Acne vulgaris is an inflammatory condition affecting the hair follicles and sebaceous glands. The pathogenesis of acne vulgaris is multifactorial. The four main factors identified are excessive sebum production, hyperkeratosis of the epidermis of the hair follicles, the pro-inflammatory effect of Cutibacterium acnes, and inflammation. Isotretinoin, also known as 13-cis retinoic acid, has been approved for use in Europe since 1983. It functions by decreasing the size of sebaceous glands, lowering sebum production, controlling cell growth, and reducing keratinization. Oral isotretinoin is a potent systemic therapy for addressing severe, hormonal, and refractory acne. The typical usage of isotretinoin is associated with numerous challenges and limitations. The list of side effects is long, but its effectiveness primarily relies on the dosage and length of treatment. Key concerns involve teratogenic effects, while the most common ones are dry skin and mucous membranes. Possible adverse effects may encompass heightened risks of depression, liver impairment, elevated triglyceride levels, and musculoskeletal discomfort. Most side effects disappear after completion of therapy, and increasing patient awareness can prevent or minimize their occurrence. Systematic monitoring of liver enzyme levels, lipid profile, and blood morphology is important in preventing the development of side effects.