Two Indian dermats answer all your questions about anti-acne drug isotretinoin

If you've been struggling with acne—especially the painful, deep-underground cystic pimples—you've probably tried to do everything you can to resolve it. If you've played around with a cocktail of over-the-counter medication, antibiotics, salicylic acid, benzoyl peroxide, face masks and even at-home remedies or diet tweaks, and still nothing's changing, your doctor might suggest you try isotretinoin. On paper, it sounds fantastic—an easy-to-take pill that promises clear, smooth skin in a month. But it's more complicated than that, because the side effects and testing required can be time-consuming, expensive and may not work for everyone. We spoke to Dr Harshna Bijlani, Medical Director, The Ageless Clinic, and Dr Kiran Sethi, celebrity dermatologist at Isya, to answer all your burning questions.

1. How does isotretinoin work?

The synthetic Vitamin A works by forcing surface skin cells to turn over and die more rapidly, which amps up new cell growth. When cell turnover is increased, it fades hyperpigmentation, clears congested pores and hampers the breakdown of collagen. Since it exfoliates the skin on a cellular level, it leaves behind smoother, brighter skin that is balanced, with better oil regulation. Vitamin A also works to slow down the bacteria production in the hair follicle, preventing acne in that manner as well. "Isotretinoin works by shrinking the sebaceous glands in the skin. This reduces sebum production in the skin (food for the acne bacteria to survive), which makes it difficult for acne to survive in the first place," confirms Dr Bijlani. How long will you be on it? Dr Bijlani says that it depends on your doctor-recommended dosage. "It is to be taken orally, in pill form, once or twice a day depending on what your doctor prescribes."

2. Who does it work for?

Doctors usually put patients on the drug who have severe acne, especially the cystic type, that are prone to scars. It is usually not the first-line approach—doctors suggest other medications and treatment options before prescribing isotretinoin, says Dr Bijlani. However, women going on the drug have to be careful about their alcohol consumption, and have to be sure they're not looking to conceive within the next six months. "Isotretinoin causes major birth defects if the fetus is exposed to the medication. Other cases where one should avoid Isotretinoin is in case of individuals who are breast feeding, have a vitamin A sensitivity, severe hair fall, dry lips, dry skin, uncontrolled diabetes and so on," she confirms. "It can cause excess dryness of skin and lips, and it can worsen cholesterol/triglyceride issues, so you need to take that into consideration," says Dr Sethi.

3. How should you prep?

Before you decide to go on isotretinoin, doctors suggest that you get blood tests to rule out any contraindications. "You will need to check your CBC levels, your liver function tests and lipid panels," says Dr Sethi. Doctors usually suggest you use at least two forms of birth control while on isotretinoin, so getting these in place before starting the drug is ideal.

4. How should you change your skincare while using isotretinoin?

Even though the medicine is considered the MVP of the anti-acne routine, it can have side effects that one must get ahead of immediately. Since they cause skin cells to turn over extremely quickly, it can cause flakiness, dryness, irritation and breakouts. Doctors suggest using moisturising and calming ingredients, especially around the lip and eye areas, that can feel parched and irritated. And sunscreen?That's a non-negotiable. "You'll want to make sure you have sunscreen on at all times," says Dr Sethi. The exfoliation can leave the skin more susceptible to sun damage, so skipping anything that can leave the skin even more imbalanced (like salicylic acid and chemical peels,) must be skipped.

5. What is the connection between isotretinoin and depression?

While the drug doesn't actually cross the blood-brain barrier, doctors usually ask the patient about a history of depression before prescribing it. One study suggests a possible connection between suicidal thoughts and isotretinoin, but most others—even ones done recently—debunk that. In general, doctors suggest monitoring for changes in mood, energy levels and weight gain while on the treatment course.

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