Why isotretinoin is still the gold standard for severe acne
Every few years, a new acne treatment is described as a “game changer”. And some of them are genuinely useful.
By Dr Sreedhar Krishna, Consultant Dermatologist
But isotretinoin has remained the reference point for one simple reason. It works when other treatments do not.
It targets acne at its source
Most acne treatments treat the symptoms. Isotretinoin treats the underlying causes by:
- Reducing oil gland activity
- Normalising how skin cells shed
- Reducing inflammation
That combination is difficult to beat.
It can change lives, not just skin
Severe acne is not a cosmetic inconvenience. It can affect confidence, social interactions, and mental wellbeing. It can also leave permanent scars.
When isotretinoin is used appropriately, it can prevent all of that. I have seen patients who had tried everything finally achieve long-term clearance and feel comfortable in their skin again.
Why we still use it despite the precautions
Yes, isotretinoin requires monitoring. Yes, there are rules.
But in medicine, treatments that truly work often come with responsibility attached.
When prescribed carefully, isotretinoin offers something very few acne treatments can. The possibility of long-term remission rather than ongoing control.
That is why, decades on, it remains the gold standard for severe acne.