Isotretinoin works on acne from the inside, but your skin barrier still needs care on the outside while it does.
Acne is one of the most common skin conditions we see at Plump, affecting people across adolescence and adulthood. While it is medically a disorder of the pilosebaceous unit, its impact can extend well beyond the physical appearance of the skin.
For many people, acne affects confidence, social interactions, relationships, work, study and overall quality of life. So when someone is living with persistent or inflammatory acne, they naturally want results, and often as quickly as possible. This is where oral isotretinoin can play an important role.
If you have been prescribed Roaccutane, Oratane or another form of oral isotretinoin, your primary focus is understandably on finally getting your acne under control. Isotretinoin is one of the most effective medical treatments we have for persistent and severe acne. But while the medication works internally on the biological drivers of acne, it is important that the skin itself doesn't take a back seat.
At Plump, we often see patients who have been prescribed isotretinoin and have simplified their skincare or stopped having skin treatments altogether. There is absolutely a time and place for simplifying your routine. During periods of significant dryness or sensitivity, reducing the number of products and avoiding unnecessary actives can be exactly what your skin needs.
But simple doesn't necessarily mean basic, and clinical skincare isn't automatically too active for isotretinoin-treated skin. Your skin still needs hydration, barrier support, inflammation management and photoprotection during this period. The goal isn't to compete with your medication. It is to support your skin while the medication does its job.
At Plump, we firmly believe in education. Understanding the skin barrier, and why prioritising its strength matters, is fundamental to both skincare and every treatment we perform.
The skin is the largest organ of the human body and is made up of three major layers: the epidermis, dermis and hypodermis. The outermost layer of the epidermis, the stratum corneum, plays a fundamental role in barrier function, creating an important interface between our body and the outside environment. In simple terms, the skin barrier protects us from harm and helps keep water inside.
The stratum corneum contains specialised cells called corneocytes. These tough, flattened cells are packed with keratin and natural moisturising factors, and form the "bricks" in the skin's bricks-and-mortar structure. The "mortar" is made up of lipids that sit between these cells, including ceramides, cholesterol and free fatty acids. Together, these components create a sophisticated protective barrier that helps the skin maintain hydration while protecting it from the external environment.
The skin barrier helps to:
An impaired barrier can present in a number of ways, including:
This is why barrier assessment is so important at Plump. We don't simply look at the treatment you have booked. We look at the condition of your skin today and ask whether it is actually ready for that treatment, and this becomes particularly important when you are taking oral isotretinoin.
Accutane is one of the brand names historically associated with isotretinoin, an oral retinoid derived from vitamin A. In Australia, you may also hear it referred to by brand names such as Roaccutane or Oratane.
Isotretinoin is a prescription medication most commonly associated with the treatment of moderate-to-severe acne, particularly acne that is persistent, inflammatory, nodular or at risk of causing scarring, or acne that has not responded adequately to other treatments.
It works on several of the underlying processes involved in acne. Isotretinoin reduces the size and activity of the sebaceous glands, significantly reduces sebum production, influences follicular keratinisation and has anti-inflammatory effects. It also changes the follicular environment and reduces Cutibacterium acnes. This is a major part of why isotretinoin can be so effective, but these changes don't only occur within the acne lesion. They change the behaviour and physiology of the skin as a whole.
One of the most common experiences during isotretinoin treatment is dryness. You may notice:
These changes are related to the way isotretinoin affects sebaceous gland activity, epidermal turnover and the skin barrier. Research has demonstrated changes in epidermal turnover and corneocyte cohesion during oral isotretinoin treatment, contributing to increased skin fragility and, depending on dose, increased transepidermal water loss.
In other words, the skin barrier can become more vulnerable while you are taking isotretinoin, and this is exactly why we believe skincare shouldn't be an afterthought.
Taking isotretinoin and unsure what your skin needs?
Start with a skin consultation. We assess your barrier, your current routine and how your skin is responding to your medication, then build a plan around where your skin is today.
There is a common misconception that someone taking isotretinoin should only use very basic, non-clinical skincare. While some patients absolutely need a very simplified routine, we don't believe pharmacy skincare is automatically the right answer simply because a patient is taking isotretinoin.
The important question isn't "Is this clinical skincare?" It is "Is this appropriate for this skin right now?"
Clinical skincare can include products specifically selected to support hydration, barrier function, inflammation and photoprotection without unnecessarily irritating compromised skin. Not every "active" ingredient is designed to exfoliate or aggressively treat the skin. Some ingredients are there to support it. During isotretinoin treatment, your routine may need to focus on the following.
A gentle but effective cleanser can remove sunscreen, environmental debris and product without unnecessarily stripping the skin.
Moisturisers help support hydration and barrier function and can reduce the discomfort associated with dryness and irritation.
Depending on your skin, this may include ingredients that support the lipid barrier, hydration and the skin's natural protective functions.
Some patients may benefit from carefully selected ingredients designed to support skin comfort and manage environmental oxidative stress.
This is particularly important during isotretinoin treatment. Your skin can become more sensitive to sunlight, so daily broad-spectrum SPF and sensible sun protection should form part of your routine.
Robust skincare doesn't mean an aggressive routine. It means a considered routine that gives your skin what it needs during a period of significant change.
For many years, patients taking isotretinoin were routinely advised to avoid a broad range of cosmetic procedures because of concerns around impaired wound healing, scarring and abnormal responses to treatment. Those recommendations were largely based on older reports and historical clinical practice.
More recent evidence has challenged the idea that every skin treatment must automatically be postponed during isotretinoin therapy. But that doesn't mean you can have any treatment you want while taking Accutane. The answer is more nuanced, and this is exactly where patient assessment becomes important.
In Part Two, we'll look at the current approach to professional treatments during isotretinoin, including superficial peels, LED, oxygen treatments and selected light-based treatments, and explain how we approach treatment selection at Plump. Part Two, Can You Have Skin Treatments While Taking Accutane?, is coming soon.
Often, yes. The question is not whether a product is clinical, but whether it is appropriate for your skin right now. Clinical skincare can be selected to support hydration, barrier function, inflammation and photoprotection without unnecessarily irritating skin that is already compromised by isotretinoin.
Isotretinoin reduces the size and activity of the sebaceous glands and significantly reduces sebum production. Research has also shown changes in epidermal turnover and corneocyte cohesion during treatment and, depending on dose, increased transepidermal water loss. Together these leave the skin drier and the barrier more vulnerable.
Not entirely. During periods of significant dryness or sensitivity, reducing the number of products and avoiding unnecessary actives can be exactly what your skin needs. Your skin still needs gentle cleansing, hydration, barrier support and daily SPF throughout treatment.
Yes. Your skin can become more sensitive to sunlight during isotretinoin treatment, so daily broad-spectrum SPF and sensible sun protection should form part of your routine.
It depends on the treatment and on your skin. More recent evidence has challenged the idea that every skin treatment must be postponed during isotretinoin therapy, but that does not mean every treatment is suitable. This is where assessment matters, and Part Two of this series covers it in detail. In the meantime, start with a skin consultation.
Acne treatment at Plump. How we assess and treat persistent acne and congestion, from homecare to in-clinic treatment.
Sensitive skin and barrier repair. Our approach to calming reactive skin and rebuilding a compromised barrier.
If you are taking isotretinoin and unsure what your skin needs, start with an assessment rather than another product. Book a skin consultation with our Dermal Clinicians at Plump, 525 Chapel Street South Yarra, or call or text us on 0478 844 048.
Plump Aesthetic Clinic acknowledges the Wurundjeri Woi-wurrung people of the Kulin Nation as the Traditional Owners of the land on which we live and work, and pays respect to Elders past, present and emerging.
Plump is a safe and welcoming space for people of all cultures, bodies, abilities, genders and sexualities.
