8 Reasons Why You May Relapse After Accutane

By VeganAcneSufferers

Accutane clears acne for most people, but relapse is more common than expected. Research shows roughly 22.5% of patients see acne return, and about 8% require a second course. The most important factor in preventing relapse is reaching a sufficient cumulative dose of 120 to 150 mg/kg during treatment. Other key risk factors include younger age, truncal acne, ongoing hormonal conditions like PCOS, and stopping treatment before skin has been clear for at least two months.

When under the care of a dermatologist, Isotretinoin (commonly known as Accutane) is widely considered the "gold standard" and most effective treatment for severe, cystic, or treatment-resistant acne. While most patients achieve clear skin after a 4 to 6-month course, a common question remains: Can acne come back after Accutane?

The reality is that an Accutane relapse is more common than many expect. Recent clinical data suggests that the long-term cure rate may be lower than initially thought, with relapse rates ranging from 10% to over 60% depending on various biological and treatment-related factors [1].

What is an Accutane Relapse?

A relapse is defined as the re-emergence of acne after completing a full course of isotretinoin. This can range from mild comedonal acne to a return of severe inflammatory nodules. According to a 2025 cohort study published in JAMA Dermatology, approximately 22.5% of patients experience a relapse, with 8.2% requiring a second course (retrial) of the medication [2].

The factors that determine if you will relapse after Accutane:

1. Severity of Acne - Severe or truncal acne often requires higher cumulative doses to prevent recurrence.
2. Age - Younger patients (under 20) tend to have higher relapse rates due to ongoing hormonal shifts [3].
3. Diet During Treatment - Taking Accutane with a high-fat meal is critical for absorption.
4. Cumulative Dosage - Reaching a target dose (typically 120–150 mg/kg) is a strong predictor of long-term success [4].
5. Gender - Males, particularly those with extensive back or chest acne, may face a higher risk of relapse [1].
6. Hormonal Factors - Women with underlying conditions like PCOS may relapse without concurrent anti-androgen therapy [5].
7. Treatment Duration  -  Continuing treatment for 2 months after the skin is completely clear significantly reduces relapse risk [6].
8. Metabolism -  Individual differences in how the body processes the drug can affect its efficacy.

What Is Accutane?

Accutane (isotretinoin ) is a powerful oral retinoid that works by shrinking the oil (sebaceous) glands, reducing oil production, and preventing clogged pores. It is often the "drug of last resort" for those who have failed antibiotics or topical treatments.

While there is often fear-mongering regarding its side effects, isotretinoin is considered safe when monitored by a professional. Common side effects like dry lips and skin are actually clinical indicators that the medication is being absorbed effectively.

Will Accutane Work Permanently?

Isotretinoin remains the most clinically effective anti-acne therapy available [7]. However, it is not a guaranteed permanent cure for everyone. For many, it provides years of remission, but for others, acne may return—often in a less severe form.

Recent research highlights that cumulative drug exposure is the most important factor in preventing a relapse. Patients who do not reach the recommended cumulative dose of 120–150 mg/kg are significantly more likely to see their acne return [4].

8 Reasons You May Relapse After Accutane

1. Use on Less Severe Cases

Isotretinoin is now frequently used for moderate acne. Patients with milder cases may perceive the return of even a few spots as a "relapse," whereas those with historically severe disease might consider the same result a success. This shift in patient expectations can inflate reported relapse rates.

2. Younger Age at Treatment

Younger patients are at a higher risk because their hormones are still in a state of flux. While treating acne early can prevent permanent acne scars, these patients should be aware that a second course might be necessary later in life [3].

3. Poor Absorption (The "Fat" Factor )

Standard isotretinoin is highly lipophilic, meaning it must be taken with a high-fat meal (at least 30-35% fat) to be absorbed. Taking it on an empty stomach can reduce absorption by nearly 70%, leading to a lower "real" cumulative dose and a much higher risk of relapse [8]. Aim for healthy fats like avocados, nuts, or olive oil.

4. Insufficient Cumulative Dosage

Relapse is minimized when the total dose reaches at least 120 mg/kg. New guidelines also suggest extending the course for 2 months after the skin is 100% clear to ensure all sub-clinical micro-comedones are resolved [6].

5. Demographic Factors (Gender and Location)

Males with extensive truncal (back and chest) acne tend to relapse more quickly than females with facial acne. Studies show the risk of relapse can be twice as high among men [1].

6. Underlying Hormonal Issues in Women

For women, hyperandrogenism (high male hormones) or conditions like PCOS can drive acne even after Accutane. The risk of relapse is 3.5 times higher in women who do not receive concurrent anti-androgen therapy, such as Spironolactone or specific birth control pills [5].

7. Individual Metabolism

Some people naturally metabolize the drug faster or slower. If you aren't experiencing the classic "dryness" (especially chapped lips), it may be a sign that your body isn't absorbing or processing the medication optimally.

8. The Lack of a "True" Permanent Cure

Acne is a chronic condition influenced by genetics, hormones, and environment. While Accutane offers the longest remission time of any treatment, it cannot change your genetic predisposition to acne. However, subsequent courses are usually successful and further reduce the risk of future relapses.

Accutane Before and After

Accutane provides life-changing results for the majority of users. Below are the results from Kali (@myfacestory) after a 6-month course. Although she experienced a mild relapse later, her skin remained significantly improved compared to her starting point.

Before Accutane

6 Months After Accutane

If you're considering this treatment, it's important to weigh the side effects and benefits carefully with your doctor.

Can I Take Accutane Twice?

Yes. If acne returns, a second course is often highly effective. Dermatologists may adjust the dosage, increase the duration, or ensure the patient is meeting the "high-fat meal" requirement to prevent a third relapse. For mild relapses, topical retinoids like Tretinoin or Adapalene (Differin ) are often sufficient.

Treating Acne Scars After Accutane

Accutane treats active acne but does not heal existing acne scars. In fact, some scarring may become more visible once the active inflammation subsides.

For post-Accutane scarring, microneedling is a highly recommended, less invasive alternative to lasers. It is generally advised to wait 3 to 6 months after finishing your course before starting professional microneedling to ensure the skin's healing capacity has returned to normal [9].

The Banish Kit 3.0 is a popular at-home option for improving the appearance of scars once your course is complete.

References

1. Demirci Saadet, E. (2021 ). Investigation of relapse rate and factors affecting relapse after oral isotretinoin treatment. Dermatologic Therapy, 34(6 ).
2. Lai, J., et al. (2025). Acne Relapse and Isotretinoin Retrial in Patients With Acne. JAMA Dermatology.
3. Layton, A. M. (2009 ). Isotretinoin therapy and the incidence of acne relapse. British Journal of Dermatology, 160(1 ), 217-218.
4. Feszak, I. J., et al. (2025). Isotretinoin Treatment for Acne Vulgaris: A Five-Year Follow-Up. Journal of Clinical Medicine, 14(18 ).
5. Morales-Cardona, C. A., et al. (2013). Relapse of acne after isotretinoin: a 12-month follow-up study. Journal of the American Academy of Dermatology.
6. Tran, P. T., et al. (2021 ). Analysis of factors associated with relapse in patients on isotretinoin. Journal of the American Academy of Dermatology.
7. Zaenglein, A. L., et al. (2016). Guidelines of care for the management of acne vulgaris. Journal of the American Academy of Dermatology.
8. Webster, G. F., et al. (2013 ). Isotretinoin: update on controversial issues. Dermatologic Clinics.
9. Waldman, A., et al. (2017 ). Isotretinoin and Timing of Procedural Interventions. JAMA Dermatology.

About Veganacnesufferers

I first got acne in high school, and it came back in my early adulthood. I was able to struggle through those difficult times and come out of it a stronger, wiser, healthier person as a result. I'm here to help you do the same thing!

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