BLOG

column (e.g. in newspaper)

2025.08.17

The Effects and Side Effects of Isotretinoin

葉山 愛弥
Supervising Physician
Aiya Hayama

As an Assistant Professor, Associate Ward Director, and Chief of Dermatopathology at the university hospital dermatology department, I deepened my expertise through academic presentations and paper publications both domestically and internationally. I have handled a wide range of treatments, from birthmark therapy in children to adult pigmentation concerns, utilizing various lasers and injection therapies, while also contributing to community healthcare. Through encountering numerous cases, I strongly felt the potential and necessity of aesthetic medicine, resolving to pursue further expertise. Building upon my solid dermatological knowledge and meticulous diagnostic skills, I value treatments that gently support each individual's skin while bringing out its inherent beauty.

I've been hearing people say they didn't know about the side effects of isotretinoin, so I thought I'd take this opportunity to explain them.

I am Dr. Aya Hayama, a board-certified dermatologist.

 

Isotretinoin

Isotretinoin is used for severeAcne vulgaris = AcnePowerful drugs used in treatmentVitamin A derivativeIn Japan, isotretinoin is an unapproved drug (as of 2025), but overseas it is widely used under brand names such as Roaccutane and Accutane.

 

As for the mechanism of action,Shrinks sebaceous glands, significantly reduces sebum secretion, and suppresses the proliferation of acne bacteria.。

The indication remains severe acne unresponsive to existing insurance-covered treatments (antibiotics and topical medications), and it also helps prevent scarring (acne scars).

 

The general method of use is usually1 to 2 times daily, at a dose based on body weight (e.g., 0.5 to 1 mg/kg)The dosage varies depending on the severity of symptoms in Japan, but for women it is 20-30 mg/day and for men it is 30-40 mg/day.0.5 mg/kg/dayIt seems to be effective.

Treatment period 16 to 24 weeks (approximately 4 to 6 months) is the basic principle.

 

Individuals who cannot use it, concerns regarding its use

 

  • Pregnant women and nursing mothers

  • People hoping to become pregnant soon

  • People with liver disease

  • People with vitamin A toxicity

  • Under 12 years old

 

The Relationship Between Isotretinoin and the Epiphyseal Line

The epiphyseal plate is a cartilaginous region present in growing children and adolescents. As long as there is a gap in this plate, height growth is expected to continue. However, around the end of puberty, the epiphyseal plate closes, halting bone growth. Therefore, the concerns regarding isotretinoin and height are outlined below.

 

  1. Premature closure of the epiphyseal plate

    • High doses or long-term use may cause premature closure of the epiphyseal plates during the growth period.

    • This is,The risk of bone growth stopping prematurelyI will do so.

  2. Effects on Bone Metabolism

    • Isotretinoin is a vitamin A derivative, and it is known that excessive vitamin A can adversely affect bone formation and metabolism.

    • Rarely, osteoporosis-like changes or abnormal bone calcification have been reported.

  3. Growth disorder

    • This is why particular caution is required when using it in pediatric and adolescent patients.

    •  

    • Under 12 years old (in principle)Effects on the epiphyseal plate (growth plate)It has been reported that there is.

 

※Views in literature and guidelines

  • The Japanese Dermatological Association and the FDA (U.S. Food and Drug Administration) state that when using isotretinoin,Risk of bone effectsHowever, while there are case reports regarding epiphyseal closure, it is extremely rare and is considered to be strongly related to dosage and duration of use. Therefore, caution is advised regarding use during the growth period. Consequently, in Japan, as a general rule,After the age of 16-18, when bone growth endsIts use is recommended.

  • If it absolutely must be used in the early teens,Consultation with multiple specialists including pediatricians, dermatologists, and orthopedic surgeonsIt is preferable to proceed while doing so.

     

    Item Content
    Impact on the epiphyseal plate Risk of premature closure (rare but caution advised)
    Target age Generally, after the age when bone growth is nearly complete
    Precautions for Use Avoid long-term and high-dose use. Regular monitoring is required.
 
 
Side Effects of Isotretinoin and Countermeasures
 
Dry, chapped lips

    • Before bed, apply a lip mask (Vaseline + plastic wrap)

    • Frequent use of highly moisturizing lip balms (e.g., Vaseline, Curel, Uriage, etc.)

 

Dry skin, flaking, itching

    • Wash your face twice daily using a mildly acidic, low-irritation cleanser.

    • Moisturize morning and night with creams or lotions containing ceramides and hyaluronic acid.

    • Do not rub. Avoid peeling or scrubs.

    • Humidifying indoor spaces is also effective.

 

Dry nose, nosebleeds

    • Apply petroleum jelly or moisturizing ointment inside the nose using a cotton swab.

    • Use a humidifier, especially at bedtime

    • Don't blow your nose too hard.

 

Dry eyes, blurred vision

    • Artificial tears (preservative-free over-the-counter eye drops are recommended)

    • Be careful, as contact lenses tend to dry out easily.

 

Liver dysfunction, dyslipidemia (generally asymptomatic)

    • Avoid greasy foods and alcohol (to reduce strain on the liver)

    • Regular blood tests (every 1 to 2 months)

    • Supplements (such as vitamins A and E) should not be taken together → Risk of excess

 

Psychological side effects (depression, anxiety, irritability)

    • While taking this medication, you may become more sensitive to changes in your mood.

    • Feeling down, listless, etc.

    • Individuals with pre-existing depressive tendencies should exercise caution → Consult a psychiatrist before use.

 

Muscle soreness, joint pain, and fatigue

    • Get plenty of sleep

    • Refrain from exercise or adjust to a lighter level
    •  

    • If symptoms persist, consider adjusting the dosage (consult your doctor).

Based on my experience, younger patients sometimes take it orally, and I get the impression that dryness is more common, with dyslipidemia slightly more frequent than liver damage.

 

Treatment in the United States

 

In the United States, this is a cautious schedule applied to women of reproductive potential (FRP).

Specific Schedule for Pregnancy Testing under the iPLEDGE Program

 

Timing Content Additional note
Before treatment (before the initial consultation) First pregnancy test (urine or blood) Confirm negative result prior to physician's examination
Before treatment (immediately before prescription) Second pregnancy test (blood test recommended)

Initial examinationAn interval of one month or more is required.。

After negative confirmation, approved via iPLEDGE and started prescription.
During treatment (once a month) Monthly pregnancy tests timed to your menstrual cycle

Prescription permitted after negative confirmation.

You must receive the medication within 7 days of the examination.
After treatment Post-treatment pregnancy test (recommended)

Continue using contraception for one month after finishing the medication.

Some physicians may still perform the test at this stage.

In some countries, six months
 
🔺In Japan and Europe, contraception for "one month after stopping the medication" is standard practice.

🔺Some U.S. guidelines recommend up to six months.

https://www.mhlw.go.jp/topics/bukyoku/iyaku/kojinyunyu/050609-1b.html

 
Differences from Japan

 

Item United States (iPLEDGE) Japan (Private medical care / Not approved)
Restrictions on Use extremely strict Doctors may handle it differently.
Pregnancy test Monthly requirement Depending on the physician's guidance
Registration System Everyone is obligated None (optional management)
Pharmacy Management Available for pickup only at registered pharmacies Prescription available through private medical care, or personal importation is also possible.

The Significance of iPLEDGE

  • It is a very time-consuming system, butIt is essential to prevent serious effects on the fetus (such as malformations of the ears, eyes, brain, and heart).is.

  • Since there is no equivalent legal framework in Japan,If you choose to use it, self-management becomes even more important.。

 

Prescription vs. Personal Import
Comparison Items Authorized medical institutions Personal import
Safety Physician supervision, blood tests available Self-responsibility, no inspections
Medication Reliability Genuine product・Under control Risk of counterfeit products
Legal risk None Possibility of violating the Pharmaceutical Affairs Law through sale or transfer

⚠️ Self-prescribing, transferring, or reselling this medication is illegal. Please be aware that such side effects may occur.

 

Here's a personal musing from me, a dermatologist...

Isotretinoin, which may become covered by insurance in Japan in the future.

Under a doctor's supervision, it's not such a scary medication, and I believe it's an excellent treatment for severe acne.

However, given the side effects mentioned above, I personally would not use it and would prefer that you consult your doctor.

Back to list
WEB Reservation
RESERVATION
24-hour reception
Click here for web reservation
 アイコン RESERVATION