Isotretinoin and Athletic Performance: Is There an Effect?

Many athletes with severe acne are prescribed isotretinoin, and a common question follows: will it hurt training or performance? Our editorial team looked at what is known about the drug's effects on muscles, joints, recovery and lab results, and how athletes and their doctors typically manage a course.

Why athletes end up on isotretinoin

Isotretinoin (13-cis-retinoic acid), a vitamin A derivative, is the most effective treatment available for severe, nodular, or scarring acne. It shrinks sebaceous glands, dramatically cuts sebum output, normalizes skin-cell turnover inside follicles and indirectly reduces Cutibacterium acnes. For many patients a single course produces long-lasting remission.

Acne is common in teenagers and young adults — exactly the age group that fills high-school teams, college programs and gyms. Sweat, friction from equipment and helmets, and occlusive clothing can aggravate breakouts. In some athletes, acne is also linked to androgen exposure, including from anabolic steroid use, which is a separate medical problem in its own right.

In the United States isotretinoin is a prescription-only drug available only through the FDA-mandated iPLEDGE REMS program. Because the drug causes severe birth defects, patients who can become pregnant must use two forms of contraception and have regular pregnancy tests, and every prescription is tracked.

The drug is not on the World Anti-Doping Agency (WADA) Prohibited List, so competitive athletes are not barred from using it. The real question is not eligibility but how its side effects interact with training — which is what this article addresses.

Musculoskeletal effects: muscles, joints and bones

The most training-relevant side effects involve the musculoskeletal system. Muscle aches (myalgia) and joint pain (arthralgia) are among the most commonly reported complaints, and they tend to be more noticeable in physically active patients. Back pain is also reported, particularly in adolescents.

Isotretinoin is associated with elevations of creatine kinase (CK), the enzyme released when muscle fibers are damaged. Intense exercise raises CK on its own, and the combination can produce strikingly high values. Landau and colleagues described patients on isotretinoin with markedly elevated CK, most of them physically active, who generally remained asymptomatic. Rare cases of rhabdomyolysis have been reported, usually after strenuous exertion.

Bone effects are a long-discussed concern because high-dose vitamin A derivatives can affect bone remodeling. At standard acne doses and course lengths, studies have generally not shown clinically meaningful bone-density loss, but hyperostosis and premature epiphyseal closure have been described mainly with high doses or prolonged therapy.

The practical takeaway is diagnostic: an athlete on isotretinoin with a high CK reading may simply have trained hard. Dermatologists sometimes ask patients to avoid very strenuous sessions before scheduled blood draws so lab results are interpretable.

Other side effects that affect training

Beyond muscles and joints, isotretinoin has a broad side-effect profile, most of it predictable and dose-dependent. Several items on the list matter specifically for people who train regularly or compete outdoors.

Severe headache with visual changes can signal idiopathic intracranial hypertension, especially if isotretinoin is combined with tetracycline antibiotics — a combination that should be avoided. Athletes should report such symptoms immediately rather than assuming they come from dehydration or a hard session.

Mood changes, depression and suicidal thoughts appear in the official labeling. The causal link remains debated, but prescribers screen for these symptoms. Since sport often anchors an athlete's identity, coaches and families should know that unusual mood changes during treatment warrant prompt medical attention.

Waxing, dermabrasion and laser procedures are also discouraged during treatment and for months afterward because of scarring risk — relevant for physique competitors who use such services before shows.

Does it affect strength or endurance?

There are no rigorous controlled trials measuring maximal strength, VO2max or sport-specific performance in athletes during isotretinoin treatment. What exists is case reports, observational data on side effects, and clinical experience.

Based on that evidence, isotretinoin does not appear to have a direct ergolytic or ergogenic effect on muscle function. Performance problems, when they occur, are typically indirect: training is limited by sore muscles, stiff joints, fatigue, dry eyes or skin issues rather than by a reduction in muscle contractile capacity.

Some athletes report difficulty recovering between hard sessions, consistent with the CK and myalgia data. Others notice nothing at all. The effects are generally reversible after the course ends, which usually lasts several months.

• Tell the prescriber about your sport, training volume and competition schedule.
• Expect periodic blood tests and plan heavy sessions around them.
• Prioritize hydration, lip balm, eye drops and sun protection.
• Avoid adding vitamin A supplements, which can compound toxicity.
• Report severe muscle pain, dark urine, persistent headache or mood changes promptly.

Alcohol, which adds to triglyceride and liver stress, and new high-dose supplements are best discussed with the prescriber before starting.

Isotretinoin and steroid-related acne

Dermatologists increasingly see severe acne in young men who use anabolic-androgenic steroids, sometimes called "bodybuilding acne." Treating the skin while the underlying androgen exposure continues is often less effective, and both treatments carry overlapping risks for lipids and the liver.

Honest disclosure of steroid use to the prescribing physician is therefore important for safety, not only for treatment success. Physicians are bound by confidentiality, and knowing the full picture allows proper monitoring.

It is also worth stressing that isotretinoin itself should never be obtained without a prescription. Online sources outside the iPLEDGE system bypass pregnancy prevention and laboratory monitoring, and the product quality is unknown.

Editorial Team Conclusions

Isotretinoin is a highly effective acne medication that competitive athletes are allowed to use. It does not directly weaken muscles, but it can make training feel harder through myalgia, joint pain, fatigue and dryness.

Elevated CK is common in active patients and needs to be interpreted together with recent training. Rare but serious problems — rhabdomyolysis, intracranial hypertension, mood changes — require prompt medical attention.

With open communication between athlete and dermatologist, most people can keep training throughout the course with modest adjustments.

You may also find useful our articles on what creatine kinase levels mean after exercise, on interpreting liver enzymes in athletes, and on androgen-related acne.

References

1. Zaenglein AL, Pathy AL, Schlosser BJ, et al. Guidelines of care for the management of acne vulgaris. J Am Acad Dermatol. 2016;74(5):945–973.
2. Landau M, Mesterman R, Ophir J, et al. Clinical significance of markedly elevated serum creatine kinase levels in patients with acne on isotretinoin. Acta Derm Venereol. 2001;81(5):350–352.
3. Brelsford M, Beute TC. Preventing and managing the side effects of isotretinoin. Semin Cutan Med Surg. 2008;27(3):197–206.
4. Layton A. The use of isotretinoin in acne. Dermatoendocrinol. 2009;1(3):162–169.
5. Chroni E, Monastirli A, Tsambaos D. Neuromuscular adverse effects associated with systemic retinoid dermatotherapy: monitoring and treatment algorithm for clinicians. Drug Saf. 2010;33(1):25–34.