To those in their late 20s who are afraid to take acne medication

To customers in their late 20s

Last Thursday, in the consultation room,

a 29-year-old office worker came in.

They said they had spent hours reading blog reviews.

"My lips are all cracked, my eyes feel like they’re going to pop out,

and I heard my liver enzymes can go up,

is this really a medicine I can take?"

They had nodular acne along the jawline

that had kept recurring for three years.

Honestly, this question,

I hear three or four times a week.

So what exactly is different?

What dermatologists call 'acne medication'

falls broadly into two types.

One is antibiotics (doxycycline, minocycline class),

and the other is what we’ll talk about today:

isotretinoin (Roaccutane, Isotinan, etc.).

Unlike antibiotics, isotretinoin

is a medicine that reduces the size of the sebaceous glands themselves.

So it’s much stronger in effect,

but the side-effect profile is more complex.

This is something many people misunderstand,

but "strong medicine = bad medicine" is not always true.

Depending on how the dosage is designed,

the same medicine can work in completely different ways.

Why do some people struggle

while others get through it easily?

"Isotretinoin (Roaccutane) side effects,

this is how dermatologists manage them."

— Director Woo Young-jin (Hongdae Beautystone Clinic)

Side effects are not a 'problem with the medicine itself'

but a matter of 'initial dose setting and moisturizing setup.'

Usually, overseas guidelines recommend

0.5 to 1.0 mg per kg of body weight

as the daily dose.

If you weigh 60 kg, that comes to 30 to 60 mg per day.

But here’s the tricky part:

if you apply that dose to Korean skin as is,

in seven out of ten cases, the lips, eyes, and nasal mucosa

fall apart within two weeks.

That’s why, for almost all of my patients,

I start with 10 mg or 20 mg a day.

Of the isotretinoin patients I saw last month,

there were about 47 people,

and only two actually had elevated liver enzymes

and needed a dose reduction.

On the other hand, some people start at 40 mg right away

and then stop on their own because of side effects.

The reason experiences differ so much with the same medicine

ultimately comes down to the initial setup.

Director Woo Young-jin’s key takeaway

Most side effects happen not because the medicine is harsh,

but because the starting dose is too high.

If you increase slowly from a low dose,

most people can complete treatment while continuing daily life.

This is how I usually divide it up in the clinic

But this isn’t always good, either.

With a low-dose approach, treatment can take

as long as 6 to 9 months.

That said, for people who want to maintain their quality of daily life

and have a much higher chance of finishing treatment,

it is still a good option.

The three questions I get most often in the clinic

Q1. While taking it, is even a single drop of alcohol really not allowed?

Honestly, having one or two drinks at a company dinner once in a while

often doesn’t have a major effect on liver enzymes.

However, drinking two or more times a week

or binge drinking is best avoided.

If your blood test is normal after one month, we can be a bit more flexible.

Q2. How long do you need to take it so it won’t come back?

Based on cumulative dose,

we aim for about 120 to 150 mg per kg of body weight.

For 60 kg, that’s about 7,200 to 9,000 mg.

At 20 mg daily, that usually takes about 6 to 8 months.

Q3. Besides the lips and eyes, what are the really serious side effects?

Elevated liver enzymes, elevated cholesterol,

rarely decreased night vision,

and very rarely mood changes have been reported.

That’s why I always do baseline blood tests before starting,

and repeat blood tests after one month.

And women of childbearing age must use contraception

because of the risk of birth defects.

There is no compromise on this part.

If anything is confusing,

I’ll look at it directly in the clinic and explain it to you.

This has been Woo Young-jin.

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Frequently asked questions

Q. Is alcohol really off-limits—even a sip—while taking the medication?

A. Honestly, in many cases, one or two drinks at a company dinner don’t have a major impact on liver enzyme levels.

Q. How long do I need to take it to avoid a recurrence?

A. As a cumulative dose, aim for about 120–150 mg per kg of body weight.

Q. Aside from the lips and eyes, what are the really serious side effects?

A. Increased liver enzyme levels and increased cholesterol have been reported. Rarely, decreased night vision, and very rarely, mood changes have been reported.

Q. If I start with a low dose of isotretinoin, how long will the treatment take?

A. For a low daily dose of 10–20mg, it typically takes about 6 to 9 months. Although this is a longer period, side effects like dryness are much milder, making it far easier to stay on track and successfully complete your treatment while maintaining your daily routine.