Is it normal for my initial breakout to be this bad on my 4th week on Accutane? (photos)

Question

I stared accutane for my second course (it's been 2 years) almost 4 weeks ago. I'm currently on 60 mg as of yesterday and my initial breakout is just god awful. Way worse than when I started taking it. Is this normal? When will it get better? I'm struggling so hard everyday.

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

Annie Chiu, MD · Answer

A significant breakout when you initially start Accutane can occur and is not unusual.  Sometimes I will start patients on a lower dose of Accutane or along with a very low dose of oral prednisone to prevent a major flare in the first weeks.  You should feel comfortable calling and discussing with your provider what would be the best steps at this point.

Reuel Aspacio, MD, FAAD - Account Suspended · Answer

Thank you for your question. I'm sorry to hear about your struggles with breaking out while on Accutane. It is not uncommon to have flares and severe breakouts may persist for several weeks. Often times, acne gets worse before it gets better. Please be patient with the therapy and your skin. I highly recommend you speak with your dermatologist regarding your concerns and alterations to your treatment may be needed.

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