20 mg Accutane and exfoliation

Question

I had rhinoplasty two months ago in Turkey, and was prescribed 20mg Isotretsnoin to take after. I haven’t started yet, but looking to start soon. I have KP on my legs and use a salycylic body wash and coffee scrub on it. Can I still continue to use these whilst on the low dose of Isotretanoin? Also, would I be able to have the occassional drink on it? Many thanks

Anna Chacon, MD, FAAD · Answer

Thank you for your questions—these are very common concerns, especially when starting isotretinoin after recent procedures like a rhinoplasty.

Regarding exfoliation for keratosis pilaris (KP): low-dose isotretinoin (20 mg) can make your skin more sensitive and prone to irritation. Using salicylic body washes or physical scrubs like coffee scrubs may increase redness, dryness, or flaking. It’s generally safe to continue gentle chemical exfoliation, but I would recommend:

Limiting physical scrubs to 1–2 times per week.

Observing your skin closely for irritation and reducing frequency if you notice redness or excessive dryness.

Considering more gentle alternatives like lactic acid or urea-based creams for KP, which are less irritating while on isotretinoin.

Regarding alcohol consumption: occasional drinking is usually fine for most people on low-dose isotretinoin, as long as your liver function is normal and your labs are being monitored as recommended. Avoid heavy or frequent drinking, since isotretinoin can affect liver enzymes, and alcohol can compound that effect.

In short: proceed with caution with scrubs, favor gentler alternatives when possible, and keep alcohol moderate. Monitoring your skin and labs will help ensure safety and minimize side effects while on isotretinoin.

Raffy Karamanoukian, MD, FACS · Answer

Accutane is a go-to medication for patients with recalcitrant cystic acne. It can reduce pore size and also reduce sebum production in your skin, making it less oily; and in turn, dryer. Accutane can be used to control acne, but patients receiving the medication should be carefully monitored. In terms of skincare, always wear an appropriate sunscreen and reduce direct sun exposure. In my patients, I recommend a good ceramide moisturizer such as Elevase whenever they are on Accutane. This will keep the skin hydrated and reduce the oiliness of the skin that is associated with oil-based moisturizers.

Best,
Dr. Karamanoukian
Realself100 Surgeon

Best, 
Dr. Karamanoukian 
Realself100 Surgeon

20 mg Accutane and exfoliation

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