Originally published in print in April 2026. View print issues here.

When acne persists despite other treatments, some students turn to a medication called isotretinoin despite its potential health risks.

According to a 2025 article published by Sabina Alikhanov Palmieri, acne is one of the most common skin conditions adolescents face, with 87% experiencing it in some form during their teenage years. That same article found that acne is associated with higher rates of depression, anxiety, failure to thrive at school and in social environments, suicidal ideation and suicidal attempts.

In order to treat the acne, students may turn to dermatologists to get prescribed ointments and medications that get rid of the pimples. After treatments such as the antibiotic pill doxycycline or the topical cream tretinoin do not work, students may be recommended isotretinoin, an oral pill and vitamin A derivative designed to shrink oil glands, prevent clogged pores and eliminate acne at the root of the problem. The most popular brand of isotretinoin is known as Accutane. 

Having recently finished her last pill of the treatment, senior Livia Roder explained how she had struggled with acne for a while before settling on isotretinoin.

“We went to a bunch of different dermatologists, and I used some skin topicals that helped, but then it stopped helping, and it just got worse,” Roder said. “I started doxycycline, and that didn’t help at all.”

Because of her persistent acne, Roder was suggested to start taking isotretinoin. 

“I think it’s a great option, and my favorite thing about Accutane was that taking the pill is your skincare,” Roder said. “All you had to do was just sunscreen, face wash and moisturize. I don’t need to worry about any other topicals or creams.”

Junior Sanviti Amarnath, president of the Skin and Derm club, recognizes that isotretinoin is usually a last resort for acne treatment after other treatments have been proven ineffective. That said, a study conducted by Blasiak et al. found that at a 12-month follow-up appointment, patients saw a 97.4% improvement in acne appearance.

“Accutane can be life-changing for people,” Amarnath said. “When it’s prescribed and monitored by a dermatologist, it can definitely improve your skin.” 

However, isotretinoin is infamous for its potential risks and side effects. Mild side effects include dryness, redness and joint pain. Roder noticed significantly dry lips during her treatment.

“I couldn’t go a class period without putting on chapstick,” Roder said. “If I went somewhere without Aquaphor, it would ruin my mood. Every 45 minutes, I would always need to reapply.”

Isotretinoin also increases the skin’s sensitivity to sun exposure due to the reduction of oil gland production and thinning of the skin barrier. Because of this, Roder’s dermatologist made sure to mention to wear sunscreen and limit sun exposure. 

“I noticed it a lot when I went to Brazil,” Roder said. “[I burned] so quickly, and that was the worst. It was so, so, so red.”

Similarly, junior Winston Middlebrook, who recently started his isotretinoin treatment, experienced some of the common side effects associated with isotretinoin. 

“First, it was really bad back pain. I still have back pain, but I hopped on fish oil and it got better,” Middlebrook said. “The dry skin was an issue at first, but I think I adjusted to it. The hair oil depletion is definitely present. My hair is so dry. It’s insanely different.”

Because the pill is metabolized by the liver, regular blood tests are usually required when taking accutane. According to Lola Health, up to 15% of patients may see some liver enzyme elevation, forcing dermatologists to adjust dosage or stop the treatment altogether to prevent liver injury. Under Middlebrook’s treatment plan, he has to get his blood drawn and analyzed once a month to monitor any changes in his levels. 

“I have online meetings usually right after a blood test,” Middlebrook said. “They just tell me, ‘Your blood’s fine. You’re ready to go on your next cycle.’”

In addition, accutane is known to cause serious birth defects. Because of this, female patients must take part of the program iPLEDGE, which informs women of the highly teratogenic properties of the medication and the dangerous impacts it can have during pregnancy. In addition, pregnancy tests and sometimes birth control pills are required to prevent possible consequences. 

“It was kind of a pain to get the medication,” Roder said. “You need to take the pregnancy test and your doctor fills out the form. Then, you need to take a quiz and fill out the form as well. [Then, you have a] seven day window to pick it up. One day, I missed the seven-day window, so I needed to go get another pregnancy test and then send it to the doctor’s office, so they can do the whole process again. They’re so strict about it.”

Isotretinoin has also been associated with serious mental health risks, such as depression and suicide, though a correlation has since been proven statistically insignificant. Still, many dermatologists require that patients sign a contract agreeing to report any and all mental health changes to ensure safety while on isotretinoin. Though the pill’s mental health history initially scared Roder, the strict monitoring programs convinced her to take the risk.

“So many people have taken it, and it’s so common now,” Roder said. “That took the fear away from it because if it would be dangerous, then it wouldn’t be so popular.”

Amarnath finds that a lot of the fear surrounding isotretinoin stems from social media apps where virality tends to keep abnormal stories on the forefront. In order to avoid this content from influencing a person’s decision to start the medication, she urges people to ask their dermatologists for medical guidance instead of apps like TikTok. 

After getting halfway through his isotretinoin treatment, Middlebrook agrees that one should only take research from reputable sources when considering the medication.

“Don’t be fearmongered,” Middlebrook said. “If you’re going to take it, take it, but taking that step is hard. Have healthy habits and just treat your body and do what your body is telling you to do.” 

Middlebrook also finds that being able to talk to his friends who have taken the medication helped alleviate some of the fears surrounding isotretinoin.

Similarly, Roder finds the best information comes from those who have taken it.

“Talk to people who you know have been on it to get different perspectives,” Roder said. “Everyone has their own side effects, and it affects people differently. My experience is going to be different than your experience.”

In fact, Amarnath thinks that the prevalent usage of isotretinoin despite its potential risks suggests that many dermatologists believe that the benefits outweigh the risks.

“The key is proper monitoring and following all the medical guidelines for the treatment,” Amarnath said. “If the dermatologist prescribes it to you, then you should definitely ask them clarifying guidelines, and you make an informed decision of whether you want to take it or not.”

Nevertheless, Roder believes that making the decision to take the medication was a great choice and overall increased her self-confidence.

“Without any makeup on, [the acne] was just so obvious, and I didn’t like how it looked,” Roder said. “Now, it feels a lot better to not need to put as much makeup on [to] not have it be so prevalent. The texture of my skin, it’s smoother.”

Headline illustration by Elliott Yau/Bear Witness