Bad breakout starting month 4 of Accutane...normal?

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

Patients should take the isotretinoin with a fatty meal which helps absorption.  Some patients do not get better as quickly because they are dieting and avoiding fat in the diet which helps absorption.  If the medicine isn't absorbed it won't work properly.  Some patients have gluten sensitivity and eating gluten worsens acne. Hormones can play a role too.  If you have polycystic ovaries, abnormal testosterone, or congenital adrenal hyperplasia you might not improve on isotretinoin until the hormone concerns are addressed.  Lastly, patients taking lithium and some acne promoting medications may fail to respond to isotretinoin.  If you feel you are not improving, talk to your doctor who is treating your acne with isotretinoin about your concerns.