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A second course of Accutane(isotretinoin) is a very good option if you are developing cystic acne again. Your dermatologist will probably put you on an oral anti-acne pill (ie minocycline) prior to starting your second course. This is a good option for at least two months prior to starting Accutane.
If the first course of Accutane was beneficial, then a second course may be an excellent option. As my rule of thumb, roughly 50% of those treated with Accutane, no matter how good the response, may eventually have a recurrence severe enough to merit another course of treatment. And after a second course of treatment, roughly 50% of these people may flare to the point of needing a third course, etc. etc. Compared to any other therapy for this chronic persistent condition, this is still a phenomenally successful treatment.
Occasionally repeat courses of Accutane (isotretinoin) are necessary for acne. Consider trying other acne therapies again before starting a second course. If you do decide on a second course, be sure to start on maintenance therapy immediately after to try to decrease chances of significant acne occurring again.