This is really interesting actually. 4th time. That's pretty extreme. How bad is your acne? Do you really need to go on isotretinoin a 4th time? Why would it work this time if it hasn't the last 3 times? What is the plan here from your derm? I'm curious.

I have not heard about acne flaring up massively that far into an isotretinoin cycle btw. At least it's extremely rare.

@dan Hey Dan, thanks for the reply and sorry for the delay. I didn't think anyone had seen this.

First time round it was really bad. Next two times were not so bad, just minor relapses. Had a good 5 year period with no acne but then started developing it again end of 2022.

Went back on isotretinoin because some of the spots I got were quite large and left deep scars.

Had month on month progress but since this post it got worse and then better. Dropped my dose back to 60.

My Derm thinks the High dosage has made my skin highly sensitive. I'm tapering down to 40 and then 20. Will take 20 for a few months as had initial success on 20, 40 and then 60. Derm thinks the skim just needs to calm a bit.

It's very frustrating but hoping things calm down.

Have you ever tried The Regimen? I'm thinking especially at your age it might be able to keep you clear without the potential damage that so many courses of isotretinoin might cause. You of course don't want to stop isotretinoin without talking to your doc and stuff, but just saying something to keep in mind for the future.

Just dropped in to leave a reply as a previous user of Accutane. In the next two months I'll turn 72 years old. I'm male. As a teen I had a small amount of acne, normal I guess, the occasional pimple. At around age 30 I began to develop cystic acne. To make a long story short I battled with it in the ensuing decades. Large dime sized painful facial cysts and the same on my back. No antibiotics or topicals worked. Eventually I tried Accutane. Finally something that worked. The dermatologist I was seeing had me on 40mg every other day for 6 months. Sadly, six to eight months after treatment acne returned. In the following years I went through 4 courses of Accutane, 40 mg daily, usually for a year. It always returned. It wasn't until one of the nurse practitioners working for the dermatologist suggested a maintenance dose of 40 mg weekly that I remained clear. I stayed on that for a number of years, eventually going without but, of course, the occasional breakout still occurred. It wasn't until I got to be around 66 that it finally stopped, simply due to the natural decrease in sebum production that occurs in the skin of older folks. I did have extremely oily skin. I had to shampoo my hair daily. If I didn't, the second day my hair would be oily to the point of appearing dirty. I realize my case was probably a rarity, I don't imagine most people develop cystic acne at age 30 or have to deal with it until they're seniors. I'm just grateful I no longer have to deal with it. So yes, sometimes multiple courses of Accutane are necessary. I just wonder what it did to the rest of my body.

I have similar experience. 10mg/day was working perfectly for 4-5 years.

After that it just destroys skin, although it does prevent trunk/scalp acne.

Try switching to ling term myonocycline/amoxicillin

Yeah, flare-ups can be a pain, even with isotretinoin. Have you chatted with your derm about tweaking your dosage or trying a different approach? Might suggest complementary treatments like adapalene gel like Differin.

Thanks everyone for replying. I don't check this regularly so apologies for the lateness. To update, I tapered down quite quickly from 60mg over three weeks in December, finishing up early Jan because I got multiple really large, angry pustules when I went away in December last year. Going abroad seems to trigger my skin in a way it has never done so before - I think the higher dose was too much for may skin.

I had initially planned to do 40 for a month and 20 for 4, but I wanted to see if coming off helped. Things were ok for a bit but I began using differin as maintenance and it triggered an almighty purge, and I was developing acne even where I wasn't applying Differin.

Now back on isotretinoin again but doing the low dose approach and see how I get on. It was probably the wrong call for me to come off when I did and should have Continued with the previous tapering schedule. So far about 4 weeks in and it's been up and down.

interestingly when I tapered over a three week period - from 60, to 40 for a week, 20 for a week, and everyy other day - my skin was excellent. hoping for better results this time round.