Second Attempt, Hope for the Best -Hanoi, Viet Nam

I have been on Accutane on 4 occasions where it was very high dose for eight month cycles: 40mg one day and 80mg the next. I had nodulocystic acne that like yours never seemed to come to a head but remained hard nodules. For me, the initial higher dose was most effective and once I achieved completely clear skin, my MD adjusted the dosage downward. I have recalcitrant, hormonal acne that doesn't respond to anything but Accutane and so now I am on maintenance therapy. There is often a significant purge when beginning treatment wherein your skin gets worse before it gets better. You may ask your MD if you could also have short course of steroids and/or topical dapsone (Aczone) to help reduce the swelling. I get nosebleeds sometime (use a little petroleum jelly on inside of nose), I only had joint pain on the really dosage (80mg), but I don't have it at 40mg and below. The mechanism(s) by which isotretinoin works are many, but the main are: 1) it reduces sebum production by inducing apoptosis (programmed cell-death) in sebaceous gland cells 2) it seems to have an antimicrobial effect on Propionibacterium acnes bacteria 3) it appears to arrest the hyperkeratinization that plugs the follicle allowing the p. acnes bacteria to thrive. I hope it is starting to work for you and you are seeing results.

Thanks for sharing your story with us, I understand how frustrating acne can be, especially cystic acne, it's extremely painful. From your description of your bumps it sounds like cystic forsure, do not touch them, drink lots of water, lots of healthy food, and let the Accutane do it's work. Do you know when your increase in dosage will be?