Breakouts one year after Accutane — do I need a second course?

It is not uncommon to have some return of breakouts after Accutane.  The good news is they nearly always resond to treatment even if your skin did not respond to the same treatments prior to Accutane. You need to see your dermatologist again.  If a second course is needed, they can prescribe it, but it is often not necessary. 

Without seeing an updated photo it is difficult to answer your question as to whether you should be treated with accutane at this time. Please submit a photo and I will try to help answer your question. Also, i ould like to know your approximate weight and how much accutane you took and for how many weeks? Perhaps you did not take enough of a dose of accutane.

With your Accutane course, you frankly may not have been on it long enough especially if you described your acne as "severe for years". The purpose of a course of Accutane is to get the proper mg of the medication into your system to combat the type and severity of your acne, taking into account your weight. If you don't get enough of the medication, acne can and will come back, though usually a lot less. If it's not as bad as before, often another course isn't needed, but another type of medication, oral or topical, can be used just for random breakouts. If the breakouts continue or worsen, a second round of Accutane may be needed. It's best to schedule an appointment with your dermatologist and go from there.