
Vitamin A is essential for healthy skin, immune function, and overall well-being. In fact, vitamin A is one nutrient that is crucial for healing acne— which is why Accutane, a high dose of vitamin A, albeit, synthetic, can work for those facing this painful skin challenge. But if Accutane is monopolizing your vitamin A receptors, the natural vitamin A from food. like retinol (the active form) from animal sources or carotenes (the inactive form) from plants can’t bind or perform it’s necessary functions. The same could be true with supplemental forms like retinyl palmitate.
This is especially concerning because most people who suffer with acne already have low retinol levels due to factors like:
Genetic variations (like mutations in the BCO1 gene, which impair the conversion of beta-carotene into retinol).
Poor digestion and absorption.
Low dietary intake of vitamin A, which is a ubiquitous problem.
If your body was already struggling with low levels of retinol, blocking its receptors with a synthetic version doesn’t solve the underlying issue—it just masks it.
Unanswered Questions: Could Accutane Cause Long-Term Deficiencies?
Here’s where things get interesting. Many researchers, practitioners, and past Accutane users are now questioning its long-term effects on:
Retinoid receptors: Could prolonged exposure to synthetic vitamin A make receptors less responsive to natural retinol later? If so, this could make it harder for the body to regulate skin health long after stopping Accutane and explain why cystic acne comes back (with a vengeance) for 52% of users.
Vitamin A conversion: If your body has been relying on Accutane for retinoic acid, does it “forget” how to convert vitamin A on its own? Could this contribute to long-term deficiencies and acne?
Gut microbiome: Medications alter our microbiome. For instance, the gut adapts to metabolizing metformin (a diabetes drug) over time, which reduces its effectiveness and requires higher doses. Could something similar happen with Accutane? If the body gets used to metabolizing large amounts of synthetic retinoic acid, does it create a higher demand for vitamin A post-treatment? And if so, is this part of why acne relapses?
And then there’s the question of vitamin A toxicity. If post-Accutane users require more vitamin A to achieve the same skin benefits, do they also have a lower threshold for toxicity? Where’s the line?
The Bigger Picture: Finding the Root Cause of Acne
These are the kinds of questions I ask as a practitioner who focuses on root-cause healing rather than symptom-masking. If you’re tired of breaking out despite eating well and sticking to a solid skincare routine, it’s time to dig deeper.
Are you ready to figure out why your acne keeps coming back?
If so, I’d love to help. My program is designed to address acne at its root, helping you achieve clear skin—without the guesswork.
Click the link below to apply, or book a free 20-minute consultation to see if this is the right fit for you. Let’s get to the bottom of this, once and for all.