"My Liver Tests Went Up While Taking Accutane—Do I Need to Stop Treatment?"

Jun 24

Starting isotretinoin (commonly known by the brand name Accutane) can feel life-changing for patients struggling with persistent acne. But what happens when routine blood work comes back showing elevated liver enzymes? Many patients immediately worry that they have to stop the medication.

Fortunately, that's not always the case.

Recently, an 18-year-old male returned to our dermatology clinic in Houston and Katy, Texas for his fourth month of isotretinoin therapy. His acne had significantly improved, he wasn't experiencing new breakouts, and he was tolerating treatment well. However, one finding during routine monitoring raised an important question—his liver enzymes were elevated.

Here's why that didn't necessarily mean his Accutane treatment had to end.

Why Does Accutane Require Monthly Blood Tests?

Isotretinoin is considered one of the most effective medications available for severe acne, but because it is a powerful medication, dermatologists closely monitor patients throughout treatment.

Routine laboratory monitoring typically includes:

Liver function tests
Triglyceride levels
Occasionally additional testing when clinically indicated

These labs allow your dermatologist to ensure your body is tolerating treatment safely while maximizing the benefits of therapy.

The Patient's Progress After Four Months

This young man had been taking:

Isotretinoin 40 mg once daily
Taken with fatty foods to maximize absorption

The encouraging news was that:

He reported no new acne breakouts over the past month.
Dry skin remained mild and manageable.
He denied significant medication side effects.
His acne continued improving steadily.

This is exactly the type of progress dermatologists hope to see midway through isotretinoin treatment.

Elevated Liver Enzymes Don't Always Mean Liver Damage

One of the biggest misconceptions surrounding Accutane is that any elevation in liver enzymes automatically requires stopping the medication.

In reality, dermatologists evaluate the entire clinical picture, not just one laboratory number.

In this patient's case:

Initial liver enzymes were mildly elevated.
Repeat testing showed improvement.
Gamma-glutamyl transferase (GGT), another marker of liver health, remained normal.
Creatine phosphokinase (CPK) was only slightly elevated.

After discussing the results, the patient mentioned something important:

He had recently been exercising much more frequently.

Exercise Can Affect Blood Test Results

Many patients are surprised to learn that strenuous exercise can temporarily elevate certain laboratory values, especially:

Heavy weightlifting, intense workouts, and endurance exercise can all cause mild elevations that are unrelated to liver injury.

When dermatologists interpret laboratory testing, they consider:

Recent exercise
Overall symptoms
Trends over time
Additional laboratory markers
Physical examination findings

Since this patient felt well, his repeat labs improved, and the remaining laboratory findings were reassuring, no additional testing was necessary.

Instead, he was encouraged to:

Stay well hydrated
Continue monitoring routinely
Maintain his prescribed treatment

Staying the Course with Accutane

Because his acne continued improving and laboratory values were reassuring overall, treatment continued with:

Isotretinoin 40 mg daily

The goal of isotretinoin therapy is to reach an effective cumulative dose, which significantly reduces the likelihood that severe acne will return after treatment is completed.

For most patients, consistency is key.

Stopping treatment too early may increase the chance of relapse.

Important Safety Reminders During Isotretinoin Therapy

Every month, patients receive counseling regarding safe use of isotretinoin.

Key reminders include:

Never donate blood during treatment.
Never share your medication.
Take your medication with food containing fat.
Attend monthly follow-up appointments.
Complete recommended laboratory monitoring.
Report severe headaches, vision changes, abdominal pain, mood changes, or other concerning symptoms immediately.
Avoid elective cosmetic procedures until your dermatologist advises they are safe.

These precautions help ensure treatment remains both safe and effective.

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Skin Care While Taking Accutane

As acne begins clearing, maintaining healthy skin becomes equally important.

Patients benefit from:

Gentle, non-comedogenic cleansers
Oil-free moisturizers
Lip balm throughout the day
Broad-spectrum SPF 30 or higher sunscreen
Avoiding harsh scrubs and drying acne products unless directed

Proper skincare can greatly reduce the dryness commonly experienced during isotretinoin treatment.

Why Monthly Follow-Ups Matter

Even when patients are doing well, monthly visits allow dermatologists to:

Evaluate acne improvement
Adjust dosing if needed
Monitor side effects
Review laboratory results
Ensure cumulative dosing goals are achieved
Answer new questions throughout treatment

Close follow-up helps maximize long-term success while minimizing unnecessary risks.

The Bottom Line

Elevated liver enzymes during isotretinoin treatment can certainly sound alarming, but they do not automatically mean treatment must stop.

This patient's improving laboratory values, normal GGT, mild exercise-related CPK elevation, and excellent acne response allowed him to safely continue therapy under careful dermatologic supervision.

Every patient is different, which is why routine monitoring by an experienced board-certified dermatologist is so important throughout Accutane treatment.

If you're considering Accutane in Houston or Katy, Texas, or you're already taking isotretinoin and have questions about your laboratory results, working with an experienced dermatologist ensures your treatment remains both safe and effective from start to finish.

Honey Cisneros