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Isotretinoin, also known as 13-cis retinoic acid, is an effective systemic therapy for severe, hormonal, and treatment-resistant acne vulgaris. It works by reducing sebaceous gland size, sebum production, cell growth, and keratinization. Despite its efficacy, isotretinoin presents challenges due to its side effects, which are dose and duration-dependent. Key side effects include teratogenicity, skin and mucous membrane dryness, and potential risks of depression, liver dysfunction, elevated triglycerides, and musculoskeletal pain. Most side effects resolve after treatment ends, and patient awareness can help mitigate them. Regular monitoring of liver enzymes, lipid profiles, and blood counts is crucial to prevent adverse effects.

Isotretinoin is highly effective for treating moderate to severe acne, offering potential long-term remission, but its use is limited by significant adverse effects. Physiological side effects include teratogenic risk, cheilitis, xerosis, ocular changes, dyslipidemia, musculoskeletal pain, and hepatic function alterations. The psychological impact is debated, with some studies indicating increased depression and suicidality, while others report improved psychosocial well-being due to acne resolution. These mixed findings may be influenced by the psychological burden of acne itself. Isotretinoin remains essential in acne management, necessitating careful monitoring and patient education. Future research should focus on distinguishing the psychiatric effects of the drug from those related to severe acne and improving strategies to reduce physiological toxicity.