Slow Responder to Isotretinoin? When Can We Expect Results?

Question

My son is 15 and 165 lbs with moderate acne. He took isotretinoin 40 mg first month, 80 mg second month, 100 third month. His 3rd month will be finished in 5 days. His face still looks worse than before he started taking the drug. He is quite frustrated. He had a very positive attitude and had been very patient, but it has become very hard to put up with all the side effects and still see so much acne breakouts. Please let me know if this is common and when he should expect results.

Sonia Badreshia-Bansal, MD · Answer

Thank you for your question. Results can usually be expected after about 1 -2 months on Accutane. Usually the first month all the oil and bacteria are pushed to the surface and the acne appears worse. The dosage of 100 mg daily is quite a high dosage, as the recommended dosing is 1 mg/kg/day. Sometimes it may require a longer course of therapy, but within a safe dosing range. Be certain to be under the supervision of a board certified dermatologist with expertise in acne for the most effective and safe treatment options. I hope this helps.

Jordana S. Gilman, MD · Answer

It's not uncommon to start with a lower dose of Accutane then move up to a "full" dose after one or two months. This may be done in cases where the acne is particularly inflammatory in order to decrease the chance of a flare, which can happen upon starting the medication. We would expect to see some improvement after the 2nd month. Some of the spots, usually the deeper white cysts, may take longer to improve, but the red pimples and red cysts should be getting better and there should be few new spots occurring.

	I would discuss this with your doctor. While every patient is slightly different, you should understand exactly what to expect and when to expect it.

F. Victor Rueckl, MD (in memoriam) · Answer

I would meet with the doctor and discuss this situation, as I would not describe the situation you've stated as common. I've prescribed Accutane to tens of thousands of people over my nearly 30 years. The minimum effective dose for Accutane is 1 mg per kg of weight per day for at least 20 weeks, for very mild to moderate acne. You describe your son's acne as moderate, so with that being said, he should be about 12 weeks into the medication. What you've stated, quite frankly, are dosages I've never put someone on. Accutane depends on weight, severity of acne, location of acne, as well as where you live. Because I am in Las Vegas, no one could tolerate a higher dosage than 40mg a day. I don't prescribe more than that, and really, I cannot believe he's not having any clearing at 100mg a day.

Slow Responder to Isotretinoin? When Can We Expect Results?

Answers (3)