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I’ve written a bit about my history with cystic acne. My older brother took Accutane when I was growing up. The side effects for him were so severe that my parents opted not to put me through it. My acne was pretty severe, and Accutane might have been a good solution, but he had just been through too much and they didn’t want to do it again. 

(And in fairness to him, he did have a really bad go of it. His skin never stopped peeling in the time he was on Accutane, so it was a really bad road. The dermatologist kept saying it would pass, and it never did until my mom just took him off it.) 

This isn’t an Accutane hate post! There are cases where Accutane is truly the best solution. But there are also many cases where a less invasive solution might have worked just as well, or been a better trade-off between results and side effects. Some people have few side effects from Accutane and can just get by with a really good lip balm.

And if you’re finding this post because you’re currently on Accutane and you’re suffering on it, maybe some of these options will reduce your acne without all the other stuff. 

Here’s all the information I wish my family had known before they decided my brother should get Accutane and I should get Proactiv! (This is 10000% a Proactiv hate post though.)

How Does Accutane Work?

Accutane, also known by its brand name isotretinoin, is a potent medication for severe acne.

What makes it so effective is that it targets the root cause of acne by reducing oil production from the sebaceous glands. This leads to fewer clogged pores and a decrease in acne-causing bacteria. Regardless of why you have acne, Accutane will generally work because if you don’t have enough sebum, you can’t get a clogged pore. The active ingredient, retinoic acid, also helps prevent the buildup of dead skin cells and minimizes inflammation. 

While it can provide similar results to other treatments, it’s known for its potential risks and severe side effects. The big difference between Accutane and other treatments is that, because it’s taken systemically, it can affect all parts of your body. Unlike a topical treatment that only affects the skin you apply it to, Accutane can affect your whole body, and your hair!

Accutane is often a last resort for stubborn acne when other treatments fail. And when nothing else works, Accutane can be a good choice! But as my own kids get closer to their teen years, I want to understand the other options avaiable to avoid the side effects if we can.

Accutane Side Effects

Accutane can cause a range of side effects.

 Some of the most common side effects include dry skin and skin irritation. Accutane patients can struggle with dryness everywhere, including their hair and eyes. Patients report dryness in the nose, leading to nosebleeds, and vaginal dryness as well. So while it will improve acne by reducing oil, it’s also going to cause a bunch of other effects in places where your body really does need the oil. 

Beyond that, because it’s a systemic medication, Accutane can cause mental health concerns such as depression. 

Accutane is also processed through the liver and create strain on that organ; if patients are drinking alcohol even moderately, that can overtax the liver. 

It also poses a risk of severe birth defects, making it unsuitable for pregnant women. The iPLEDGE program requires female patients to undergo regular pregnancy tests while using isotretinoin. Many dermatologists will require the use of birth control in female patients as well, which a user may or may not want depending on her situation. (I think a big part of my parents’ refusal to give me Accutane did actually have to do with the thought of birth control. It’s not the choice I would make as a parent, but I do understand where they were coming from.)

A typical course of Accutane is about six months on the meducation. Some people will see the benefits for years and others will see their acne return after the course. 

Alternatives to Accutane

Here are some treatment options that are alternatives to Accutane that you can try first.

Non-prescription skincare ingredients

Listen, almost no one goes straight to Accutane without trying these ingredients first. So if you tried these already, skip down to the next section. 

But, if you’re brand new to skincare, there are two simple, inexpensive ingredients you can try for acne.

(Actually there are a lot, but these two are cheap and easily accessible.)

Benzoyl peroxide is an inexpensive ingredient that you can get at any drugstore that will attack the acne bacteria. I wrote a whole guide about benzoyl peroxide as a skincare ingredient here. 

You can get benzoyl peroxide as a face wash or a treatment cream. Be aware that this ingredient can bleach fabrics! So use a towel you don’t care about. 

And also – salicylic acne will dissolve the oil that causes clogged pores. I wrote a bit about this one in this post about salicylic acid and rosacea.

If you’re just getting started with a skincare routine to treat acne, start here! You may find that you don’t need any more. No decent dermatologist will start you with Accutane anyway. 

Retinoids for Acne

Topical retinoids are effective alternatives to Accutane for many types of acne. Retinoids work the same as Accutane, but they’re applied to the skin where the acne is instead of taken systemically. 

Retinoids also help prevent clogged hair follicles and reduce inflammation. These treatments can treat mild to moderate acne with fewer side effects compared to oral isotretinoin.

You can get a treatment like adaptalene (sold as Differin in the US) over-the counter. 

If that is not enough, prescription retinoids come in a lot of different strengths. Tretinoin is an example of a prescription retinoid, and you can start with a milder concentration.

Retinoids such as adapalene and tretinoin work by speeding up skin cell turnover, which helps clear skin and reduce dark spots caused by acne breakouts. They turn over the skin cells faster than acne can form, without impacting the whole body or reducing oil and skin hydration. 

Many healthcare professionals consider them the best option for acne sufferers seeking effective treatment with minimal risk.

They also have the added benefit of just being something easy that gets added to your skincare routine. The adaptation period to retinoids can be uncomfortable, but after you’re adapted, it’s just one extra step in the evening, not a special appointment. It’s probably one of the easier alternatives to Accutane for that reason.

Chemical Peels for Acne

If you can’t or don’t want to do a retinoid, or it isn’t enough, a chemical peel is also an option! This requires a treatment session and possibly paying for a medspa visit, but it can be an effective way to manage acne. 

Chemical peels involve applying acids, such as glycolic acid or salicylic acid, to the skin to remove dead skin cells and reduce excess oil. These treatments can help improve moderate acne, and can treat some scarring or discoloration left behind by past acne.

Peels vary in strength, with some available over-the-counter and others performed by dermatologists. They are particularly helpful for female patients dealing with hormonal fluctuations or stubborn acne.

Chemical peels may cause mild skin irritation but generally offer effective alternatives for those seeking non-invasive acne treatment options.

Chemical peels are great for keeping acne in check, but it’s a long-term commitment because it won’t have the lasting acne suppression that Accutane does. However, if you’re willing to commit to doing a peel every six to eight weeks, it can be a great strategy for managing acne. Another benefit is bright, even skin and a reduction in scarring! 

If you choose, you can do your chemical peels at home – I do. That’ll make this process much less expensive. Start with a mild glycolic peel of about 30%, and increase your treatments slowly! You can read more about chemical peels for acne in this post about acne scarring solutions. 

Laser Acne Treatments

Okay, this option is newer and I have no personal experience with it, but I am so curious about it that I’ve been collecting reviews of Neoclear laser acne treatments in this post. It’s one of the most interesting new alternatives to Accutane.

Laser treatments, including photodynamic therapy, target acne-causing bacteria and reduce oil production. These therapies are recommended for both inflammatory acne and cystic acne.

Recent clinical trials have demonstrated that laser treatments can achieve clearer skin without the severe side effects of Accutane. It appears that they have a similar long-term effect to Accutane because of the way they affect sebum production. However, they only affect the parts of the body that are treated, so you won’t have the hair, eye, and other problems. 

Healthcare providers often suggest laser therapies for patients who want effective alternatives to Accutane. Ongoing research continues to improve these techniques. 

Obviously, this is much more costly than buying a face wash or even a bottle of chemical peel solution, so consider that in your decision-making as well. 

Oral Contraceptives and Spironactalone

Hormonal acne is a separate beast, and it needs its own approaches. 

For hormonal acne, women can benefit from hormonal birth control. 

Hormonal birth control has got a bad rap on social media right now! The ‘balancing your hormones’ girlies want to sell you coconut water instead. And I think it’s reasonable to be reluctant to spend thirty fertile years on hormonal birth control. 

But hormonal birth control is likely to be a lot less invasive than Accutane. 

Similarly – spironactalone is an oral medication that can address hormonal acne. It requires a prescription. If your acne is not homonal, it won’t help at, but 

Coping With Accutane If It’s What You Need

In some cases, Accutane remains the best way to treat severe or nodular acne. Alternatives to Accutane may not be enough for every person. If your healthcare provider recommends this potent medication, it’s essential to follow their treatment plan closely.

Minimizing potential side effects involves maintaining good skin care habits, staying hydrated, and using moisturizers to combat dry skin. Dietary changes may also help reduce skin irritation.

I wrote about the best lip balms for Accutane, because almost every Accutane patient will feel that lip dryness first. But the Accutane subreddit is a wealth of information about how people cope. 

If it gets to be too much, go back to your doctor. Sometimes they can adjust your dosage to be taken morning and evening to reduce the side effects. Other times, they may be able to help you replace Accutane with another treatment option.