I took Accutane 20mg/6months and then again a couple yrs later. My cystic acne is back all over my neck. Why after 2 treatments?

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

Thanks for your question,  You are definitely not out of options.   Some patients take several courses of accutane over the years and just seem to have recurrent and resistant acne.  I think your dose was quite low, so we would generally recommend starting at 40mg daily and then seeing if you tolerate it well and gradually build up to a more effective standard dose.  That being said, some of my tiniest young patients can tolerate and need a high dose (80 to 120mg daily for 6 months), and some of my biggest, heaviest patients can't handle the dryness even on 40mg daily, so we go slower and sometimes take the medication for a longer period of time.  Each patient is different, so talk to your derrmatologist about spironolactone to help with the hormonal component of your acne for the month you will have to wait before re-starting your accutane.  Your dermatologist will be able to help you, and as long as you follow the Ipledge rules, it is fine to take another more robust course of the medication.  Good luck!

Accutane is a weight based drug and requires a certain mg/kg cumulative dosing. I like patients to get to over 200mg/kg  total over a period of 6 months typically. That usually requires anywhere from 60mg a day to over a 100mg a day depending on your weight. Sounds like you were on a light dose in the past. I have found that if I don't get to a high cumulative dose the likelihood of recurrence is higher. You can still take it again just make sure your dermatologist gets you to at least 200mg/kg cumulative dose. 

To be effective Accutane requires a cumulative dose of between 8000-16000mg total dose. If you took 20mg daily for 6 months you merely took 3600mg total. That is far, far below even the minimum dosing required, and for cystic acne, you'd be more likely to be up into the 10000mg dose range. So, basically, you need to be on the meds longer or a higher daily dose to get the right cumulative total. "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."

Hello and thank you for your question. There is a target minimum cumulative dose that you would want to reach before stopping Accutane, and that dose depends on your weight. There still is a chance that Accutane will not completely clear your acne as there is no cure. I would recommend a consultation by a board certified dermatologist for evaluation of your skin and discussion of appropriate treatment. Best of luck.