Synopsis
Identify severe acne that merits consultant-dermatologist-led isotretinoin, apply the current 2026 UK risk-minimisation framework, prevent pregnancy exposure and monitor physical, mental-health and sexual adverse effects.
- Consider isotretinoin from age 12 for severe acne resistant to adequate systemic antibacterial and topical therapy, including nodulocystic acne, conglobata, fulminans or disease at risk of permanent scarring.
- A Lead Prescriber with systemic-retinoid expertise initiates treatment and confirms that no other appropriate effective option remains; every patient completes the current Acknowledgement of Risk process.
- From January 2026, UK patients under 18 no longer require agreement from a second independent prescriber; enhanced risk documentation, patient information and clinical audit replaced that regulatory step.
- Assess mental health with a patient-reported outcome measure and ask about sexual function before treatment, then revisit both at every follow-up.
- Anyone who can become pregnant enters the Pregnancy Prevention Programme unless robustly established criteria show no pregnancy potential.
- Effective contraception starts at least one month before treatment, continues throughout and for one month after stopping; pregnancy testing follows current programme and product requirements.
- A usual starting dose is 0.5 mg/kg/day with food, adjusted within approximately 0.5–1 mg/kg/day; a lower dose can be used when adverse-effect risk or intolerance requires it.
- Do not combine isotretinoin with tetracyclines or vitamin A supplements, do not donate blood during treatment or for one month afterwards, and never share capsules.