Mark Horowitz, DO

I usually recommend my patients stay away from things like peels while they are on Isotretinoin.  Your skin becomes much more sensitive and the reactions that you can have from peels can be unpredictable.  A better method to clear the comedones may be to increase the dose, then to add a second treatment.   

The dose of Accutane is often determined based on weight of the patient and the response to treatment.  However, when ever there seems to be confusion between the doctors orders and the pharmacy, the best thing to do is call the doctors office and ask.  Unfortunately mistakes can happen, so it is always better to be safe then sorry.  

Accutane can make your skin very sensitive to a variety of treatments.  I would not recommend having any laser treatment performed while on accutane.  5FU+steroids would be ok to use while on accuntane.

If you are a female i would be concerned that maybe your acne is  hormonally driven.  An adult female who has acne and  has failed Accutane would make me think that your primary issue is your hormones.  In this case, Accutane is not the best course of action, as you will most likely clear initially with another course of Accutane and then break out a few months later.  I would recommend having blood work to make sure there are no hormonal imbalances.  Even when hormone levels are with in normal range, a good medication for hormonal acne is Spironolactone.  This is a diuretic that is very good at blocking hormones called androgens  which can be responsible for adult acne.