Accutane for acne: Ultimate guide & tips for starting

After years of living with acne and countless failed treatments, finally being handed a prescription for accutane can feel like a dream.

But once you start reading the nitty-gritty details of accutane, it’s also pretty damn scary.

Dry lips. Headaches. Tiredness. Joint pain. Nosebleeds. Mood changes. The dreaded purge. Uh, what the hell have I signed up for here?!

I know exactly how you’re feeling, because I’ve been there. But guess what? It was totally worth it.

I went from unpredictable cystic acne to clear skin within 6 months. Plus, those 6 months were nowhere near as bad as the internet made out they were going to be.

So today, I’m talking all things accutane: the facts, what to expect, tips for getting started, the stages your skin might go through and all about my experience on accutane.

Accutane for acne

Accutane guide: Let’s cover the basics

So what is accutane, anyway?

Accutane (some might call it roaccutane, others isotretinoin) is a medication used to treat moderate to severe acne that hasn’t responded to any other treatments.

It’s only available on prescription and is usually prescribed by a dermatologist.

And, in case you’re interested in the sciencey part, it’s actually a synthetic form of vitamin A.

How does accutane work for acne?

Accutane reduces the amount of sebum produced by the oil glands in your skin.

It’s sebum that causes those pesky spots in the first place – so by waving goodbye to sebum, you can also say hasta la vista to acne. Winner.

In fact, science-based literature states that a dose of 0.5–1.0 mg per kg body per weight per day actually reduces sebum by 90% within 6 weeks.

It also helps your skin to turn over and renew itself at a faster rate (hello, glow!). Winner. Double winner.

How long does accutane take to work?

According to the NHS, 4 out of 5 people who use accutane have clear skin after 4 months.

But I’ve followed (what feels like) hundreds of accutane journeys online; and if I’m completely honest, there’s no straight answer to this question.

Some people see an improvement within weeks, while others find that their skin gets worse before it gets better. There’s no way to predict how your skin will react – all you should know is that it will get better.

Essentially, you just gotta hang in there.

20mg accutane tablet

Does accutane work permanently?

In most cases, accutane works as a permanent cure for acne. That doesn’t mean you’ll never have a breakout again (I’m sorry, forgive me okay) – it just means your acne will be much more manageable for the long-term.

But this isn’t the case for everyone. For some people, the acne will come back, whether that be a few months later, or years ahead. I’ve seen some stats claiming that this happens in a third of patients, while other sources claim it’s more around the 20% mark.

The good news? You can take a second round of accutane if your acne comes back and your dermatologist feels it’s appropriate.

What are the side effects of accutane?

There’s a long, long list of possible accutane side-effects, but let me tell you one thing to start with: dry skin, dry lips and tiredness are pretty much a given. Everyone I’ve spoken to who’s tried accutane has experienced these 3, me included!

According to the NHS, the common side effects of accutane include:

  • skin becoming more sensitive to sunlight
  • dry eyes, throat and nose
  • headaches and general aches and pains

The following side-effects are rare, but it’s worth knowing about them before you get started.

  • back pain
  • changes in behaviour
  • diarrhoea
  • joint pain
  • mental depression
  • nausea
  • pain or tenderness of the eyes
  • stomach pain
  • vomiting
  • yellow eyes or skin

Don’t let that list put you off though. They’re unlikely, and you can always stop treatment if you were to experience any of these.

Are there long-term accutane side effects?

The dreaded question. Before I started accutane, this was the one I wanted an answer to. I knew I could deal with 6 months of dry skin and dodgy lips, but a lifetime? Nope.

Here’s the thing: long-term side-effects are unlikely, but not impossible. Most, if not all, of the accutane users I’ve spoken to didn’t experience any long-term side-effects, other than drier skin than they had before they started.

A study on the long-term safety of isotretinoin (accutane) concluded that xeroderma (extremely dry skin), dry eye syndrome, arthralgia (joint pain) and possible exacerbation of eczema were considered to be infrequent, but possible, long-term side-effects.

However, overall, they concluded that accutane in the treatment of acne is a safe drug, with no serious long-term side-effects.

Girl holding accutane pill and packet

Can you drink on accutane?

Nope, you shouldn’t drink alcohol whilst taking accutane.

The NHS states that “It’s best to avoid alcohol while taking isotretinoin capsules, or at least keep the amount you drink to a minimum. This is because there’s a risk of damage to your liver – and that your cholesterol levels will increase.

If you do drink, try not to drink more than the recommended guidelines of up to 14 units of alcohol a week. A standard glass of wine (175ml) is 2 units. A pint of lager or beer is usually 2 to 3 units of alcohol.”

I never drank heavily whilst on accutane, but I did have a few drinks with friends on special occasions during my treatment. The bad news? I found that my hangovers were 10x worse; and I got those hangovers even though I hadn’t really drank all that much.

Do you have to be on the pill to take accutane?

No, you don’t necessarily need to be on the pill.

But you do need to use at least 1, but ideally 2, forms of contraception if you are of child-bearing age during your accutane treatment (and for 1 month after). That might be the pill, the implant or the copper coil, plus a barrier method such as condoms.

That’s because accutane can harm a baby and increase the risk of miscarriage. You’ll also need to take pregnancy tests both before you start accutane and during your check-ups.

Yup, you’ve essentially gotta head to the toilet, pee in a cup and hand it to your derm at the beginning of every appointment. Don’t worry, you get used to it quickly!

Stages of accutane: Worse, then WAY better

Let me just point out that there’s no science or evidence-based studies behind these 3 stages of accutane.

I’ve come to this conclusion based on the stories of many other guys and gals I’ve spoken to, or seen on Instagram, who’ve used accutane.

Your journey isn’t guaranteed to go this way – because everyone’s journey is different!

20mg accutane tablet for acne

Month 0–1: The accutane purge – and dryness galore!

Many (if not most) people find that their skin gets worse before it gets better on accutane.

To start with, your skin is likely to become super dry and sensitive. Make sure to stock up on plenty of gentle but hydrating skincare. You can find my recommendations in my accutane skincare guide.

Next, you might experience what’s commonly known as the ‘accutane purge’. This is when all your old skin cells start turning over at an accelerated rate, which can cause even more pesky breakouts.

A study found it happens in 32% of patients and typically lasts around a month. But don’t let this put you off – if your acne is really getting you down, it’s so, so worth it. Hang on in there, trust me.

Month 1–4: Slow but steady progress

After the first month or so, you should start to see a slow but steady improvement. Nope, you’re not going to wake up one day and have clear-as-can-be skin. This is gonna take time.

You might also find that your skin feels like it’s clearing up one day, only to be faced with a breakout the next. It can be disheartening when this happens, but know that it’s all part of the process.

Month 4–6: Hello, clear skin

Hallelujah, hello clear skin! Most people I’ve spoken to find that their skin is crystal clear for the last month or two of their treatment. This doesn’t mean you should just chuck the rest of your accutane tablets in the bin; you need to keep taking it until you’ve finished the full course.

As The Lancet points out, the cumulative (total treatment course) dose is the key to long-term remission. In plain English, this means that taking the full course of accutane (even once your skin has cleared) will significantly reduce your risk of your acne returning in the future.

Accutane for acne packets

My accutane experience: Tough, but worth it

Now we’ve covered the accutane basics, I thought I’d share a little bit about my personal accutane experience. Remember that my experience will probably be totally different to yours, because no one’s journey is the same.

My dosage

I was on 60mg accutane for 4 months. I was surprised when I first got my prescription; most other people I’ve spoken to were on accutane for 6 months at a lower dose. I never actually asked what the reason behind this was – but despite my higher dose, my side effects seemed to be pretty standard.

My accutane side-effects

You won’t be surprised to hear that my main side-effects were dry, dry DRY skin and lips.

I won’t lie, the dry skin was super annoying. But I did manage to get it mostly under control with the right accutane skincare. The problem was that no matter how well-hydrated my face was, I had a few patches of super stubborn dry skin that would flake off everyday once I’d done my makeup. Not a good look, so in the end I just stopped applying make-up to these areas entirely.

And the lips. Oh god, the lips. It started with them being dry and crusty af – and it ended with a split down the middle of my lip that didn’t heal for months. I must have got through 10+ lip balms during my accutane journey; you’ve really gotta get in the habit of slathering the stuff on throughout the day.

Other than that, I got tired more easily and, at times, felt a bit low. I did have a few headaches throughout my accutane treatment, but that was only on the days I didn’t hydrate well enough (top tip: water is your bestie whilst on accutane – chug it like there’s no tomorrow).

For me, none of these symptoms were severe or unmanageable; so in my experience, the side-effects were more than worth it for the end result.

Holding 20mg accutane tablet

My accutane stages

My accutane journey wasn’t exactly normal. I came immediately off spironolactone (a medication that blocks the effects of androgens and progesterone on the skin and, therefore, can be used to treat hormonal acne) and went straight onto accutane.

This meant that my skin was already pretty clear – and for this reason, I only had a very minor purge. After a ‘purging’ stage of a few weeks, it was pretty plain sailing for me. I had clear, but very dry, sensitive and red skin, as I detailed above.

If I hadn’t been on spironolactone initially, I think my accutane journey would have followed more of a normal pattern (i.e. crazy purge, followed by slow but steady improvement).

(If you’re wondering why I came off spironolactone, it was because I’d been experiencing side-effects such as hair thinning. It was also a medication I’d have to take forever, whereas I liked the idea of accutane being a longer-term cure. You can read more about spironolactone in my spironolactone for acne guide.)

My accutane results

Once I’d finished my accutane for acne journey, my skin was crystal clear – and I really mean crystal clear! No spots, no blackheads and my pigmentation had cleared up pretty well too. I felt super confident. It was lovely to wake up in the morning and see the clear skin I’d always wanted.

At first, my skin remained fairly dry post-accutane, but that’s expected, as it literally shrinks your oil glands. The good news? The sensitivity and redness faded pretty quickly and it was easy enough to keep the dryness at bay with the right accutane skincare.

The top photo wasn’t immediately before accutane (this was actually pre-spiro), but it gives you an idea of the type of acne I was dealing with. The photo underneath was in the 6 months after accutane where I enjoyed clear as can be skin.

Before and after accutane

My long-term accutane results

I know this won’t be what you want to hear, but my acne did slowly return after accutane. It was clear-as-can-be for a good 6 months or so, but after that, I started experiencing more regular breakouts.

But trust me when I say these breakouts are nowhere near as bad as they were before I’d been on spironolactone and accutane. They’re fairly manageable. I typically get 3 or 4 spots at a time on my cheeks, chin and jaw. I know they’re hormonal, too, as it happens at the same time every month. Before accutane/spiro, breakouts were constant.

It’s not bad enough that I’d consider going on accutane, at least for the moment. In general, I’m still in a much better place with my skin.

My skin also slowly became oilier in the months following, but never to the extent that it was previously.

2024 update: Although accutane was a succesful treatment for me in the short-term, it didn’t cure my hormonal breakouts long-term. I’ve since taken a natural approach to clearing my acne, which you can read about in my guide on how to clear your acne. I’m not anti-accutane, though; for many, it’s a very impactful treatment. Make sure to see your treatment through if it’s working for you.

The big question: Is accutane worth it?

Yes, yes, yes – to me, accutane was well worth it. If acne is getting you down, accutane is the best treatment that I, and many many others, have ever tried for acne.

Even though my skin isn’t as clear as it was immediately post-accutane, it’s so much more manageable now. It doesn’t consume my thoughts or take over my life in the way it did before. And if your acne is more severe than mine was, you could always take a second round to really nip it in the bud (if your doctor/dermatologist feels it’s appropriate).

That said, it can be a tough few months and you’d best be ready to get used to flakes falling off your face and lips at every opportunity. Plus, some people get worse side-effects, so make sure you’re fully informed of all the possible outcomes before committing.

Accutane survival guide: Tips for starting accutane

Stock up on accutane skincare

The only way to make the dry skin and chapped lips situ more bearable is hydrating and moisturising the shit out of your face, lips and body.

So, first things first, stock up on simple, fragrance-free, hydrating products and make them a part of your daily routine. If you’re not much of a skincare fan, I’d recommend a moisturiser, lip balm and SPF at the very least. But for the best flakey-face-avoiding results, I’d recommend adding hydrating serums/oils into your routine as well.

Need a bit of guidance? Here’s a basic routine with some affordable product recommendations that you could follow:

  • Moisturising cleanser (AM & PM): CeraVe Hydrating Cleanser or Simple Micellar Gel Wash
  • Hydrating serum (AM+ PM): The Ordinary, Inkey list or Revolution Hyaluronic Acid
  • Nourishing moisturiser: CeraVe Moisturising Lotion or Cream or, if you’re happy to spend a little more, Dr Sam’s Flawless Intense
  • Fragrance-free SPF: La Roche Posay Anthelios or Cetaphil SPF 50+
  • Hydrating lip balm: Aquaphor (yep, on your lips) or Blistex Relief Cream

And as for your body, the CeraVe Moisturising Lotion or Cream does the job, so why not just double-up and use it for both?

I’ve recommended products to suit all budgets in my accutane skincare routine, so check that out if you need more tips or information.

Cetaphil Moisturising Lotion for acne

Double-up your water intake

However much you’re drinking now… take that and double it. Increasing your water intake can seriously help with those dreaded accutane side-effects, like dry skin and lips.

I bought a huge 2 litre water bottle and tried to get through at least one, but ideally 2, of them everyday. It sounds like a lot, but you get used to it quickly and it’ll help to minimise that dreaded dry skin side effect.

Avoid the sun and slather on SPF

If you’re not an avid SPF wearer, well, you should be – during your accutane treatment and beyond. You’ll thank me when you’re 60, but looking more like 40.

Accutane can make your skin more sensitive to sunlight, meaning you can sunburn quickly and unexpectedly. I’d recommend an SPF of 30 or greater, even in the winter. Yep, even in the winter.

If you’re new to SPF, give these a try:

  • La Roche Posay Anthelios SPF 50: My all-time fave – it’s lightweight and works really well under makeup.
  • Body Shop Vitamin E Day Lotion SPF 30: Equally lightweight, but this one’s vegan & cruelty-free too, so I made the switch.
  • Cetaphil Moisturising Lotion SPF 30: Not so lightweight, but super super moisturising – a bonus whilst on accutane!
  • Neutrogena Hydro Boost SPF 30: If you’re looking for something with more of a gel consistency, this is a great one. It absorbs to absolutely nothing.
  • Simple Triple Protect SPF30+: Absorbs well and is SUPER affordable, but I find it breaks up a little if you apply makeup on top.

Tell your friends & family

Before you start your treatment, have a chat with your close friends and family. Tell them what accutane is, what the potential side-effects could be and that life might be a little tough for you in the next few months.

Why? Because on days your skin is literally flaking off your face, you might want to cancel that night out at the last minute. And if you wake up with ‘the purge’ (which, you can totally get through), you might not fancy going to that huge family gathering your Mum had planned.

Look, I’m not saying you should be a hermit. Dry skin and acne are nothing to be afraid of, after all. But what I am saying is that you should give yourself a break sometimes. And it’ll help so much if your close friends and family understand why you need that break.

Plus, you need support – and if they don’t even know what’s happening, they won’t be able to provide that.

20mg accutane packet

Be patient

I know that constant breakouts suck and can affect your self-esteem. And I know that, in an ideal world, you’d take an accutane pill and wake up with clear skin the very next day.

But in reality, accutane takes time to work – and it’s best that you know that before you start your treatment. As I’ve already explained, your skin might get worse before it gets better, and it might take several months before you actually see some progress.

So be patient. It might feel like your breakouts will never go away, but I promise they will. And it might not feel like you’re getting anywhere, but stick with it and I promise you’ll get to where you want to be. You’ve got this!

If you’re struggling or feel that accutane is negatively affecting your mental health (it’s a possible side-effect), please seek help from your friends, family or GP. Plus, if you just need a bit of a pep talk from someone who’s been through it too, I’m only an Instagram DM away.

How to get accutane in the UK

Haven’t started your accutane treatment yet? If your skin is getting you down and you’ve tried countless other treatments, it might be time to use accutane.

There’s one thing I need to make absolutely clear: roaccutane needs to be prescribed under medical supervision. You need regular blood tests and check-ups during your treatment. If you buy it from a dodgy online shop (I’m not sure if you can, but I wouldn’t be surprised!), you won’t really know what you’re getting and your health won’t be monitored in the way that it needs to be.

Here are a few safe options if you’re from the UK:

Get it from the NHS

I got accutane through the NHS and, other than the long waiting times, I had a great experience.

I’d been going to the doctor for years about my acne. After trying antibiotics, the pill, numerous creams and spironolactone, my GP referred me to a dermatologist. I have to say though, it took a while to get to this referral. I was 25, but had been visiting the doctor about my skin since I was 16 or so.

So while I can’t speak for doctors, my understanding is that you’ll need to try other treatments before going on accutane. It’s best to get that appointment booked sooner rather than later and be open about how your skin is making you feel.

Once I had a referral, I waited about 4–6 months (sorry, I can’t remember exact dates!) for an appointment, but I think my wait was longer than average.

After accutane for acne treatment

Go private

If you have the means to do so and don’t want to wait, you could go private. I’m not entirely sure how the process works, but I believe your best bet is to ask your GP for a private referral. There are also private hospitals like Spire that you could enquire through.

From what I’ve read, there’s not much benefit to going private other than the shorter waiting time. Your treatment will be the same otherwise, so this really depends on your financial situation and how desperate you are to skip the queue.

You can expect to pay around £85+ per month, for the Roaccutane prescription and medication alone. There will be other costs, such as consultations and bloods, involved too. My advice would be to go through the NHS if you can.

Use an online service

More recently, I’ve seen companies like TretDirect popping up, who offer a doctor-led accutane treatment from the comfort of your own home.

You’ll have a virtual video consultation with a prescribing doctor. You’ll then need to head to their lab or get your bloods done locally before getting the tablets sent straight to you.

This is cheaper than going private (around half the cost, I’ve been informed), but much quicker than the NHS. There’s also less travel involved.

Accutane for acne: Tough, but worth it

Well, that was a lengthy blog – but I really hoped it helps you!

For me, accutane was totally worth it, despite the sometimes-crazy side effects.

If you’re on edge about taking it, just take this three things from me: stock up on loads of hydrating skincare, be patient whilst waiting for results and let your friends and family know what you’re going through.

Accutane can be tough, but so are you. I’m wishing you all the luck on your journey! Make sure to follow me on Instagram and send me a message if you have any questions or just need some support.

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4 responses to “Accutane for acne: Ultimate guide & tips for starting”

  1. I wish I had read this before I started on mine back in my twenties- so helpful! xx

    • Alice says:

      Hey Charlotte!

      Thanks so much, that really means a lot.

      Did you try accutane? How’d it go?

      Lots of love x

  2. Katie says:

    I’m about to start acctuane and this guide has been so so helpful. Looking online at side effects and the right skin care is so overwhelming, this has made me feel so reassured! Thank you x

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