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Jump to Key Points CARLSBAD, Calif. — There’s still more to learn about isotretinoin, a mainstay of acne therapy since the 1980s, a dermatologist told colleagues at the symposium.
Recent research is offering insight into its potential effects on height, its compatibility with common laser treatments, and a strategy to prevent relapse, said Carol Cheng, MD, associate clinical professor of dermatology and director of the Acne & Rosacea Clinic at the University of California, Los Angeles. Cheng offered a series of acne treatment pearls in a presentation at the fall symposium of the California Society of Dermatology and Dermatologic Surgery.
‘Reassuring’ Research on Impact on Height
Parents occasionally express concern that isotretinoin has the potential to reduce height, especially if their children play basketball or volleyball, Cheng said. Indeed, isotretinoin warnings list reduced bone growth as a possible impact of use.
As Cheng highlighted, a 2026 Danish study published in JAMA Dermatology seems to resolve this question. The study used a database to track 368,338 men (4.5% isotretinoin users) and 10,858 women (2.6% isotretinoin users) who were conscripted into military service from 2001 to 2015. There was no clinically significant difference in adult height between isotretinoin users and nonusers.
- 2026 Danish cohort: isotretinoin not linked to ↓ adult height.
- Laser/procedure restrictions during isotretinoin use are being relaxed.
- Consensus supports vascular + nonablative fractional lasers most; ablative fractional less certain.
- Higher cumulative isotretinoin dose, not daily dose, associated with ↓ retrial/relapse.
- Some nutraceuticals show limited acne benefit; zinc most studied, GI AEs common.
“Overall, this gives us reassuring data,” Cheng said.
Changing Views on Laser Compatibility
“We’re taught to avoid lasers and other procedures while patients are taking isotretinoin and for at least 6 months after because of concerns about delayed wound healing and hypertrophic scarring,” Cheng said. But perspectives are changing.
In 2017, an American Society for Dermatologic Surgery task force concluded there was “insufficient evidence” to support delaying non-ablative laser therapy in patients who were taking or had recently taken isotretinoin.
In addition, “an international consensus on energy-based devices for acne scars has provided additional reassurance” she said, pointing to a 2022 report published in Lasers in Surgery and Medicine, which also addressed the use of energy-based devices in patients on isotretinoin, as an intervention to mitigate scarring.
“Overall, 82% of the expert panel agreed that energy-based devices could be safely used while patients were actively on isotretinoin,” Cheng said. “The most confidence was in vascular lasers, with 80% supporting use; 60% supported the use of non-ablative fractional lasers. There was less consensus around ablative fractional lasers with 45% supporting use.”
Insight Into Continued Treatment After Acne Clearance
Isotretinoin doesn’t always work on the first try. “Historically, relapse rates range anywhere from 10% to 60%,” Cheng said. She highlighted a 2025 study that linked higher cumulative dosages of isotretinoin — but not daily doses — to lower risk for retrial.
Cheng advised colleagues to consider continuing isotretinoin for 2 months after the patient is clinically clear and aim for a higher cumulative dose.
Evidence Supports Use of Some Supplements for Acne
Cheng also offered insight into non-isotretinoin topics. Patients may ask dermatologists about whether any supplements may help with acne, she said.
A 2023 systematic review that identified four good-quality studies that supported vitamin D, green tea extract, probiotics, and cheongsangbangpoong-tang, a traditional East Asian herbal formula in treating acne.
The review also found that “there is also some fair-quality evidence for the use of vitamin B5 and omega-3 and omega-6 fatty acids,” Cheng said. “Zinc was the most studied supplement, but the studies were a little bit inconsistent, with about half the fair-quality studies showing efficacy. It was also the supplement with the most side effects, notably GI [gastrointestinal] side effects of nausea, vomiting, and abdominal pain.”
In the big picture, “while nutraceuticals may have a role, the evidence currently is still fairly limited,” Cheng said. “But given they’re generally low risk, it’s reasonable for patients to try them if they’re very interested.”
Cheng reported having no disclosures.
