Why is Accutane not working 4.5 months into treatment?

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

You can safely take up to 2 mg per kilogram or 140 mg per day. I would ask doctor to increase dose to 120 mg per day and stay on until totally clear for one month. 

Thank you for your question. Depending on the severity of your acne, it make take a higher dose and longer course (or sometimes multiple courses) of isotretinoin to completely stop breakouts. In some patients, I have them take doses of up to 120 mg daily if the side effects are tolerated. It may be that you need a higher dosage.Isotretinoin is an amazing medication for treatment of severe, recalcitrant nodulocystic acne that works when most other medications do not. Don't lose hope, but keep in mind it may take a higher dose and longer course of the medication to get clear skin.I hope this answer is helpful! Best of luck.