Influencers have helped turn isotretinoin into a beauty trend. What was originally developed as a prescription treatment for severe acne is now being promoted on social media as a kind of “glow-up” solution.

The buzz has long since made its way into dermatology practices. Demand is increasing, manufacturers are reporting supply shortages, and clinicians are facing more and more unrealistic expectations. But what is driving this trend — and what does the evidence actually show about the benefits and risks of this medication?

Isotretinoin as Miracle Cure

How did a prescription acne medication even become a social media phenomenon? It all began with personal testimonials that were shared millions of times on TikTok. The trend reached a peak in early 2026, when model Kendall Jenner spoke openly on the In Your Dreams podcast about her acne treatment with Accutane — the former US brand name for isotretinoin. In doing so, she picked up on a myth that had been circulating on TikTok for years: that the active ingredient had made her nose narrower. Singer Olivia Rodrigo also spoke publicly about her treatment, further contributing to the drug’s popularity.

However, the trend really took off on TikTok. Under hashtags like #AccutaneJourney or #AccutaneGlowUp, young users in particular document their treatment with supposedly impressive before-and-after videos. In these posts, isotretinoin is often portrayed as a universal beauty drug — detached from its narrow medical indication and extensive safety guidelines.

The ‘Nose Myth’

The so-called “Nose Myth” exemplifies how social media exaggerates scientific observations. In fact, isotretinoin shrinks the sebaceous glands and reduces sebum production. In the area of the nose, this can make the skin appear thinner and slightly reduce soft tissue volume. However, the active ingredient does not alter the bony and cartilaginous structure of the nose — and thus the actual shape of the nose.

This limited pharmacologic effect has given rise to the promise of a permanent aesthetic change on social media: a claim for which there is currently no scientific basis.

From a TikTok Trend to a Supply Shortage

The growing hype is already having consequences. Since the fall of 2025, the Federal Institute for Drugs and Medical Devices (BfArM) has been reporting supply shortages affecting several isotretinoin-containing products. The first to be impacted were Isotretinoin Basics 10-mg and 20-mg soft capsules, followed by temporary shortages of Aknenormin (Almirall) and Isogalen (Galenpharma). According to the latest manufacturer updates, some of these shortages could extend into the fall or even last until the end of 2026.

The companies cite limited production capacity as well as increased demand as the causes. Whether this is directly attributable to the social media hype cannot be proven based on the available data, but it seems plausible given the timing.

The Indication Has Not Changed

As much as public perception has changed, the medical assessment of isotretinoin has remained unchanged. According to current guidelines, the active ingredient is still considered the most effective systemic treatment for severe, treatment-resistant forms of acne.

Isotretinoin is recommended primarily for severe papulopustular acne and acne conglobata, as well as for patients who do not respond adequately to topical or other systemic therapies. However, there is no indication for mild acne or purely cosmetic concerns. Even though social media often portrays isotretinoin as a “glow-up” drug, the decision to prescribe it continues to be based on the severity of the condition, clinical guidelines, and a careful risk-benefit assessment.

Controversy Surrounding Psychiatric Side Effects

Speaking of risks: Hardly any aspect of isotretinoin therapy has been the subject of as much controversy over the years as potential psychiatric side effects. The focus is primarily on depression and suicidal ideation.

The most robust evidence to date comes from a meta-analysis published in JAMA Dermatology, which included 25 studies and more than 1.6 million participants. The pooled 1-year prevalence of depression was 3.83%, while suicide, suicide attempts, suicidal ideation, and self-harm each occurred in less than 0.5% of cases. Overall, the authors found no significant association between isotretinoin therapy and psychiatric disorders (risk ratio [RR], 1.08; 95% CI, 0.99-1.19). It was also noteworthy that isotretinoin users actually had a lower risk for suicide attempts than control individuals in the 2-4 years following the start of treatment.

An older meta-analysis published in the Journal of the American Academy of Dermatology reached a similar conclusion. According to that study, depressive symptoms actually decreased significantly after the start of treatment (RR, 0.588). The most likely explanation is that the successful treatment of severe acne reduces the psychological distress experienced by many affected individuals.

However, the evidence is not entirely clear. Another meta-analysis of 15 observational studies found a 52% increased risk for depression and a 68% increased risk for suicidal behavior among isotretinoin users.

The conflicting results are likely due primarily to differences in study design and control groups, as well as to the difficulty of adequately accounting for acne itself as an independent risk factor for depression.

The Undisputed Risk

Unlike with psychiatric side effects, there is no scientific doubt regarding teratogenicity. Isotretinoin is one of the most potent known human teratogens. Even exposure during the first trimester can be associated with a high risk for severe birth defects. According to data from Embryotox, this risk is as high as 25%. In contrast, there is very little data available on use after the first trimester.

For this reason, a mandatory Pregnancy Prevention Program has been in place in the European Union for years. It includes a pregnancy test before starting therapy, reliable contraception during treatment, and a limit on the prescribed quantity to a maximum of 30 days.

The social media frenzy only highlights how important it is to keep this program in place. As isotretinoin is requested more often — even by patients whose interest is largely cosmetic — it becomes all the more essential that counseling does not overlook the drug’s most significant and best-documented risk.

Other Known Side Effects

Even aside from teratogenicity, isotretinoin is well studied. The most common adverse effects include dose-dependent mucocutaneous side effects such as dry skin, cheilitis, and dry mucous membranes. In addition, liver enzyme and blood lipid levels may temporarily increase, which is why laboratory monitoring is recommended before starting and during therapy.

Overall, serious adverse drug reactions occur only rarely. After isolated cases of Stevens-Johnson syndrome and toxic epidermal necrolysis came to light, the BfArM prompted an update to the product information as early as 2010.

Clear Indication Rather Than a Social Media Trend

The social media hype has fundamentally changed the public perception of isotretinoin, but the scientific evidence has not. When used for a clear indication, the active ingredient remains the most effective systemic treatment for severe forms of acne. This makes evidence-based education, realistic expectation management, and the consistent implementation of established safety measures all the more important. After all, isotretinoin is not a beauty hack but a highly effective medication with clearly defined indications and equally well-known risks.

This story was translated from Medscape’s German edition.