Optimizing Isotretinoin Treatment of Acne: Update on Current Recommendations for Monitoring, Dosing, Safety, Adverse Effects, Compliance, and Outcomes

Am J Clin Dermatol. 2020 Jun;21(3):411-419. doi: 10.1007/s40257-020-00508-0.


Acne vulgaris is the most common skin disease treated by dermatologists. It can be severe and result in permanent scars. Isotretinoin is the most effective treatment for acne and has the potential for long-term clearance. Prescribing and monitoring protocols can vary widely among prescribers. Recent studies, reports, and consensus statements help shed light on optimizing the use of isotretinoin for acne. A recent literature review is summarized in this article to help the practitioner optimize isotretinoin use for acne. The article outlines the advantages and disadvantages of standard, high-dose, and low-dose isotretinoin regimens; discusses the current status of controversies surrounding isotretinoin (including depression/suicide, pregnancy, and inflammatory bowel disease); reviews monitoring recommendations and treatment for hypertriglyceridemia and elevated transaminase levels; and discusses common adverse effects seen with isotretinoin, along with their treatment and prevention.

Publication types

  • Review

MeSH terms

  • Abnormalities, Drug-Induced / etiology
  • Abnormalities, Drug-Induced / prevention & control
  • Acne Vulgaris / drug therapy*
  • Acne Vulgaris / psychology
  • Anxiety / chemically induced
  • Anxiety / prevention & control
  • Anxiety / psychology
  • Contraception / standards
  • Depression / chemically induced
  • Depression / prevention & control
  • Depression / psychology
  • Dose-Response Relationship, Drug
  • Drug Monitoring / standards
  • Drug Prescriptions / standards*
  • Female
  • Humans
  • Inflammatory Bowel Diseases / chemically induced
  • Inflammatory Bowel Diseases / prevention & control
  • Isotretinoin / administration & dosage*
  • Isotretinoin / adverse effects
  • Isotretinoin / toxicity
  • Patient Compliance
  • Patient Education as Topic
  • Practice Guidelines as Topic*
  • Pregnancy
  • Suicide / psychology
  • Teratogens / toxicity*
  • Wound Healing / drug effects


  • Teratogens
  • Isotretinoin