Severe Acne · Medication Guide
Isotretinoin in Thailand
What isotretinoin is, how well it clears severe acne, its real side effects, and how to get it legally and safely in Bangkok. Reviewed by a licensed physician at a MOPH-registered clinic.
- One course, 4–6 months for most
- Thai FDA controlled · doctor-supervised
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Medically reviewed by Dr. Thitaree Vongseenin
Menscape Clinic
Last reviewed
11 July 2026
1982
First approved by the FDA
over 40 years of clinical use
90%+
Develop dry, cracked lips
cheilitis is expected, not a surprise
120–150
mg/kg cumulative dose
the total that drives lasting clearance
4–6
Months per course
most people need only one course
Key takeaways
Isotretinoin is an oral prescription retinoid for severe, scarring or treatment-resistant acne, and the only acne medicine that can produce lasting remission after a single course.
It causes severe birth defects. Pregnancy must be strictly prevented before, during, and for one month after treatment (Category X). This is non-negotiable, not a caution.
It needs blood-test monitoring (liver enzymes and blood fats) and doctor supervision throughout, which is exactly what medicine bought off a pharmacy shelf does not come with.
In Thailand it is a specially controlled drug, yet often sold without proper oversight. A doctor must decide if it is right for you and monitor you on it.
01
What isotretinoin is & how it works
Isotretinoin is an oral prescription retinoid, a vitamin A derivative used to treat severe nodular or cystic acne, and acne that has not cleared with antibiotics and topical treatments. It is the most effective acne medicine available.
It works by targeting the root causes of acne at once. It dramatically shrinks the skin's oil (sebaceous) glands, so far less sebum is produced. With less oil and a normalised pore lining, pores clog less, the bacteria behind acne have nowhere to thrive, and inflammation settles. Uniquely among acne treatments, it can reset the skin enough that many people stay clear long after they stop taking it.
That power comes with real responsibility. Isotretinoin causes severe birth defects and can affect blood fats and the liver, so it is taken as a supervised course with blood tests, not as an open-ended daily pill. Whether it is right for you depends on how severe your acne is, your health history and your risk factors, which is what the doctor's assessment is for.
Shrinks the oil glands
Isotretinoin sharply reduces the size and output of the skin's sebaceous glands.¹
Less oil, fewer blockages
With far less sebum, pores are much less likely to clog and form comedones.
Starves acne bacteria
A drier, less oily follicle is a poor home for Cutibacterium acnes, and inflammation falls.
The skin resets
Over a full course the follicle normalises, which is why many people stay clear long after stopping.²
02
Getting isotretinoin in Thailand
Thai FDA status
Registered and classified as a specially controlled drug (ยาควบคุมพิเศษ), which by law means it requires a doctor's prescription. It is sold in Thailand under brands such as Roaccutane and several registered generics.⁴
How Menscape dispenses it
A licensed physician assesses your acne, orders the required blood tests, prescribes only if suitable, and dispenses through a licensed pharmacy with monitoring built in for the whole course.
The grey-market risk
Despite its legal status, isotretinoin is widely sold over the counter here with no exam, no blood tests and no pregnancy safeguards. That is the single most dangerous way to take this drug, and counterfeits also circulate.
Specially controlled drug (ยาควบคุมพิเศษ) under Thai law: a valid prescription is required. The Thai FDA has repeatedly warned against buying prescription medicines from unlicensed sellers, where counterfeits are common and nobody is accountable for what you receive.⁷
03
Does it work? The evidence
Isotretinoin has been used and studied since the late 1970s, and it remains the reference treatment for severe acne. The original trials showed prolonged remission of cystic and conglobate acne that had failed every other treatment, and decades of follow-up have confirmed the result.²
Two things shape the outcome. The first is the cumulative dose: a course is guided toward a target of roughly 120–150 mg/kg total, and reaching it is linked to more durable clearance. The second is time. A typical course runs 4–6 months, most people need only one, and a minority relapse and require a second course later.
~85%
Long-term clearance
after a single standard course, in reviews
1 course
Usually enough
a minority need a second course later
Figures from long-term follow-up studies and clinical reviews of oral isotretinoin. Relapse rates vary with dose and acne severity; individual results differ.²·⁵
04
Side effects & who shouldn't take it
Common and expected
Almost everyone gets dry, cracked lips (cheilitis), dry skin and eyes, and more sun sensitivity. These are dose-related, managed with lip balm, moisturiser and sunscreen, and reverse after the course ends.¹
Needs blood-test monitoring
It can raise blood fats (triglycerides and cholesterol) and, less often, liver enzymes. Blood tests before and during treatment catch this early, which is why unsupervised use is genuinely risky.
Serious but rare
Rare reports of mood changes, severe headache with raised pressure in the head (worse if combined with tetracycline antibiotics), and reduced night vision. Tell your doctor any mood history, and stop and seek help for severe headache with vision changes or vomiting.⁶
Absolutely not for
Anyone who is or may become pregnant: it causes severe birth defects (Category X). Also avoided with significant liver disease, very high blood fats, vitamin A supplements, or tetracycline antibiotics.
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Alternatives & combinations
Topical · first-line
Retinoids & benzoyl peroxide
For milder acne, a topical retinoid such as adapalene or tretinoin with benzoyl peroxide is usually tried first and carries far fewer risks.
Oral · often tried first
Oral antibiotics
A course of an oral antibiotic such as doxycycline, usually with a topical, is a common step before isotretinoin for moderate inflammatory acne.
For some patients
Hormonal treatment
In female patients, a doctor may consider hormonal options such as certain oral contraceptives or spironolactone; the right choice depends on your acne type and history.
06
How prescription works at Menscape
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Doctor consultation & blood tests
A licensed Thai physician reviews your acne by video call or in clinic at Asoke, and orders baseline blood tests (liver and lipids), plus a pregnancy test where relevant.
Prescription, if suitable
If isotretinoin is appropriate, you receive a prescription dispensed by a licensed pharmacy, with a clear plan and dose.
Monitoring & follow-up
Check-ins and repeat blood tests through the course, with the dose adjusted toward your target cumulative dose.
The doctor decides. Starting a conversation is not a commitment and does not guarantee a prescription. Isotretinoin is only started after the right checks, and only if it is safe for you.
Medically reviewed by
Dr. Thitaree Vongseenin
Menscape Clinic, Bangkok
“Severe acne can leave permanent scars, so I would rather see patients early than after the damage is done. Isotretinoin is powerful, but it is only as safe as the monitoring around it, and that is the part a pharmacy counter can't give you.”
- Reviewed
- 11 July 2026
- Next review
- January 2027
- Editorial standard
- Each guide is checked against the Thai FDA label and the primary literature, then reviewed by a licensed physician.
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Frequently asked questions
Can I buy isotretinoin over the counter in Thailand?
Legally, no. It is a specially controlled drug that requires a doctor's prescription. In practice some pharmacies sell it anyway, with no exam, no blood tests and no pregnancy safeguards, which is exactly what makes this drug dangerous to take on your own.
How long is a course, and will the acne come back?
A typical course runs 4–6 months, guided toward a cumulative dose of about 120–150 mg/kg. Most people stay clear long-term after one course; a minority relapse and may need a second.
Why does it need blood tests?
Isotretinoin can raise blood fats and, less often, liver enzymes, so a doctor checks these before and during treatment. This monitoring is a core reason to take it under supervision rather than from a pharmacy shelf.
Does isotretinoin cause depression?
Severe acne itself affects mood, and the evidence linking isotretinoin to depression is mixed rather than proven. Even so, tell your doctor about any mood history and report any mood changes promptly so they can be reviewed.
Is it safe during pregnancy or if my partner is pregnant?
It causes severe birth defects and must never be taken by anyone who is or may become pregnant (Category X); strict contraception is required before, during and for a month after. It is not known to harm a pregnancy through a male partner's use, but discuss any concerns with your doctor.
Can I drink alcohol while on isotretinoin?
Heavy drinking adds to the strain on your liver and can raise blood fats, both of which the medicine already affects. Your doctor will advise limiting alcohol and will track it through your blood tests.
Do the dry lips and dry skin ever go away?
Yes. Cheilitis and dryness are the most common effects and are dose-related; they are managed with lip balm and moisturiser and settle after the course ends.
Can I start or continue isotretinoin in Thailand as an expat or visitor?
Yes. No Thai residency is required; bring any past prescriptions and blood results. A licensed doctor can start a course or continue one you began abroad, with local monitoring.
08
References
1. U.S. FDA. Accutane® (isotretinoin) prescribing information. Accessed July 2026.
2. Peck GL, et al. Prolonged remissions of cystic and conglobate acne with 13-cis-retinoic acid. N Engl J Med. 1979;300(7):329-333.
3. Layton AM, et al. Isotretinoin for acne vulgaris — 10 years later: a safe and successful treatment. Br J Dermatol. 1993;129(3):292-296.
4. Thai Food and Drug Administration — drug control classification (specially controlled drugs), fda.moph.go.th. Accessed July 2026.
5. American Academy of Dermatology. Guidelines of care for the management of acne vulgaris. J Am Acad Dermatol. 2016;74(5):945-973.
6. European Medicines Agency. PRAC review of systemic retinoids — pregnancy prevention and psychiatric risk. 2018.
7. Thai FDA / Oryor consumer warnings on purchasing prescription medicines from unlicensed sellers, oryor.com. Accessed July 2026.
This guide is educational information, not medical advice. Isotretinoin is a prescription medicine that must be prescribed, dosed and monitored by a licensed physician, with the required blood tests and pregnancy precautions.
This guide is part of the Menscape skin library
Explore the condition hubSevere acne that won't clear? Ask a doctor, not a pharmacy counter.
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