The Ledger · treatment · prescription

Isotretinoin (oral)

Worth itfor severe or resistant acne
Evidence
High
Typical cost
~£20–60 / mo
Time to results
16–24 weeks
Access
Specialist prescriber

Isotretinoin is the strongest option that exists for acne, and often the only thing that works for severe, cystic, or scarring-risk cases that haven't responded to anything else. A full course frequently means long-term remission — not just control while you're using it, which is unusual for an acne treatment.

The most effective option on this list, and the one with the most oversight. That's not a coincidence.

It comes with real requirements: regular blood tests, a mandatory pregnancy-prevention programme if you can become pregnant, and side effects like significant dryness that need managing. This is specialist-prescribed and monitored, never a self-directed decision.

Where it sits against the alternatives

Ranked honestly against the other things people reach for. Same concern, different pathways.

treatmentSpironolactoneA lighter option for hormonal patterns specifically, tried first for many.
treatmentOral antibioticsFaster access, weaker and shorter-term than isotretinoin.
treatmentCourse of in-clinic chemical peelsAddresses texture and marks, not the underlying severity this treats.

Want this ranked for your skin, not the average?

Take the quiz

Reviewed July 2026 · Sources: NICE CKS referral criteria, BAD, AAD guidelines · Not yet clinically signed off