Why did pimples and nodules pop up 1 month after 30mg isotretinoin treatment?

Doctor's Answers 1

Hi

There are 2 possible scenarios here.

Firstly acne flare-up with isotretinoin has been well documented. These flare-ups are usually mild in nature and the acne actually becomes worse before getting better.

In one study done they concluded that males and those with severe grades of acne as well as coexisting truncal acne are more likely to experience these flare-ups.

The second scenario is related to what has been termed purging of the acne. This occurs more often in those with long-standing cases of acne. Purging occurs because the isotretinoin pushes the dead cells and debris up to the skin surface. This, in turn, causes the skin to become red and inflamed.

In both cases, perseverance with the oral isotretinoin will result in improvement of the acne although it may take 3-6 months.

Hope this helps.

Regards
Dr Chew

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thanks for your pictures. There is no evidence that pimples are caused by 'toxins' in the body. However stress and hormonal imbalances are a major cause, which increases the activity of the oil glands. You seem to be suffering from papular acne, which can be treated with topical retinoids and benzoyl peroxide. Niacinamide and zinc may help alleviate symptoms, but is not a medical treatment for acne. I would recommend a full consultation to determine what are the other possible causes and discuss the various treatment options. Hope this helps!

How should I prevent Post-Accutane relapse, and advise on long term maintenance isotretinoin dose?

Hi S – 6 years is a long time to be on a course of isotretinoin, unless you were specifically prescribed a low dose, long term “maintenance” isotretinoin regime by your doctor. If you’ve been compliant to the dosage regime (at 120 mg/kg), 85% of patients only need one course to achieve complete remission of acne – this would take 4 – 6 months of treatment, depending on the dose administered. Relapse rates in patients after treatment with oral isotretinoin vary between 10% and 60%.

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