Accutane vs Soolantra

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. Soolantra: A once-daily cream for the bumps and pustules of rosacea. It calms inflammation and reduces the mites that live in facial follicles, but it does not treat flushing or fixed redness.

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.

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 Soolantra if…

Choose for rosacea bumps and pustules as a once-daily cream that often clears them — it doesn't treat flushing or fixed redness.

Rosacea bumps and pimples
You want once-daily use
You'll give it 12–16 weeks

Fine together

Can you take them together?

Soolantra treats rosacea bumps and does not interact with Accutane. It can be used during a course if your dermatologist agrees.

At a glance

● Accutane

● Soolantra

Type

Oral retinoid (isotretinoin)

Topical antiparasitic and anti-inflammatory (ivermectin 1%)

What it does

Shrinks oil glands and stops pores clogging

Calms inflammation and reduces Demodex mites

Best for

Severe or scarring acne

Rosacea bumps and pustules

Prescription

Yes, through the iPLEDGE program

Yes

Form

Capsule

Cream

How often

Once or twice daily with a fatty meal

Once daily

Course length

5–8 months

Ongoing

Time to results

Steady clearing from about week 4

4–16 weeks

Main side effect

Dry lips and skin

Mild burning or dryness

Blood tests

Liver and cholesterol

None

Pregnancy

Never

Check with your clinician

Cost

Moderate; generic available

What it treats

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

Evidence level

Accutane

Soolantra

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.

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

Rosacea

Reduces bumps and pimples.

Moderate evidenceSome supportive research

Rosacea

Low doses help stubborn bumps.

—

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.

The finger webs and wrist on fair light skin, with small red bumps, several thin gray burrow lines a few millimetres long, and scratch marks across the area.

Scabies

Scabies needs permethrin or ivermectin tablets.

Not effective

Acne Scarring

Doesn't treat existing scars.

Acne

Not an acne treatment.

Post-Inflammatory Redness

Doesn't fade redness alone.

Can make it worse

Eczema

Severe dryness can trigger flares.

—

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

Soolantra. Ivermectin helps settle rosacea bumps and pimples. 1. Reduces Demodex mites: Kills mites that may contribute to rosacea inflammation. 2. May calm immune signals: Anti-inflammatory effects may also help skin settle. 3. Reduces bumps and pimples: Inflammatory rosacea lesions gradually improve. — Open full-size diagram
Diagram explanation and sources
Reduces Demodex mites: Kills mites that may contribute to rosacea inflammation. May calm immune signals: Anti-inflammatory effects may also help skin settle. Reduces bumps and pimples: Inflammatory rosacea lesions gradually improve.
The label states that the rosacea mechanism is unknown. Anti-parasitic and anti-inflammatory actions are supported by a small in-vivo pilot; clinical efficacy has randomized-trial support. Demodex is not the sole cause of rosacea.
Source 1 · Source 2 · Source 3

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.

When to Apply: Once a day, usually at night, on clean dry skin. A pea-sized amount for the whole face, spread thinly rather than dabbed on bumps. Keep it off the eyes, lips and inside of the nose. Moisturizer and sunscreen go on top once it has dried.

How to Start: Once daily from day one. No build-up schedule, and twice a day speeds nothing up.

If It Irritates: Mild burning, stinging or dryness early on is common; moisturizer before or after usually settles it. A flare of bumps in the first two to four weeks happens and passes. It does not mean the cream is wrong.

If It's Not Working: Give it twelve weeks before judging, up to sixteen for the full effect. There is one strength, so the next step is adding something else, often azelaic acid or an oral antibiotic, not more cream.

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.

Not covered in this guide yet

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.

Not covered in this guide yet

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.

No blood tests or laboratory monitoring. Very little is absorbed through intact skin, far below the amounts involved with the tablets.

Monitoring is a conversation at around twelve weeks: have the bumps reduced, is the cream comfortable, is anything separate needed for redness. People stay on it for years without a dose change, because nothing accumulates.

Irritation after months of comfortable use usually points to a change in the routine or a second problem such as contact dermatitis, worth reviewing rather than pushing through.

When you’ll see results

Approximate windows, not promises.

● Accutane

● Soolantra

Weeks 1 to 4

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

Weeks 4 to 12

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

Weeks 4 to 12Working: Steady reduction in bumps and pustules. Most of the gain happens here, and background pink fades as the inflammation settles.

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.

First few minutes

First few minutesApplying it: A pea-sized amount once a day, thinly over the whole face.

Weeks 1 to 2

Weeks 1 to 2Adjusting: Mild burning, dryness or itching. Some get a short flare as mite numbers drop. Little visible change yet.

Weeks 2 to 4

Weeks 2 to 4First change: Fewer new pustules, which clear before the firm red bumps. The face looks calmer before the count is obviously lower.

Weeks 12 to 16

Weeks 12 to 16Judge it here: The point the trials measured, where most people were rated clear or almost clear.

Side effects

Sorted by what to do about them.

Accutane

Soolantra

Common

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

Common

Mild burning or stinging
Dry skin

Tell your doctor

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

Tell your doctor

Rosacea worsening

Stop and get care

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

Stop and get care

Swelling or trouble breathing

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.

Use care

Ask the doctor managing your pregnancy.

Breastfeeding

Avoid

Not recommended.

Use care

Discuss with your clinician.

Children

Teens OK

Commonly used from about age 12.

Not used

Adults only.

Monitoring

Required

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

None

Judge at 12–16 weeks.

Key interactions

Check

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

None known

—

Other cautions

Discuss

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

Use care

Keep out of eyes.

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.

Sold as Soolantra, with generic ivermectin 1% cream now available in some markets. Price varies widely between pharmacies and plans, and many plans want metronidazole or azelaic acid tried first.

A tube lasts a while, since a pea-sized amount covers the whole face once a day. If cost is the barrier, price generic ivermectin cream, a pharmacy discount card, or generic metronidazole or azelaic acid.

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.

Bumps can return 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.

Restarting usually works.

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.

Soolantra:Does it get rid of the redness in my face?

Not the kind most people mean. It reduces redness from inflamed bumps, so the face looks calmer. It does not stop flushing or remove visible vessels; those need brimonidine or oxymetazoline, or laser and light.

Soolantra:Why did my rosacea get worse in the first two weeks?

A short early flare is common, probably because dying mites release material the immune system reacts to. It settles within a few weeks.

Soolantra:Is this the same as taking ivermectin tablets?

Same drug, completely different medicine. The cream goes on the face, almost none enters the bloodstream, and it treats skin only.

Soolantra:How long will I need to use it?

Rosacea is managed, not cured, so most people use it long term. Bumps return within a few months of stopping.

Soolantra:Can I use it alongside other rosacea treatments?

Yes, and combinations are common: a redness treatment in the morning and ivermectin at night, or ivermectin with oral doxycycline.

Soolantra:Do I need to change my pillowcases because of the mites?

No. These mites live in the follicles of nearly every adult face. They are not caught from bedding, pets or people, and cleaning does not change their numbers.

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