As a clinical professor of dermatology at Mount Sinai School Of Medicine In NY who has been in practice for several decades, I am thoroughly familiar with Accutane, which is by no means a new drug., and the treatment of acne. Accutane has been around since the very early 1980s when I first started prescribing it. However, only a few years later, after I began doing so, I stopped prescribing it altogether after it became associated with many side effects, some serious, and some that were later reported to first appear even five, ten or twenty years later. I myself published a medical journal paper on a permanent bone problem related to its use. Over the decades, I have literally treated all kinds of acne from mild to very severe and have not needed Accutane. Numerous patients have come to me during that time supposedly having seen by primary physicians, pediatricians and even dermatologists who have supposedly failed on "everything." However, upon closer investigation, it often turns out that failure was not related to what was prescribed, although that was sometimes responsible, but far more often than not, failure was due to 1) improper use of the at-home medications prescribed often because clear instructions for use were not given, 2) erroneous expectations that the medications--be they topical or oral (seldom needed)--will start to miraculously work in just a few days or a couple of weeks (typically takes just about any acne medication, including Accutane, about 8-16 weeks to really kick in), or 3) side effects, such as dryness, irritation, etc. from improper use of the topical medications. So, best, and safest approach to treating acne, even severe acne, requires the combination of a diligent and proper at-home use of topical medications to prevent new breakouts (usually a minimum of 8-16 weeks for prevention to begin), combined, in the interim, with in-office treatments to clean out fully formed comedones, inject acne acne cysts and nodules before they eventuate in scars and the application superficial peels to unclog incipient comedones. And this combined effort by the patient at-home and the doctor in the office has been just about uniformly successful for even severe cases of acne without the need for systemic medications--like oral antibiotics, hormones, and Accutane, that essentially make the whole body pay for the sins of only the face. I hope this helps. Best of luck.
