Accutane vs Birth Control Pills

Accutane: A high-dose oral vitamin A drug for severe or scarring acne. It is the only acne treatment that can produce lasting remission after a fixed course. Birth Control Pills: Birth control pills containing estrogen and a progestin. Four are FDA-approved for acne, and they work by lowering the amount of active testosterone in the blood.

Reviewed by Dr. Schwarz, Board-Certified Dermatologist

A white blister pack photographed flat on a white background, holding eight white oblong capsules in two rows of four under clear domes. ACCUTANE is printed in blue capitals on the empty left half of the foil.

An illustrative blister pack and white sleeve labeled Birth Control Pills.

Which one?At a glance What it treats Diagrams How you take it Results Side effects Safety Cost When you stop Questions

Which one is right for you?

Choose Accutane if…

Choose for severe, scarring or stubborn acne that keeps coming back after other treatments. It is the only acne medicine that can give lasting remission after one course.

Nodules or cysts, or acne leaving scars
Antibiotics and creams have not held it
You can commit to monthly visits and blood tests

Choose Birth Control Pills if…

Choose for hormonal acne along the jaw and chin when you also want contraception and have no clot risk factors.

Breakouts that track your cycle
You want contraception anyway
You don't smoke and have no clot or migraine-with-aura history

Often combined

Can you take them together?

Effective contraception is required for anyone who could become pregnant while taking Accutane, because isotretinoin causes severe birth defects. The pill is one of the most common choices, usually with a second method.

At a glance

● Accutane

● Birth Control Pills

Type

Oral retinoid (isotretinoin)

Combined hormonal pill (estrogen + progestin)

What it does

Shrinks oil glands and stops pores clogging

Lowers active testosterone, so less oil

Best for

Severe or scarring acne

Hormonal acne in people who also want contraception

Prescription

Yes, through the iPLEDGE program

Yes in most states

Form

Capsule

Tablet

How often

Once or twice daily with a fatty meal

One tablet daily

Course length

5–8 months

Ongoing

Time to results

Steady clearing from about week 4

About 3 months

Main side effect

Dry lips and skin

Nausea, breast tenderness, spotting

Blood tests

Liver and cholesterol

None; blood pressure checks

Pregnancy

Never

Not used in pregnancy

Cost

Moderate; generic available

Low; generic, often no copay

What it treats

Compare uses by strength of evidence. Evidence level describes confidence in a benefit, not its size.

Evidence level

Accutane

Birth Control Pills

Strong evidenceMost established uses

Acne

Clears severe and stubborn acne.

Visible sebum shine and natural pores on the nose and cheek.

Oily Skin

Sharply reduces oil.

Acne

Reduces hormonal breakouts.

Moderate evidenceSome supportive research

Redness and fine superficial vessels across a light-skinned cheek and nose.

Rosacea

Low doses help stubborn bumps.

Oily Skin

Lowers oil production.

Hirsutism

Slows unwanted hair growth.

Little evidence

An inflamed lump in the armpit on fair skin. The skin over it is swollen, shiny and red, with a pair of small blackhead-like openings in the skin beside it.

Hidradenitis Suppurativa

Usually not helpful.

—

Not effective

Acne Scarring

Doesn't treat existing scars.

Acne Scarring

Doesn't change scars.

Can make it worse

Eczema

Severe dryness can trigger flares.

Flat tan patches with soft irregular edges across the forehead and upper cheek of an adult with light skin, the surface completely smooth.

Melasma

Hormones can trigger or darken melasma.

How it works

Isotretinoin mechanism diagram. Reduces pore clogging: Helps normalize cell buildup inside follicles. Reduces acne bacteria: Less oil makes follicles less favorable for C. acnes. Makes less oil: Shrinks oil glands and reduces their oil output. Calms inflammation: Dampens immune responses involved in acne. — Open full-size diagram
Diagram explanation and sources
Reduces pore clogging: Helps normalize cell buildup inside follicles. Reduces acne bacteria: Less oil makes follicles less favorable for C. acnes. Makes less oil: Shrinks oil glands and reduces their oil output. Calms inflammation: Dampens immune responses involved in acne.
Oral isotretinoin mechanism overview. Reduced C. acnes is an indirect effect of a changed follicular environment, not antibiotic action. The complete mechanism is not known. Gland outline is conceptual, not a measured size reduction or permanent cure.
Source 1 · Source 2 · Source 3 · Source 4

Birth Control Pills. Combined pills can reduce hormone-driven acne. 1. Reduces ovarian androgens: Combined hormones lower androgen production by the ovaries. 2. Binds more testosterone: Estrogen raises SHBG, leaving less testosterone free to act. 3. Turns down oil stimulation: Less available androgen means less oil-gland stimulation. 4. Reduces acne over time: Hormone-driven breakouts can gradually improve. — Open full-size diagram
Diagram explanation and sources
Reduces ovarian androgens: Combined hormones lower androgen production by the ovaries. Binds more testosterone: Estrogen raises SHBG, leaving less testosterone free to act. Turns down oil stimulation: Less available androgen means less oil-gland stimulation. Reduces acne over time: Hormone-driven breakouts can gradually improve.
This refers to combined estrogen-progestin pills, not progestin-only contraception. Estrogen effects include suppression of ovarian androgen production and increased SHBG, reducing free testosterone. Specific formulations and clinical responses differ.
Source 1 · Source 2

How you take it

Treatment plan

Dose is set by body weight, and the total across the whole course matters more than any single day.

Starting dose: Often about 0.5 mg/kg a day, sometimes lower to ease into the side effects. Not the target.
Going up: Usually raised after the first month or two if blood tests and side effects allow, commonly to about 1 mg/kg a day.
Usual dose: About 0.5 to 1 mg/kg daily for most of the course.
Total course: Judged by cumulative dose, usually about 120 to 150 mg/kg of body weight. Reaching that total is what cuts relapse. Most people need five to eight months.

The pack is the dose.

Starting dose: One active tablet daily, begun where in the cycle your prescriber says.
Going up: No increase. If acne has not responded by six months, change the formulation or add another drug.
Usual dose: One tablet daily at about the same time.
Total course: As long as contraception and acne control are both wanted.

When to take it

With a fatty meal, unless you have the formulation made to work without food. Absorption of standard capsules roughly doubles with fat, so an empty stomach lowers your dose. Splitting the daily amount into two doses with meals is common.

One tablet daily at the same time, with food if it causes nausea. Backup contraception covers the first week unless you start at a set point.

If you miss a dose

Take it with your next meal if it is the same day, otherwise skip it. Do not double up. The total over months is what counts, and the missed dose moves to the end of the course.

Take it as soon as you remember, even if that means two in a day. For more than one, follow the pack instructions and use backup contraception. Missed pills affect pregnancy protection far more than acne.

Monitoring

Liver enzymes and triglycerides are checked before you start and again during the course, usually in the early months and after a dose increase. Cholesterol and triglycerides commonly rise, then settle afterwards.

Anyone who can become pregnant is enrolled in iPLEDGE, a federal safety program requiring two forms of contraception or documented abstinence, a pregnancy test before starting, monthly tests during, and pickup inside set time windows. Miss a window and that month starts again.

Nobody stays on this drug. The course ends, and the effect on the oil gland lasts, so most people need nothing more than a topical retinoid. A smaller group needs a second course.

Blood pressure and a careful history come before the first prescription: migraines, past clots, smoking, family history. Blood tests are not routinely needed.

People stay on this for years, and what drifts is risk, not the drug. Clot risk is highest in the first year and after restarting, and rises with age, weight, smoking and immobility. Blood pressure is rechecked periodically, and the decision is revisited around age 35.

When you’ll see results

Approximate windows, not promises.

● Accutane

● Birth Control Pills

Weeks 1 to 4

Weeks 1 to 4Dry lips first, almost always. Skin dries. Acne may flare.

Weeks 1 to 4Nausea, breast tenderness and spotting between periods. Acne may briefly worsen.

Weeks 4 to 12

Weeks 4 to 12Steady clearing. Dryness peaks and stays.

Weeks 4 to 12Oiliness drops and inflamed spots become less frequent.

Months 4 to 6

Months 4 to 6Most people are clear or nearly clear.

After the course

After the courseSkin keeps improving for a few months, and dryness clears within weeks to a couple of months.

After 12 weeks

After 12 weeksThe fair judgment point, though improvement often runs to six months. Nothing changed by then means a different formulation or drug.

Side effects

Sorted by what to do about them.

Accutane

Birth Control Pills

Common

Dry, cracked lips (almost everyone)
Dry skin, eyes and nose; nosebleeds
Acne may flare in the first month

Common

Nausea, usually gone by month three
Breast tenderness
Spotting between periods

Tell your doctor

Low mood, anxiety or feeling not yourself
Joint or muscle aches that limit exercise
Trouble seeing at night

Tell your doctor

New or severe headaches, especially with vision changes
Low mood that does not lift

Stop and get care

Severe headache with blurred vision
Severe stomach pain or yellowing skin
Thoughts of self-harm

Stop and get care

Pain, swelling or warmth in one calf
Sudden breathlessness or chest pain
Sudden weakness, numbness or trouble speaking

Safety and who should avoid it

Pregnancy

Never

Causes severe birth defects. Anyone who can become pregnant is enrolled in iPLEDGE: two forms of contraception or documented abstinence, and monthly pregnancy tests.

Stop

Not taken in pregnancy.

Breastfeeding

Avoid

Not recommended.

Avoid early

Estrogen can reduce milk supply; progestin-only methods are preferred early on.

Children

Teens OK

Commonly used from about age 12.

After periods start

Used in teens once periods are established.

Monitoring

Required

Liver enzymes and triglycerides before starting and during the course, plus monthly visits.

Blood pressure

Checked before and a few months in.

Key interactions

Check

Tetracycline antibiotics (raised pressure around the brain) and vitamin A supplements.

Check

Rifampin, St John's wort and some anti-seizure drugs reduce how well it works.

Other cautions

Discuss

Tell your doctor about any history of depression or mood problems.

Avoid

Smoking at 35+, past blood clots, migraine with aura, uncontrolled blood pressure, breast cancer, liver disease.

Cost and getting it

Getting it and cost

Generic isotretinoin is moderately priced; the formulations that absorb without food cost much more. The real obstacle is not cost but iPLEDGE, with monthly appointments and pickup windows to plan travel and work around.

Most combined pills are generic and cheap, and many plans cover contraception with no copay. The branded acne-approved versions cost more with no advantage. Availability without a prescription varies by state.

When you stop

Comes back?

Most stay clear or much improved. About one in five needs a second course, more likely with early-teen onset, very oily skin, hormonal acne, or stopping short of the target dose.

Often, and acne can flare in the first few months after stopping.

Taper needed?

No. There is no withdrawal and no taper — the course ends once you reach the target total dose.

No.

After the last dose

Dryness clears over weeks to a couple of months, and skin often keeps improving for three to six months. Pregnancy precautions continue for one month after the last capsule.

Fertility returns within a cycle or two. Have the next acne step in place first.

Common questions

Accutane:Does isotretinoin cause depression?

The label warns about mood changes and some people report them. Large studies have not shown that isotretinoin causes depression, and severe acne itself is strongly linked to low mood. Mood is asked about at every visit, and any change should be reported.

Accutane:Does it cause inflammatory bowel disease?

The concern came from case reports, and larger studies have not shown a clear causal link. Severe abdominal pain or bloody diarrhea still needs assessment.

Accutane:Why do I need pregnancy tests if I am not sexually active?

iPLEDGE applies the same rules to everyone who can become pregnant. A program rule, not a judgement about you.

Accutane:Will one course be enough?

For most people, yes. About one in five needs a second, and stopping short of the cumulative target is the most avoidable reason.

Accutane:Can I drink on it?

Occasional drinking is usually fine. Heavy drinking adds to the liver and triglyceride effects already being monitored.

Accutane:Why did my acne get worse at the start?

An early flare is common in the first few weeks, especially with more severe acne. It is managed, not a reason to stop.

Birth Control Pills:Which pills actually help acne?

Combined pills, which contain estrogen. Four are FDA-approved for acne; many others work similarly. The mini-pill, implant and hormonal coil can make acne worse.

Birth Control Pills:Will my acne get worse first?

Sometimes, in the first month or two. It settles.

Birth Control Pills:Does my acne antibiotic stop the pill working?

Rifampin does. Doxycycline and the other acne antibiotics do not.

Birth Control Pills:How risky are blood clots really?

The increase is real, but absolute risk stays low in healthy non-smokers, and pregnancy itself carries a higher clot risk. It rises sharply with smoking after 35, a family history of clots, and migraine with aura.

Birth Control Pills:What happens to my skin when I stop?

Acne commonly flares for a few months. Plan the next step before you stop.

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