Acne Treatment Post-Accutane

Dr. David Roy • January 29, 2017
Post-Accutane | Pine Belt Dermatology
Dear Readers,

We have had several questions regarding isotretinoin, better known by its old trade name, Accutane. I will tackle two of these questions today. The first question is, “Why is Accutane not working after 6 months?
 
The answer to this question is not often clear and may be due to several factors. The first question I would ask is, what dose were you taking and how much do you weigh? The typical dosage for the medication is .5 to 1 mg/kg/day to start and I typically increase this up to 2 mg/kg/day as tolerated. For example if you weigh 176 lbs, a dose of 40 mg twice a day would put you right at 1 mg/kg/day. If you were on a low dose for the entire course of your treatment and you were stopped at 5 or 6 months, this may explain why your acne is not clear, or why you relapsed after being clear.

The next question I would ask is, “Did you take your pills with a fatty meal?” Isotretinoin is not absorbed well on an empty stomach, and as such, taking it with a fatty meal will significantly increase absorption. This will ultimately lead to more of the drug being available to work on your acne.

Patients, who take isotretinoin, do not always demonstrate complete clearance of acne. Around 15% of patients will need a second course to achieve their goals, and some may even need a third. In addition, no matter what treatment you receive, you and everyone else on the planet will still get pimples occasionally. This is part of out normal skin cycle.

Certain triggers can make us break out. These include stress, changes in environment, hormonal fluctuations, use of certain medications/supplements, changes in skin care products, excessive sweating, and sometimes dietary habits, although this last one is a bit controversial.

If you have been on an appropriate dose for your weight, for an appropriate amount of time and you have not seen reasonable results, the cause for your breakout needs to be established. Is it really acne that you are suffering from? If so, what factors, other than the typical (overproduction of oil, overgrowth of bacteria, inability to clear pores, and inflammatory reactions to the these things) might be contributing to its severity.

The second question is, “How should I care for my skin after Accutane?”

There are several things that I think are important in a skin care regimen after isotretinoin therapy. These include the following: daily sunblock, a gentle cleanser, a daily moisturizer, and semi regular to daily use of a topical retinoid.

So, what is a topical retinoid? These are creams or gels that you probably used prior to starting isotretinoin therapy and these medications are related to isotretinoin and have some similar effects. There are several different formulations and these go by many names. The most common generic names include tretinoin, tazarotene, and adapalene. Brand names include Retin A, Tazorac, and Differin. There are also combination therapies such as Epiduo or Veltin that contain both a retinoid and a secondary medication. 

The use of a retinoid is key to helping prevent relapse. These medications, in addition to treating acne, are also excellent anti-aging creams, so the benefit is two fold.

If you are unfortunate enough to relapse after therapy, the use of an oral antibiotic for a short duration (8 weeks) combined with sustained retinoid therapy can sometimes calm down the breakout and help us avoid repeating a course of isotretinoin. It is not clear why, but certain oral antibiotics seem to work much better following a course of isotretinoin.

I hope this helps to answer some of your questions. Keep them coming and we will do our best to get you informed, accurate and relevant answers.

Sincerely yours,


Dr. David B. Roy, D.O., F.A.O.C.D., F.A.A.D., F.A.S.M.S.

Board Certified Dermatologist

Pine Belt Dermatology and Skin Cancer Center

June 29, 2026
At Pine Belt Dermatology & Skin Cancer Center, we believe education is key to protecting and maintaining healthy skin. July is significant for skin health, featuring both UV Safety Awareness Month and World Skin Health Day on July 8 . These occasions highlight the importance of sun protection and raise awareness of common concerns, such as hyperpigmentation and melasma . Understanding how ultraviolet (UV) exposure affects your skin helps prevent long-term damage and supports a healthier, more even complexion. Why UV Protection Matters The sun emits ultraviolet rays that can damage skin even on cloudy days. While many associate UV exposure with sunburn, its effects are broader. Repeated UV exposure accelerates skin aging, increases skin cancer risk, and contributes to pigmentation disorders. Common effects of excessive UV exposure include: • Sunburn and skin irritation • Premature aging, including fine lines and wrinkles • Dark spots and uneven skin tone • Increased risk of skin cancer • Worsening of hyperpigmentation and melasma Daily sun protection is one of the most effective ways to maintain healthy skin and reduce preventable damage. What Is Hyperpigmentation? Hyperpigmentation is a common condition where areas of skin become darker than the surrounding tissue due to excess melanin production. Multiple factors can contribute to hyperpigmentation, including: • Sun exposure • Acne scars and inflammation • Hormonal changes • Skin injuries or irritation • Certain medications While hyperpigmentation is mostly harmless, many seek treatment to improve skin tone as well as restore confidence. Understanding Melasma Melasma is a type of hyperpigmentation that shows up as brown or gray-brown patches, typically on the cheeks, forehead, nose, and upper lip. Melasma is frequently associated with: • Hormone changes during pregnancy • Birth control medications • Hormone replacement therapy • Genetic predisposition • Sun exposure Although melasma is not dangerous, it can be difficult to treat because UV exposure frequently triggers or worsens it. Even minimal sun exposure can increase pigment production and make discoloration more noticeable. Protecting Your Skin from UV Damage Whether you are concerned about skin cancer, hyperpigmentation, or melasma, daily sun protection is essential. Dermatologists suggest: • Using sun lotion with SPF 30 or higher every day • Reapplying sunscreen every two hours when outdoors • Wearing wide-brimmed hats and protective clothing • Seeking shade during peak sunlight hours • Wearing UV-protective sunglasses • Avoiding tanning beds Consistent sun protection helps prevent new pigmentation issues. World Skin Health Day: A Reminder to Prioritize Skin Care Observed annually on July 8, World Skin Health Day encourages preventive steps to maintain healthy skin. This is a reminder to perform regular self-exams, schedule dermatology visits, and address concerns early. If you notice persistent dark spots, changes in pigmentation, or new skin lesions, seek an expert assessment to determine the cause and identify treatment options. Supporting Healthy Skin Year-Round UV Safety Awareness Month and World Skin Health Day remind us that protecting your skin is an investment in long-term health. Practicing sun safety and understanding conditions like hyperpigmentation and melasma help preserve your skin’s health, appearance, and function. At Pine Belt Dermatology & Skin Cancer Center, our team provides personalized evaluations and treatments for pigmentation concerns, sun-damaged skin, and overall skin health. Plan a visit and learn how we can help you achieve healthier, more confident skin.
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