Start 4th course Accutane at 23?

Do not despair.  I have two comments about this:1) It is not uncommon to need more than 1 course of Accutane.  A number of factors contribute to the daily dosage, duration of treatment, and decision when to end the course.  Your weight is one of those factors, but not the only one.  When we start Accutane we determine a desired TOTAL dose, usually a range.  Looking at your weight alone, without knowing more about you, it appears that your courses may have been too short, i.e. prematurely stopped.  For example, the total doses you had were:first course: 10,500 mg (70mg daily x 30 days x 5 months)second course: 9,600 mgthird course: 10,800 mgHowever the desired TOTAL dose, based on your weight, may be higher (12,000+).  It is important to reach the desired TOTAL because the medicine has a cumulative effect in shutting down the glands that worsen acne.  Stopping too early may put you at risk for relapse and needing another course.2) Your description of the acne reminds me of a hormonal pattern.  It may be a good idea for you to have an evaluation for hyperandrogenism (too much male hormone, or too much sensitivity to male hormone in your skin), which could explain acne resistant to Accutane.  History of irregular periods, excess hair, etc., are other signs of hyperandrogenism.  A blood test can detect this easily.Best-

The normal Accutane cumulative dose range is between 8000-16000mg total. With all the doses you've taken, you've fallen into the lower to mid range. My assumption would be that you need to be on the meds longer (or a higher daily dose if tolerable) for a higher cumulative total. Weight is not the only thing to consider when dosing and some people simply need to be on the much higher total cumulative mg dosing scale. "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."