Isotretinoin has revolutionized the field of dermatology, offering a cure for severe acne vulgaris and a therapeutic option for a variety of other chronic diseases and cancers. This drug has done more for many diseases in medicine than many drug classes have done for a single disorder, and yet, its use and availability have been threatened in the United States. Federal restrictions in the form of the IPLEDGE teratogenicity prevention plan have made the use of this drug more complex. Millions of dollars in litigation and claims of injury have fueled hysteria among laymen about the use of this drug. Overwhelmed with worries of its potential adverse effects, the public forgets that withholding isotretinoin therapy is not without its own risks. Isoteretinoin therapy can prevent lifelong and permanent physical and psychological scarring that comes as a matter of course with severe acne. Over 20 million people worldwide have taken the drug, with several studies demonstrating its safety and few long term adverse effects. This wonder drug's continued availability depends upon its responsible and informed use. This paper will review and put in perspective the issues important to consider in the proper use of isotretinoin.