For many teens, the fight against acne feels endless and exhausting: bathroom counters stacked with serums and creams, late-night Google searches for the ultimate cure and hours spent staring at the red bumps that seem to define confidence. After cycling through product after product, only to pile on layers of makeup in hopes of feeling comfortable in their own skin, many people still wonder if a real solution even exists. For teenagers drained by the false promises of countless treatments, Accutane may offer something different — the possibility of finally seeing lasting results.

Accutane, formally known as isotretinoin, is one of the most effective acne treatments on the market. About 500,000 people in the U.S. take it annually, and a third of users report never needing another acne treatment. For many, this might sound like the perfect cure for the world’s most common skin condition, acne, which affects approximately 650 million people globally. However, every clear face comes with risks, and for some, the cost is heavier than expected. 

Most teenagers usually start dealing with acne around middle school, and from then on, begin a long journey where pimples, blackheads and deep red cysts dictate a teen’s self-esteem. The issue goes deeper than the skin barrier; it can disrupt social life, lower confidence and take a toll on mental health. Constantly worrying and analyzing breakouts can be exhausting, often contributing to anxiety or depression.  

In the 1960s, senior investigator Hoffman-LaRoche developed Accutane to prevent skin cancer. The Food and Drug Administration (FDA) approved the treatment in 1982, and after its patent expired, other companies began producing generic versions. Between 1982 and 2000, the number of isotretonin prescriptions dispensed in the U.S. increased by 250%, from around 800,000 to nearly 2 million per year. Today, friends’ success stories and social media influencers’ skincare journeys influence teens to consider Accutane. Alix Earle, a TikTok influencer with over 7 million followers, talks openly about her struggles with acne and is a passionate advocate for Accutane. She is one of many social media creators who share their textured, but overall successful experience with the medication, inspiring many teens to consider it. 

Accutane works by shrinking oil glands, like turning down a faucet, preventing pores from clogging in the first place. The process works from the inside out, reducing oil production and calming the inflammation that most creams and antibiotics can’t reach. Patients take the medication orally, and often see results within two to three months of taking the drug, though many report their skin worsens before it improves. 

In a billion-dollar market full of countless oral and topical acne treatments, Accutane is the most effective. About 85% to 90% of patients who take it for six months see clearer skin — a success rate higher than that of its competitors. Other options like antibiotics or prescription creams often deliver temporary relief and can lose their effectiveness over time, whereas Accutane gets to the root of the acne. 

Junior Olivia Zisa has struggled with acne since seventh grade. She said it hurt her self-confidence, and the search for an answer was mentally exhausting. After trying numerous creams and topical treatments, she found an effective solution in Accutane. 

“It was amazing,” Zisa said. “In the first few weeks, I saw results, and I have now been off of it for almost 2 years. My skin still looks great and I’m really thankful I did it.” 

For Zisa, finally seeing results after frustration was a huge relief, and her experience can demonstrate what so many teens hope for when they start the medication, she says. While patients highlight the medication’s success, doctors and dermatologists stress the importance of understanding both the benefits and the risks before beginning treatment. 

Dr. Anne Rothman, a dermatologist at Adventist HealthCare in Gaithersburg, Maryland, has more than 25 years of experience and recommends Accutane to many of her patients. 

“It can be life-changing,” Rothman said. “You can be cured of your acne and not have to use acne medications at all after taking it.”

Rothman says that although Accutane’s results are unlike any other treatment, it comes with a long list of side effects.

Accutane can cause allergic reactions, skin blistering, hearing loss or ringing in the ears, stomach pain, joint and muscle pain, blurred vision, hair thinning, extremely dry skin and in rare cases, liver damage. Beyond the physical side effects, researchers have also linked Accutane to mental health struggles, including depression, anxiety and mood swings; however, recent studies show this may be a false correlation. One of the more serious concerns of Accutane can cause potential birth defects ranging from hearing and eyesight problems to heart defects, abnormal brain fluid and a deformed head and jaw. 

“I usually would never recommend it first because there are so many other treatments that can be a little bit simpler for acne with fewer side effects,” Rothman said.

Accutane can raise the risk of miscarriage by 40%, even at small doses. Because of this, women who take Accutane carry a heavier burden than men, facing strict rules and monthly monitoring to follow the safety regulations. The FDA requires female patients to enroll in a program called iPLEDGE. Before starting the prescription, patients must have two negative pregnancy tests and agree to use a form of birth control; sexual abstinence is also an acceptable option rather than an oral or physical pregnancy preventive. Throughout the acne treatment, dermatologists require women to return every month for a negative pregnancy test, blood work and a new prescription. If they miss the seven-day pick-up period, they must repeat the steps. Zisa went through the iPLEDGE process.

“I never had super severe side effects; however, I definitely experienced joint pain and dry skin,” Zisa said. “It was also annoying to have to go to the doctor every month and get my blood drawn.” 

Accutane also requires close health monitoring for patients not at risk of pregnancy. Monthly blood draws track liver enzymes, cholesterol and triglycerides to make sure the medication isn’t damaging the bloodstream. To avoid extra stress on the liver, doctors advise limiting or avoiding alcohol while on medication. Doctors also recommend patients to avoid the sun, waxing and any form of laser treatment because their skin becomes significantly more sensitive. 

While Accutane is known for its high success rate, it doesn’t always get rid of acne in a single treatment. Rothman says it’s common for a patient to need another round, often meaning the first dose was too low. 

“Twenty percent of people might need to take a second course of Accutane at some point or they might have a mild acne that they need a topical for,” Rothman said. “Very rarely, we have people who do a third course.” 

Even for teens willing to endure the side effects for the chance at clear skin, there is still the obstacle of cost. Generic isotretinoin has made treatment more affordable than the brand-name pill, but monthly doctor visits, blood work and prescription refills can add up costs. Insurance usually covers most of the expenses, but doctors still encourage families to talk to their insurance provider early to understand the final cost, Rothman says. For many, the promise of not having to waste money on endless creams and washes makes Accutane feel worth the price, but for others, the costs become yet another barrier.

Senior Zoe Marlin has struggled with acne since her freshman year. She began Accutane in August and says she wishes she had started it earlier.

 “It’s been really awesome,” Marlin said. “Accutane is my 11th medication, and I have already seen results in the couple of weeks I have been on it.”

Marlin’s story reflects Accutane’s reliability compared to other acne treatments. In an NIH study, 18% of patients on doxycycline reached their definition of clear skin, while 50% on Accutane reached their goal. 

Although the side effects are serious, Accutane can be a reliable and effective treatment when patients follow their doctor’s guidance, Rothman says. Most of the more intimidating side effects, like liver damage, only occur in a small percentage of patients.

Despite the warnings, for many teens, Accutane is more than a prescription — it’s a chance to regain their confidence and feel comfortable in their skin again.

“When people go online, they can get really scared from reading all the horror stories people post,” Rothman said. “It can be life-changing, so I think it’s important for people to keep an open mind about it.”