If you have severe acne, treatment with isotretinoin (commonly referred to as Accutane, one of its former brand names) can lead to life-changing improvements in your symptoms. Although the treatment can help treat acne, it can also cause skin reactions like eczema. People with a history of eczema may experience worsened symptoms or flare-ups when they use isotretinoin.

Though isoterinoin is no longer sold as Accutane, formulations of the drug are available under other brand names, including Absorica, Amnesteem, Claravis, Myorisan, and Zenatane. Read on to learn more about how isotretinoin affects the skin and ways to manage eczema during treatment with isotretinoin.

How Isotretinoin Works

Understanding how isotretinoin works can help clarify potential side effects. Isotretinoin is a systemic retinoid, a relative of vitamin A that works throughout the body. It’s taken orally to treat severe cystic acne or moderate acne that doesn’t respond to standard therapies.

Health experts aren’t exactly sure how isotretinoin works to treat acne. However, the drug has been shown to block the skin’s production of sebum (oil), which is one of the main factors in acne development.

How Isotretinoin Affects the Skin

Although isotretinoin can be very effective in treating cystic acne, its skin-related side effects are important to consider, especially for people living with eczema. Common side effects of isotretinoin that affect the skin include:

• Skin rashes or infections, including serious skin reactions like Stevens-Johnson syndrome and toxic epidermal necrolysis
• Painfully chapped, dry lips that burn
• Dry skin
• Sun-sensitive skin

These side effects can be especially problematic for people with eczema-prone skin for several reasons. First, skin dryness increases the risk of eczema flares. Additionally, eczema itself can make people more sensitive to the sun, so adding isotretinoin to the mix can worsen this sensitivity.

More research is needed to get a full picture of which type of eczema is most likely to occur during isotretinoin therapy. However, researchers have documented several types.

There have also been reports of people experiencing nummular dermatitis (eczema that forms itchy, round lesions on the body, especially the arms and legs) and seborrheic dermatitis. Seborrheic dermatitis is inflammatory eczema that usually affects the scalp. Notably, contact dermatitis — a common form of allergic eczema caused by skin irritation — has not been reported, possibly because isotretinoin is taken orally and not applied directly to the skin.

Skin Care Tips While Taking Isotretinoin

The good news is that skin-related side effects caused by isotretinoin should go away once you stop taking it. That said, people living with eczema who take the drug must be diligent about protecting their skin during treatment.

Sun Safety

The American Academy of Dermatology Association (AAD) has recommendations for safe sun practices when taking isotretinoin:

• Stick to the shade when outside, especially when the sun is at its strongest (generally between about 10 a.m. and 2 p.m.). A good rule to use is to get in the shade whenever your shadow is shorter than you.
• Wear clothing that protects you from the sun, including lightweight and long-sleeved shirts, pants, ultraviolet (UV)-protection sunglasses, and wide-brimmed hats. Clothes with a UV protection factor (UPF) label number are the best for sun protection.
• Use water-resistant, broad-spectrum sunscreen (containing both UVA and UVB protection) that has an SPF of 30 or higher. Apply sunscreen to all skin exposed to sunlight every two hours or after swimming or sweating.

For people with eczema, finding sunscreen that works without irritating their skin can be challenging. The National Eczema Society recommends reviewing all ingredients carefully and avoiding sunscreen with added fragrances and other irritating additives. People with eczema should also test any new sunscreen on a small patch of skin before applying it liberally.

Other practical tips for sunscreen use include the following:

• Apply emollient moisturizer about 30 minutes before applying sunscreen to help prevent sun exposure from drying the skin. For greasy or oily emollients, don’t apply too much, as this can cause bad sunburn.
• Store sunscreen in a cool, dry place away from sunlight. Leave it in the shade when you have it outside.
• Avoid rubbing in sunscreen, which can trigger itchiness. Apply it in downward strokes.
• Apply a large amount of sunscreen, as many people apply too little.

Members of MyEczemaTeam often discuss techniques that work for them for managing eczema in the sun. One member shared, “Washing off the salt water with fresh water and moisturizing right away has been helpful for me. I also apply sunscreen every two hours and make sure I get a good balance of sun/shade.”

The type of sunscreen you use is also important. The two most common types of sunscreen are chemical absorbers that absorb UV rays and mineral-based reflectors that reflect UV rays. Generally, people with eczema experience less irritation with mineral-based sunscreens.

Importantly, older formulations of mineral-based sunscreens can leave a white film on the skin, which can be frustrating. Thankfully, this is less frequent with newer formulations.

Daily Moisturizing

Along with practicing sun safety, daily moisturizing routines are essential to preventing and treating dryness and itching for people with eczema who take isotretinoin. The AAD recommends using an oil-free moisturizer to reduce dryness and prevent breakouts. The best time to apply a thick layer of moisturizer is immediately after washing to lock in moisture.

The National Eczema Association provides these tips for moisturizing:

• Apply any prescription topical (applied to the skin) medication before moisturizing.
• Use a clean device to remove moisturizer from its container to prevent contaminating it with your hands.
• Rub the moisturizer between your hands to soften it before applying it to your skin. As with sunscreen, avoid rubbing in the moisturizer, and apply it in downward strokes.
• Leave moisturizer that feels “tacky” on your skin because it’ll be absorbed for added moisture within minutes.
• Moisturize your hands after washing them or whenever they come in contact with water.
• Choose moisturizers that feel greasy. Greasier moisturizers contain more oil and are better at retaining moisture and keeping out irritants.

Talk With a Dermatologist

If you or someone you love is living with eczema and thinking about using isotretinoin, remember that everyone’s experience is different. Talk with your dermatologist as a first step to decide if isotretinoin is right for you, especially if you have eczema. They will help you weigh benefits and risks, and review strategies for reducing side effects and eczema flares based on your needs.

Find Your Team

MyEczemaTeam is the social network for people with eczema and their loved ones. On MyEczemaTeam, more than 49,000 members come together to ask questions, give advice, and share their stories with others who understand life with eczema.

Are you living with eczema? Are you using isotretinoin to treat your acne? Are you interested in trying it? Share your experience with other MyEczemaTeam members. You can start a conversation by posting on your Activities page.