Accutane Relapse: How Often It Occurs? What Are The Options?

Last Updated: January 21, 2021

Authored by Sharon Levy, MD, MPH

The success of Accutane has its dark side. Understandably, three decades of treating severe acne often becomes a target. Accutane relapse occurs in up to 60% of the patients who have taken it to deal with acne.
It is a highly effective treatment for severe acne. Almost every user taking a full course of the treatment has achieved a total clearance. Additionally, up to 80% of the patients remained acne-free with just a single course of it.

A Short Note On Accutane

It contains a potent Vitamin A derivative which they call Isotretinoin. One of the most powerful acne medications available till date, it treats severe acne that does not go away with oral or topical antibiotics.
Isotretinoin is a member of chemicals known as “retinoids.” One has to take the capsules of Accutane only under a doctor’s prescription.

What Accutane Relapse Is

Accutane relapse refers to a condition where the severe acne, once clear, comes back. This may occur once one completes course of the therapy.
Various studies have attempted to explore the exact mechanism behind Accutane relapse. But only to end up as a failure. For this reason, the causes remain a mystery.
However, new studies have shed light on two factors that may play a contributory role in the relapse. The highlights of the studies are:

Food Habit Could Be One Of The Reasons Why One Has Accutane Relapse

Notably, the relation between the food intake and gastric absorption of Accutane is well established. Put it simply, for better absorption, take it with a high-fat meal.
In fact, the role of food in the safety and effectiveness of Accutane may be way higher than what we previously knew. Recent studies suggest that a high-fat meal can increase its absorption in the digestive tract by as much as three times. The Journal of Clinical and Aesthetic Dermatology, 2012. “Face to Face with Oral Isotretinoin.”

Taking Lower Doses May Make One More Prone

The ideal dosing is largely unknown.
However, most clinicians agree that the normal dosage is 0.5 to 1.0 mg/kg/day in two divided doses with food. The treatment usually lasts for 15 to 20 weeks. Nevertheless, they may adjust the doses depending on how one responds to it.
Additionally, if the acne persists even after the first course of the therapy. One may have to take a second course. Notably, there should be a gap of at least two months between the first and second courses.
Studies have linked the intake of low Accutane doses to an increased risk of relapse.
For this reason, a doctor may ask to take a high dose of it. Worried about the side effects of Accutane? The researchers say there is no significant difference in the incidence of side effects between the low dose and high dose groups. JAMA Dermatology, 2013. “High-dose isotretinoin treatment and the rate of retrial, relapse, and adverse effects in patients with acne vulgaris.”

Measures To Prevent Relapse

Accutane relapse is lower in the patients who take maintenance therapy with retinoid creams. For men, they take antiandrogen, while for women they take cyproterone and spironolactone.

Common Treatment Approaches After One Has Accutane Relapse

Commonly, they use three treatment approaches to treat the relapsing acne. They include:

  1. Topical retinoids: They may ask to apply a topical retinoid (for example Retin-A topical) over the affected areas once completing the first course. Similar to Accutane, topical retinoids are also very powerful. Therefore, exercise precautions to lower the risk of complications.
  2. Oral antibiotics plus topical retinoids: Under a doctor’s prescription, one may also start taking Tetracycline or Minocycline in addition to applying topical retinoids.
  3. The second course of Accutane: After a gap of at least two months, they may start a second course of the Accutane therapy.

What New Studies Suggest About Accutane Relapse?

Recurring acne can be really painful. Additionally, mood will reach a new low. Especially, when the most successful treatment (Accutane) shows the signs of a failure.
All things considered, it’s a better idea to stay updated with what’s going on regarding this wonderful acne medication.

  • Accutane is very effective in clearing the severe acne. Moreover, it also extends the remission period. Factors like age, type of acne, and smoking habits may play a role in the relapse. In future, we can expect it to become a potential treatment for aging skin and other related conditions. The Australasian Journal of Dermatology, 2013. “Isotretinoin: dose, duration, and relapse. What do 30 years of usage tell us?”
  • The rate of relapse may be lowered with topical retinoids and antiandrogen treatments. Actas Dermo-Sifiliograficas, 2013. “Acne relapse rate and predictors of relapse following treatment with oral isotretinoin.”

Seek Help

Severe acne is both a cosmetic as well as a health issue. Following an apparently successful treatment, it may come back again when Accutane leaves one’s system.
Nevertheless, Accutane remains the most preferred treatment for severe acne. Using it properly is very important. It is because a wrong use may lead to some very dangerous complications. This is of immense importance if a patient is a woman of childbearing age.
NEVER use it if one is pregnant or planning to become pregnant. One has to sign a document as a part of the iPLEDGE program before the start of the therapy.
Talk to a doctor to learn more about the treatment for severe acne and relapse or to find out the price of Accutane.

Page Sources

  1. Bauer LB, Ornelas JN, Elston DM, Alikhan A. Isotretinoin: controversies, facts, and recommendations. Expert Rev Clin Pharmacol. 2016 Nov;9(11):1435-1442.
  2. Lee YH, Scharnitz TP, Muscat J, Chen A, Gupta-Elera G, Kirby JS. Laboratory Monitoring During Isotretinoin Therapy for Acne: A Systematic Review and Meta-analysis. JAMA Dermatol. 2016 Jan;152(1):35-44.

Published on: April 18th, 2017

Updated on: January 21st, 2021

About Author

Sharon Levy, MD, MPH

After successful graduation from Boston University, MA, Sharon gained a Master’s degree in Public Health. Since then, Sharon devoted herself entirely to the medical niche. Sharon Levy is also a certified addiction recovery coach.


Leave a comment

  • Jayne
    I completed 6-7 months of Accutane treatment. Fast forward 2 years and I have had the best skin I’ve ever had…. after 2 years being clear the cystic acne is coming back 🙁 I am almost 27 and so upset and can’t figure out what can be the cause! Any suggestions?!
    • Syd
      It could be your diet. I’ve been on 2 almost three rounds of antibiotics to clear my skin and topicals to put on my face. Also on birth control off and on to clear my skin and even considered Accutane. I would get super clear then almost 2 years later it would come back with vengeance, then the process of me spending money to clear my skin comes back. I did my research and it was my gut flora. Medicine like Accutane and antibiotics kill your gut flora causing acne. And I realized my diet was filled with seafood and shellfish. That caused my acne all these years and my love for peanut butter. I changed my diet and start seeing a face reality esthetician and start using their products and I’m just now starting to get clear without medication. Looking into face reality and get hooked up with an esthetician near you.
  • Melissa
    Thanks for sharing your wonderful posts ❤️. I suffered severe acne for more than 10 years before I tried accutane. It basically cured my acne almost completely. So happy I googled ‘ Ben247ac ‘ and got this treatment. I don’t have much side effects, if any. My advise is to start off with low dose and work it up according to your weight. Side effects should be minimal with low dose.
  • Dodi
    I took isotretinoin for 7 months, when I stopped it there was about 5 white heads in my forehead(not sure if it is white heads or milia), then 2or 3 appeared beside my lips, today (3 days after ovulation) I found 2 very small pimples under my eye brow and beside my lips. Is that normal or I need to take another course. Is there a maintenance dose for isotretinoin?