Accutane for Pimples and Blackheads?

Accutane is a go-to medication for patients with recalcitrant cystic acne. It can reduce pore size and also reduce sebum production in your skin, making it less oily; and in turn, dryer. Accutane can be used to control acne, but patients receiving the medication should be carefully monitored. In terms of skincare, always wear an appropriate sunscreen and reduce direct sun exposure. In my patients, I recommend a good ceramide moisturizer such as Elevase whenever they are on Accutane. This will keep the skin hydrated and reduce the oiliness of the skin that is associated with oil-based moisturizers.

Best,
Dr. Karamanoukian
Realself100 Surgeon

Real Self is a great site for information, but I am hesitant to second guess a dermatologist who knows your full history. Accutane for blackheads is kind of like a hand grenade for a fly in the room, but it will help all forms of acne. It is usually not recommended for milder acne because the possible side effects outweigh the possible benefits to milder acne. You are, however, post-menopausal, so pregnency is not an issue and that is the big contraindication for Accutane. Your doctor likely factored in your 45 year history of frustration and is trying to give you results. In older patients, in addition to watching liver enzymes and lipids, I also recommend a bone density study and do not recommend Accutane for patients with osteoporosis or osteopenia.

Accutane will help with inflamed (red) pimples, nodules, cysts, even pustules.  The one form of acne that Accutane is not very good for is comedones (whiteheads and blackheads).  This form of acne is best managed with acne surgery (manual extraction by your physician or an esthetician).
Good luck.

Accutane is like an athlete or team who only performs best when faced with a tough challenge. When matched with brutal cystic acne, nodules and large pustules, Accutane does a great job. With smaller lesions, such as papules and small pustules, it also performs well. However, Accutane is a paper tiger against blackheads; mild improvement but not even as well as topical Retin A.
As usual I agree with Dr. Chen that manual extractions such as found in a deep pore cleansing would be very therapeutic. I would add salicylic acid peels to the regimen.
If your dermatologist felt that the "pimples" needed to be treated, then Accutane certainly was appropriate. This might be especially true in that pregnancy does not seem to be an issue.