Can I use Accutane for mild acne/closed comedones?

Question

I have been on tretinoin 0.025% and clindamycin for the last few months and I have not really seen improvement. Will accutane cause me to get cystic acne?

Raffy Karamanoukian, MD, FACS · Answer

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

Best, 
Dr. Karamanoukian
Realself100 Surgeon

Heather M. Richmond, MD, FAAD · Answer

I often will treat patients with accutane who are nonresponsive to standard topical therapies.  It would likely be highly effective for your acne with lasting results.  There are other options as well, such as stronger topicals, hormonal therapies, chemical peels, facials, etc.  The benefit of accutane is the likelihood of durable long term results.  It can cause an initial flare and possibility of temporary cystic acne.  However, the majority of patients with milder acne do not have a severe flare, many patients do not flare at all.  If a severe cystic flare does occur, oral steroids can be used for a short period to calm it down and it usually subsides by the second month of treatment.  Accutane does have some potential risks and side effects and requires blood work monitoring, but the majority of my patients are very happy with their results and do well throughout the treatment period.  It is often a great option.  Good luck with your treatment plan!

Can I use Accutane for mild acne/closed comedones?

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