How to deal with persistent acne? What to do when Accutane fails?

Accutane (Isotretinoin) is the right choice for you.  Rarely, some patients require repeated courses of treatment throughout life, but each course nudges you closer to a chance for "cure".  Your acne should completely clear with an appropriate course of Accutane, normally about 330mg/lb of body weight over about 5-6months, though sometimes 7-8months may need to be used (with a rough goal of about 2.2mg/lb of body weight/day).  I also like to make sure you have been completely clear for about 1-2 months before stopping Accutane.  With these guideline, you should get a great result.  I would not have any concern about affect on bones with these treatment regimens-- especially since you have been off treatment for 7 years.All other options are suppressive, such as birth control pills and spironolactone, which inhibit the hormones associated with acne.Be sure to consult with a Board Certified Dermatologist for best results.

If you "failed" Accutane it is because you didn't take enough. This is what I find again and again. People will take the meds until the skin looks good and not continue after. If you do this, you never actually get a full course of the medication, and the acne will return. An Accutane course is between 8000-16000mg total. If you didn't get into this range, you didn't take enough. And if you did get into the range but only on the lower end, then you just might have needed more. Seek a doctor with a good amount of Accutane experience. This is key. "This answer has been solicited without seeing this patient and
cannot be held as true medical advice, but only opinion. Seek in-person
treatment with a trained medical professional for appropriate care."