Does Everyone Experience an Initial Breakout when on Accutane?

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

One of the problems of the internet is that everybody is an "expert."  And you might feel that what they went through will be exactly what you will experience.The truth is that everybody's course on Accutane is slightly different.  Some people get more red and inflamed than others.Last year I had shoulder surgery which friends told me would be extremely painful.  I had NO pain and was out and about the next day and did not need one serious pain medication.The point is that your course will be yours.Be careful of what others tell you and what you read on the internet.

Accutane is a great medication for the right acne patient.  To prevent initial flares, I start patients on a low dose for 2 weeks, then increase to the full dose, which is dependent on the patient's weight.  It is very unusual for patients to flare with this regimen.  Topical medication, cortisone injections into cysts, oral antibiotics or oral cortisone may be required to control flares.  Make certain you see your dermatologist monthly for assessment and blood tests. 

When starting isotretinoin, some but not all patients flare.  It can depend on the severity of your acne, your starting dose of medication, and any other medications that you are on.  If the flare is severe, it is sometimes necessary to prescribe oral steroids or topcial treatments in addition to the isotretinoin.  I advise you to discuss your concerns with your physician to develop your best treatment plan. 

No, not everyone experiences as initial breakout; however, the majority of people who take Accutane have more severe acne, so yes, this does happen as the pores are changing. There's not a lot that can be done to avoid it, though some topicals do help. Consult your dermatologist about using topicals at the beginning of the course.