💊 Isotretinoin (Roaccutane): Why Does Acne Get Worse at First?

I’ll organize everything for you, including why acne worsens early in treatment, side effects, and the products currently sold in Korea.

Hello, this is Yonsei Bombit Dermatology.

‘Isotretinoin (formerly Roaccutane),’ a treatment for severe acne, is widely used because it is highly effective at suppressing sebum.

But many patients say their acne actually gets worse within 1 to 2 weeks after starting treatment.

Today, I’ll explain the reason scientifically, along with side effects to watch for when taking it, and the products that can currently be prescribed in Korea.

1️⃣ Why does isotretinoin make acne worse at first?

✔ A sudden increase in inflammatory immune response

Isotretinoin quickly suppresses the bacteria that are a major cause of acne.

As bacteria are broken down, an inflammatory immune response is rapidly triggered, and as a result, red acne lesions may temporarily increase on the skin.

✔ Expulsion of excess sebum and retained comedones

As sebaceous gland activity is sharply suppressed, the sebum, dead skin cells, blackheads, and whiteheads that had already built up are pushed out to the surface.

In particular, adolescents and men with many comedones tend to experience more severe flare-ups.

✔ Changes in gene expression

Isotretinoin can affect the expression of certain genes in the skin, changing the regulation of inflammation-related proteins.

During this process, inflammatory responses can vary from person to person, and in some people, acne may temporarily worsen.

✔ Starting with a low dose can reduce early worsening

Starting with a low dose of 10 mg or less per day, or using it together with antibiotics and moisturizers, can help minimize early worsening.

It is important to adjust the dose and pace of treatment according to each person’s condition.

2️⃣ Five side effects you must know

✔ Absolutely contraindicated during pregnancy

→ The risk of birth defects is very high, so women of childbearing potential need strict contraception.

✔ Dryness of the lips, skin, and eyes

→ This is the most common side effect, and moisturizers and artificial tears are essential.

✔ Muscle and joint pain

→ Pain may worsen before or after exercise, so avoid overexertion.

✔ Abnormal liver function and elevated triglycerides

→ Regular blood tests are needed to check for abnormalities.

✔ Low mood and mood swings

→ Although rare, psychiatric side effects can occur, so if symptoms appear, you should seek counseling right away.

3️⃣ Isotretinoin products currently sold in Korea (as of 2025)

Various generic products are currently distributed, and the following are representative formulations.

Product name	Manufacturer	Strength
Finple Soft Capsule	Theu Pharmaceutical	10 mg
Nimegen Soft Capsule	Medica Korea	10 mg
Trenon Soft Capsule	Dongkoo Bio & Pharma	10 mg
Tretin Soft Capsule	Kolon Pharmaceutical	10 mg
Isotino Soft Capsule	Hanmi Pharmaceutical	10 mg
Zeroqutan Soft Capsule	JW Pharmaceutical	10 mg
Opiqutan Soft Capsule	Iworld Pharm	10 mg
Akinol Soft Capsule	Aju Pharm	10 mg
Roitan Soft Capsule	Mothers Pharm	10 mg
Isotam Soft Capsule	Sungwon Adcock Pharmaceutical	10 mg

※ ‘Roaccutane’ is not currently sold in Korea.

※ All products contain the same active ingredient, but tolerability may differ depending on excipients or capsule characteristics.

✨ In closing

Isotretinoin is a powerful acne treatment, but temporary worsening can occur early in treatment.

If you get through this period well, acne will then improve steadily, and your skin condition will become noticeably better.

The most important thing is to start taking it only under the diagnosis and guidance of a board-certified dermatologist,

and to seek immediate counseling if any abnormal symptoms occur while taking it.

📍 Yonsei Bombit Dermatology

📞 02-837-8275

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