Isolime 20 Softgel Capsule contains isotretinoin 20 mg, a potent retinoid primarily indicated for the treatment of severe recalcitrant nodular acne that is unresponsive to conventional therapies such as systemic antibiotics and topical treatments. Isotretinoin acts by reducing sebaceous gland size and sebum production, inhibiting comedogenesis, and exerting anti-inflammatory effects, thereby addressing multiple pathogenic factors of acne. The softgel formulation facilitates optimal bioavailability and ease of administration. Isolime 20 is prescribed under strict medical supervision due to its significant teratogenic potential and risk of serious adverse effects, including hepatotoxicity, hyperlipidemia, and mood alterations. Baseline and periodic monitoring of liver function tests, lipid profile, and pregnancy status in females of childbearing potential is mandatory throughout the treatment course. Patients are advised to adhere to contraceptive measures before, during, and after therapy to prevent fetal exposure. Common side effects include cheilitis, dry skin, and mucous membrane dryness. Dose adjustments may be necessary based on clinical response and tolerability. Isolime 20 should be used cautiously in patients with pre-existing hepatic or lipid disorders and is contraindicated in pregnancy and hypersensitivity to isotretinoin or any excipients. This medication should be dispensed with comprehensive patient counseling regarding its risks and benefits.