Isotretinoin, commonly known as Accutane, is a potent oral retinoid medication derived from Vitamin A. It is primarily prescribed for severe, nodular, and cystic acne that has not responded to other treatments. The medication works by systemically targeting the underlying causes of severe acne, leading to significant clearing of the skin. Acne scarring represents lasting structural damage, such as depressions or raised areas, left behind after profound skin inflammation has healed. While the primary goal is resolving active breakouts, isotretinoin is a powerful preventative measure, stopping the source of new damage, rather than a direct treatment for established fibrous scar tissue.
Accutane’s Role in Preventing Future Scarring
The most significant benefit of isotretinoin for long-term skin health is its effectiveness in preventing new acne scars from forming. Scarring results from deep, prolonged inflammation and tissue destruction caused by severe acne lesions. By resolving this inflammation, the medication prevents the damage that leads to permanent marks on the skin.
The drug drastically shrinks the sebaceous glands, reducing sebum production by up to 90%. This reduction removes the primary food source for acne-causing bacteria and prevents clogged pores, stopping the formation of new breakouts that could lead to scars. Isotretinoin also possesses anti-inflammatory properties that reduce the severity and duration of current breakouts, minimizing tissue damage. Normalization of skin cell turnover further contributes to scar prevention by preventing pores from becoming blocked.
The Drug’s Effect on Existing Scar Tissue
Isotretinoin is not considered an effective treatment for established acne scars, whether they are atrophic (depressed) or hypertrophic (raised). These scars represent structural changes in the dermis, where collagen and elastin fibers have been permanently damaged or improperly formed. The medication does not possess the capability to fill these depressions or smooth these fibrous bumps. While isotretinoin promotes increased skin cell turnover and may offer mild collagen remodeling, this effect is minimal and generally only improves the appearance of very superficial marks or discoloration.
During treatment, existing scars may temporarily appear more prominent or noticeable. This is due to severe skin dryness and increased fragility, a common side effect of the medication. The resulting thinning and temporary sensitivity can exacerbate the visual contrast between normal skin and scarred areas. Consequently, dermatologists strongly advise against aggressive scar revision procedures, such as deep chemical peels, dermabrasion, or ablative laser treatments, while taking isotretinoin. The skin’s impaired wound healing and increased fragility raise the risk of poor healing and can potentially lead to new, undesirable scarring.
Next Steps for Scar Revision After Treatment
Since isotretinoin is primarily preventative, a separate plan is needed to address existing scars once the acne is cleared. The most important first step is a required waiting period after the course of medication is completed. This wait allows the skin’s barrier function, wound healing capacity, and normal tissue integrity to fully recover from the systemic effects of the drug.
The standard recommendation for aggressive, energy-based procedures, such as laser resurfacing or deep peels, is to wait at least six months post-treatment. Some guidelines suggest a minimum of three months for less invasive procedures. Once this waiting period is complete, a combination approach is often used to treat the varied types of scars.
Common Scar Revision Treatments
Procedures like fractional laser resurfacing, which creates microscopic columns of injury to stimulate new collagen production, are effective for improving texture. Microneedling, often combined with radiofrequency energy, also stimulates the body’s natural healing response to remodel scar tissue. For depressed scars involving volume loss, dermal fillers can be injected directly beneath the scar to lift the depression and smooth the contour of the skin.