Clinical author's note Michael Stewart 20/05/2021: Isotrexin® gel was discontinued in the UK in January 2020. At the time of review there are no skin preparations containing isotretinoin available in the UK. Isotretinoin skin preparations may still be available in other countries. This medicine leaflet is based on medical information available in the UK at the time of writing and is left here for reference purposes. Please also refer to the manufacturer's information supplied with your medicine.
For information about taking isotretinoin as a capsule please see the medicine leaflet Isotretinoin capsules for acne.
Apply the gel once or twice a day, as directed by your doctor.
Your skin may become more sensitive to sunlight than usual. Avoid strong sunlight and do not use sunbeds.
You should avoid getting pregnant. Ask your doctor about suitable contraception.
About isotretinoin gel
|Type of medicine||A rub-on (topical) retinoid|
|Used for||Mild-to-moderate acne|
|Also called||Isotrex® (discontinued); Isotrexin® (discontinued) (contains isotretinoin and erythromycin)|
Acne is the common cause of spots. Most people with acne are aged between 12 and 25, but some older and younger people are affected too. Small sebaceous glands lie just under your skin surface and make an oil (sebum) that keeps your skin supple and smooth. Tiny pores on your skin allow the sebum to come on to the surface of your skin. In acne, some of these pores become blocked, causing small pimples, blackheads and whiteheads (comedones).
Applying isotretinoin to the areas of your skin with acne will help to unblock pores and treat blackheads or whiteheads. It also has some effect on reducing inflammation. If your spots are inflamed, you may be prescribed a brand called Isotrexin® as this gel also contains an antibacterial agent called erythromycin.
Isotretinoin is also available as capsules for more severe forms of acne which have not got better by using rub-on skin treatments. There is a separate medicine leaflet which contains more information about this, called Isotretinoin capsules for acne.
Before using isotretinoin gel
Some medicines are not suitable for people with certain conditions, and sometimes a medicine may only be used if extra care is taken. For these reasons, before you start using isotretinoin gel it is important that your doctor knows:
- If you are pregnant, trying for a baby or breastfeeding. You must not use isotretinoin gel if you could be pregnant.
- If you have a skin problem other than acne, such as if you have eczema or rosacea.
- If you or any close family members have ever had skin cancer.
- If you are taking or using any other medicines. This includes any creams you are using which are available to buy without a prescription.
- If you have ever had an allergic reaction to a medicine.
How to use isotretinoin gel
- Before you start the treatment, read the manufacturer's printed information leaflet from inside the pack. It will give you more information about isotretinoin and will provide you with a full list of the side-effects which you may experience from using the gel.
- Apply isotretinoin gel exactly as your doctor tells you to. It is best if you wash and gently dry the affected areas of your skin before you apply isotretinoin. A general point is that you should apply it to all of the area where your spots occur and not just to each spot. It is usual to apply it once or twice a day at first, although your doctor may suggest you use it less than this once your skin has improved. You only need to apply a thin layer of gel. Remember to wash your hands after you have finished applying the gel.
- If you have recently been using a preparation for your acne that causes your skin to peel, allow your skin to recover for a few days before you start using isotretinoin gel.
- Do not use the gel on any areas of your skin which are sunburnt or sore. Also, try to avoid getting it on the sensitive areas of your skin in or around your nostrils, your eyes and your mouth. Try not to let it build up in the folds or creases of your skin.
Getting the most from your treatment
- It is recommended that you use a mild soap and lukewarm water to wash with, as very hot or cold water can worsen acne. You cannot clean off blackheads. The black tip of a blackhead is actually a skin pigment and cannot be removed by cleaning or scrubbing.
- If your skin becomes very dry, it may help to use a moisturising cream (preferably a fragrance-free and water-based cream). Do not use ointments or oil-rich creams, as these could clog your pores again.
- You can use make-up and moisturisers, but do not apply them at the same time as you use isotretinoin gel. Try to avoid any skin products which exfoliate or dry your skin.
- Isotretinoin gel can make your skin more sensitive to sunlight than usual. A sun protection cream can help if you are out in the sun on bright days, even if it is cloudy. Do not use sunbeds.
- It is normal for isotretinoin treatment to take several weeks before there is a noticeable improvement in your skin. The most common reason for treatment failure is stopping treatment too soon thinking it is not working. If there is no improvement despite having used the gel for eight weeks, speak with your doctor again as there are other treatments which could be more suited to your condition.
- You should avoid getting pregnant while you are using isotretinoin as there is a slight risk of harm to unborn babies. If necessary, discuss with your doctor which types of contraception are suitable for you and your partner.
- Once your spots have cleared, acne commonly flares up again if you stop treatment. To prevent this, it is usual to carry on with a maintenance treatment after your spots have gone. The dose used to prevent spots from returning is often lower than that used to treat acne. It is common to need maintenance treatment for a number of years to keep acne away.
Can isotretinoin gel cause problems?
Along with their useful effects, most medicines can cause unwanted side-effects although not everyone experiences them. The table below contains some of the most common ones associated with isotretinoin gel. You will find a full list in the manufacturer's information leaflet supplied with your medicine. The unwanted effects often improve as your body adjusts to the new medicine, but speak with your doctor or pharmacist if any of the following continue or become troublesome.
|Very common isotretinoin gel side-effects (these affect more than 1 in 10 people)||What can I do if I experience this?|
|Skin irritation, redness, burning, dry or peeling skin||Reduce how often you are using the gel for a few days to see if this settles. If it is severe or troublesome, speak with your doctor|
If you experience any other symptoms which you think may be due to isotretinoin, speak with your doctor or pharmacist for further advice.
How to store isotretinoin gel
- Keep all medicines out of the reach and sight of children.
- Store in a cool, dry place, away from direct heat and light.
Important information about all medicines
If you buy any medicines, always check with a pharmacist that they are safe to use with your other medicines.
This preparation is for external use only. If you suspect that someone has swallowed some of it by accident, contact the accident and emergency department of your local hospital for advice.
If you are having an operation or dental treatment, tell the person carrying out the treatment which medicines you are using.
This medicine is for you. Never give it to other people even if their condition appears to be the same as yours.
Do not keep out-of-date or unwanted medicines. Take them to your local pharmacy which will dispose of them for you.
If you have any questions about this medicine ask your pharmacist.
Further reading and references
British National Formulary, 81st Edition (Mar 2021); British Medical Association and Royal Pharmaceutical Society of Great Britain, London.