Lip balm on Accutane (isotretinoin): what to use and how often

A thick, plain ointment, put on before the lips crack, six or more times a day and at bedtime. What the leaflet says, what a trial found, and what to avoid.

Use a thick, plain ointment, such as petroleum jelly or an unflavoured ointment balm. Start on the first day, before your lips crack. Put it on many times a day and again at bedtime. Dry, chapped and inflamed lips are listed as a very common effect of isotretinoin, the drug sold as Accutane and Roaccutane. The patient leaflet tells you to use a lip balm during treatment. The full prescribing text says to start "from the start of treatment". In one clinical study, people using an ointment balm and nothing else still got worse in the first two months. By month two they needed it about seven times a day. So expect to apply often, and do not wait for your lips to split.

• Cheilitis: very common (1 in 10 or more)
• Reported in 78% of 1,743 patients
• Ointment users, month 2: about 7 times a day
• Start: day one
• Corner splits: see someone at 2 weeks

What isotretinoin does to your lips

Isotretinoin is a drug for severe acne, taken by mouth as a capsule. It is a retinoid, which means it is related to vitamin A. Accutane is the brand name most people search for. In the UK and Ireland the brand is Roaccutane. Whatever the name on the box, the drug inside is isotretinoin, and this page is about what it does to the lips.

The lip problem has a medical name: cheilitis. It just means inflamed lips. On isotretinoin it looks like dry, tight lips at first. Then come redness, flaking, crusts, and small splits called fissures. The corners of the mouth can split as well.

A 2023 paper by Turan and Öner, two Turkish dermatologists, gives the cause in one line. They put it down to less sebum, a thinner stratum corneum, and changes in the skin barrier. Sebum is the oil your skin makes. The stratum corneum is the thin outer layer of dead cells that holds water in. Lips have little oil of their own to begin with, so the loss hits them hard.

Lips start with a weak barrier even before any drug. Our lip balm vs lip oil comparison sets out a study that found lips lose water almost three times as fast as cheek skin, and hold about a third as much water at the surface. Thin that surface further and it splits easily.

Two more words matter for what follows. An occlusive is anything that forms a film over the skin and slows water leaving it. An ointment is a greasy, water-free product, thick enough to sit on the skin as a layer. Petroleum jelly is the plainest example. How occlusives differ from emollients and humectants is set out in occlusive, emollient and humectant.

What the leaflet and the prescribing text say

The patient leaflet for Roaccutane 20 mg, published by Ireland's medicines regulator, the HPRA, is plain about it. In the section on what to know before taking it, the leaflet says: "Your skin is likely to get dry. Use a skin moisturising ointment or cream and a lip balm during treatment." In the next line it says: "To prevent skin irritation you should avoid using exfoliating or anti-acne products."

It also says, a few lines later, that "it is fine to use moisturisers and emollients". It defines those as "skin creams or preparations that prevent water loss and have a softening effect on the skin". That is a description of a plain lip balm.

Under side effects, the leaflet puts lips in the top group, "very common", which it defines as "may affect more than 1 in 10 people". The entry reads: "Dryness of the skin, especially of the lips and face; inflamed skin, chapped and inflamed lips, rash, mild itching and slight peeling. Use a moisturising cream from the start of treatment."

The Summary of Product Characteristics, or SmPC, is the full prescribing text written for doctors. The UK SmPC for Roaccutane 20 mg, revised in April 2026, says the same thing more firmly. Section 4.4 reads: "Patients should be advised to use a skin moisturising ointment or cream and a lip balm from the start of treatment as isotretinoin is likely to cause dryness of the skin and lips."

Section 4.8 of the SmPC lists the side effects. It names "dryness of the mucosae e.g. of the lips (cheilitis)" among "the most commonly reported" effects. In its table, cheilitis sits in the very common band, 1 in 10 or more. The SmPC gives no percentage for it. For a number, you have to go to studies.

How common dry lips are, in numbers

The largest single count we found comes from New Zealand. Marius Rademaker, a dermatologist, went back through the charts of 1,743 people he had started on isotretinoin over six years. His review was published in 2010.

Cheilitis was the most common side effect. It affected 78 percent of users. Nothing else came close: eczema and tiredness were next, at 12 percent each.

It also rose with the dose. In people on less than 0.25 mg for each kilogram of body weight a day, 47 percent reported cheilitis. In those on more than 0.75 mg, 96 percent did. DermNet, a dermatology reference from New Zealand, puts it more bluntly: on 1 mg per kilogram a day, dry lips and cheilitis affect "100% of patients". Your dose is your prescriber's decision, and this page does not touch it. The point here is simpler. Almost everyone gets this, and more so on a higher dose.

It is also the side effect most likely to end treatment early. In Rademaker's review, 24 people (1.4 percent) stopped because of side effects, and cheilitis was a reason for 22 of them.

What a balm can and cannot do: the ointment study

The clearest look at a balm on its own comes from the 2023 study by Turan and Öner. It was a small pilot study, looking back at patients treated at Turkish dermatology clinics in early 2021. Everyone was over 18 and taking about 0.5 mg per kilogram a day.

The study tested an injection, but its control group is what matters here. Those 26 people used only one product on their lips. It was an ointment made with witch hazel distillate, sold as Hametan 25% ointment. Nobody used anything else on their lips. People who habitually licked or bit their lips were left out of the study, and so were people with atopy, a tendency to eczema and allergies.

The researchers scored the lips on the Isotretinoin Cheilitis Grading Scale. It runs from 0 to 12. It adds up four scores of 0 to 3: redness, scaling and crusting, the number of fissures, and how much the corners of the mouth are involved.

Here is what happened to the ointment-only group:

The rise in the score was statistically significant at both months. So even with a balm, used about six or seven times a day, the lips got worse over the first two months. That is the honest picture. A balm does not prevent isotretinoin cheilitis. It keeps it milder and more bearable.

The other group also had injections of dexpanthenol into the lips, a clinic procedure. They still needed the balm 4.7 times a day in month one. The authors say every patient should get topical lip care, because the need for lip balm rose sharply in both groups.

A worked case: the first two months

Take someone starting a course on a dose like the one in that study. Suppose their lips are normal on day one, and they own one lip product: a flavoured wax stick. Nobody has tested this exact case. What follows is the published figures, walked through one person's first eight weeks.

1. Day one. The leaflet and SmPC say start now. Our person buys a tub of petroleum jelly or a plain ointment balm, and the stick stays in the drawer. They put a thin layer on in the morning and a heavier one at night.
2. Weeks one to four. In the study, the average score went from 0.6 to 2.8 by the end of month one. That is a step from nearly clear to a mix of redness, flaking and perhaps a fissure. Applications rose from under once a day to six. So our person sets a routine: on waking, after each meal, mid-afternoon, early evening, and at bedtime. That is six. They add more whenever the lips feel tight.
3. Weeks five to eight. The study's average rose to 3.4, and use to about seven a day. That is the expected path, not a failed balm. Our person adds a seventh application.
4. A split appears at one corner. They keep the ointment off the inside of the fold and watch it. If it is still open at two weeks, or it crusts or weeps, they call the prescriber. The section on corners below explains why.

Walked through like that, the plan is clear. Start early, and expect to need more as the weeks pass.

What to use: thick and plain

The product that works is the one that seals best. On this site's own evidence, that is a semi-solid ointment, not a liquid oil and not a light stick.

The lip balm vs lip oil page sets out the studies. A 1988 test found that a cream's oil phase gave "little occlusivity" when it was liquid mineral oil, and much more when it was held as petrolatum. A trial on the lips found that a "highly occlusive" mix of plain oil and wax improved roughness without any special care ingredient. In a test of petrolatum films on the arm, a film just 0.1 mm thick cut water loss by 77.5 to 93.0 percent. So the seal is the working part, and petroleum jelly is the plainest way to get it.

DermNet's advice on isotretinoin side effects names the same product. It lists "emollients, lip balm, petroleum jelly" among things that "should be applied frequently and liberally when needed".

Good choices, in practice:

• Petroleum jelly. One ingredient, no scent, very cheap. It is white soft paraffin, explained in petrolatum and mineral oil. The worry that it is harmful on lips is covered in is petroleum jelly bad for you.
• A plain ointment lip balm in a tube or tin. Look for petrolatum, wax or both near the top of the list, and nothing that cools, tingles or smells.
• Lanolin ointment. It seals and softens well, as lanolin explains. A small number of people are allergic to it, so see lanolin allergy explained if your lips get worse on it.
• A plant-based ointment. A beeswax and plant butter balm is also an oily seal, as natural vs petroleum explains.

"Thick" means the texture, not the amount. One application is a rice-grain amount from a pot, or one or two light passes of a stick.

Why not the flavoured stick? Many sticks add flavour and scent. Flavour invites licking, and scent and flavour are among the common irritants on lips, as ingredients for chapped lips sets out. A stick that is plain and unflavoured is fine. The problem is what gets added, not the tube.

How often, and when

Neither the leaflet nor the SmPC gives a number. DermNet says "frequently and liberally". The only real figure we found is from the ointment study: about six times a day in month one, and about seven in month two. Use that as a starting point, not a limit.

Apply on a schedule, not when the lips feel tight. How much balm to apply makes the same case for anyone with dry lips. On isotretinoin, a schedule might look like this:

1. On waking. The night's layer has worn thin.
2. After every meal and drink. Eating and wiping your mouth take the film off.
3. Mid-morning and mid-afternoon. These fill the long gaps.
4. Before going outside. Cold, wind and sun all dry lips further. In the sun, use a lip product with SPF over or instead of the ointment, as covered below.
5. At bedtime, a heavier layer. Sleep is the longest stretch with no reapplication. A thicker coat of ointment carries you through it. An overnight lip mask is the same idea.

That makes six to eight applications a day. Add more whenever your lips feel tight. Frequent use is not a problem in itself. The idea that lip balm makes lips "addicted" has no published evidence behind it, as does lip balm dry your lips explains.

Start on day one. Both regulatory texts say so, and the study shows why: the lips were close to normal at the start and clearly worse a month later. The seal needs to be there before that slide begins.

What to avoid

Lips on isotretinoin have a weakened barrier, so they irritate easily. Keep these off them.

Menthol, camphor and phenol. These give a cooling or tingling feel. On inflamed lips that feel is not healing anything. Menthol acts on a cold sensor in the skin and is an irritant at higher levels. Phenol is an irritant on broken lips. Both points are set out in ingredients for chapped lips, and the limits are in menthol and camphor safety limits. Check the ingredient list on any medicated lip product before you use it.

Salicylic acid and other exfoliants. Salicylic acid loosens the bonds between surface cells. It is also a common acne ingredient. The leaflet is direct here: "avoid using exfoliating or anti-acne products". That covers lip scrubs and peeling lip products as well. Do not pick or peel the flakes either. Soften them with ointment and let them come away by themselves.

Fragrance and flavour. Both are common causes of irritation and allergy on lips. Flavour adds a second problem: it invites licking. See flavour and sweeteners and fragrance allergens. On the label, "parfum", "aroma" and "flavor" are the words to look for, as reading a balm label explains.

Retinoid lip products. Do not add a retinol lip treatment on top of an oral retinoid. Retinoids cause dry, scaly lips even on their own, as retinol and bakuchiol explains. The leaflet also rules out vitamin A supplements during treatment.

Lip licking. It brings brief relief, then the saliva dries and the lip ends up drier. Saliva also carries digestive enzymes that are hard on thin skin. Licking was serious enough that the ointment study excluded people with the habit. The full loop is set out in does lip balm dry your lips. Keep water to hand and sip instead.

Waxing near the lips. The leaflet says no waxing during treatment, or for at least 6 months after, because it could cause scarring or skin irritation. That includes the upper lip. DermNet says to shave rather than wax.

Sun on your lips

The leaflet warns that your skin "may become more sensitive to sunlight". It says to use a sun protection product of SPF 15 or higher before going out, and to avoid too much sun and sunbeds. DermNet lists sunburn among the common skin effects.

Plain petroleum jelly is not a sunscreen. For time outdoors, add a lip product with SPF, chosen with lip balm with SPF. Pick one with few other ingredients, and put the ointment back on indoors.

When cracked corners are angular cheilitis

Splits at the corners of the mouth are common on isotretinoin. The grading scale used in the study scores the corners as one of its four parts. Even in the group that had the injections, 3 of 28 people got mild angular cheilitis.

Angular cheilitis is inflammation in the corners where the lips meet. It is often more than dryness. Saliva pools in the fold and softens the skin. Then yeast (Candida albicans) or bacteria (Staphylococcus aureus) can grow in the damaged skin. Cracked corners of the mouth covers it in full.

The signs that it is angular cheilitis and not plain chapping:

• the split stays in the same place at the corner, and opens each time you yawn or eat;
• the fold is red, moist, or has a white film or a crust;
• it does not improve on the same ointment that is helping the rest of your lips.

Plain chapping at the corners usually improves in three to five days of protection. Angular cheilitis usually does not. Do not pack ointment deep into the fold: a thick plug holds saliva against the skin. Use a thin film instead.

Infection matters more on isotretinoin. DermNet lists skin infections, including impetigo, among the drug's common side effects. Impetigo is a bacterial skin infection. DermNet notes that antibiotic creams or tablets may be prescribed for it, and only a prescriber can give those. So a corner that crusts, weeps or spreads, or is still split after two weeks, needs a call to your prescriber, a GP or a pharmacist. Do not try a stronger balm instead.

When to call your prescriber

Most lip dryness can be managed at home. Your prescriber can treat cheilitis that balm alone is not controlling. DermNet notes that when side effects are troublesome the drug may need to be paused or the dose lowered. That is your prescriber's decision. Never change or stop your dose yourself because of your lips.

Call your prescriber or dermatology team if:

• your lips bleed, or the splits get deeper, even with ointment six or more times a day;
• a corner split lasts two weeks, or keeps coming back;
• there is crusting, pus, or spreading redness or soreness that looks like infection;
• a rash, sore or itch spreads beyond the lips. DermNet notes that dermatitis on isotretinoin can be treated with steroid creams, which need a prescription;
• your lips get worse on a new balm. That may be an allergy to the product, and how to patch test a balm explains how to find out.

Quick reference

What this answer does not cover

The advice above is about lip care. It does not make isotretinoin safe in any other way, and it does not replace your prescriber's follow-up. The drug has serious risks, including harm to an unborn baby and effects on mood, that no lip product touches.

The frequency figures come from one small study. It looked back at 26 adults on about 0.5 mg per kilogram a day, followed for two months, using one witch hazel ointment. It left out people with eczema-prone skin and people who lick their lips. If you are on a higher dose, or further into your course, or have atopic skin, your lips may need more. No study we found tested petroleum jelly against other balms in people on isotretinoin. The case for a thick ointment comes from occlusion studies on ordinary skin and lips.

This page does not cover the rest of your skin, dry eyes, a dry nose or clinic treatments for the lips. If your lips do not settle after treatment ends, ask a doctor rather than buying a new balm.

Reviewed and updated 4 November 2026. Spotted an error? Tell us and we will fix and log it.