Isotretinoin, commonly known by its former brand name Accutane, is a powerful oral medication often prescribed for severe and persistent acne that has not responded to other treatments. While highly effective in clearing stubborn breakouts, some individuals may experience an initial temporary worsening of their acne, often referred to as the “purge.” This phase can be disheartening, but understanding and managing it can help patients navigate the treatment journey more comfortably.
Understanding the Purge Phase
The Accutane purge is an initial flare-up of acne that can manifest as new breakouts, increased redness, and inflammation. This occurs because isotretinoin accelerates the skin’s cell turnover, pushing blockages and impurities to the surface more quickly. This rapid exfoliation and temporary irritation can lead to a paradoxical worsening of acne before significant improvement is seen.
Not everyone experiences a purge, but it is a normal and anticipated part of the treatment for many. Approximately 5-20% of patients may see their acne worsen, typically within the first month of treatment, though it can sometimes appear in the second month or with a dose increase. The purge usually lasts between two to six weeks, though for some it might extend into the second month. This temporary phase signals the medication is actively working.
Managing Skincare During the Purge
A gentle and supportive skincare routine is important during the Accutane purge due to the medication’s drying and sensitizing effects. Mild, non-foaming cleansers are recommended to cleanse the skin without stripping its natural moisture barrier. Products like Cetaphil, CeraVe hydrating cleansers, or Dove Sensitive Skin bar soap are often suggested for their gentle formulations. These help remove impurities without exacerbating dryness or irritation.
Applying a rich, non-comedogenic moisturizer is important to combat the extreme dryness isotretinoin commonly causes. Moisturizers containing ingredients like ceramides and hyaluronic acid can help replenish the skin’s moisture and support its barrier function. Consistent application of these hydrating products can alleviate discomfort and flaking associated with the purge.
Sun protection is another important component of skincare during isotretinoin treatment, as the medication significantly increases sun sensitivity. Daily use of a broad-spectrum sunscreen with an SPF of 30 or higher is highly recommended, even on cloudy days. Mineral sunscreens containing zinc oxide and titanium dioxide are often preferred for their gentle nature on sensitive skin.
During this phase, it is important to avoid harsh skincare practices and active ingredients that could further irritate already sensitive skin. This includes:
Physical exfoliants
Chemical peels
Astringents
Other acne treatments containing salicylic acid or benzoyl peroxide
Patients should also refrain from picking or squeezing breakouts, as this can worsen inflammation, increase the risk of scarring, and potentially lead to infection.
Supporting Your Body and Mind
Beyond topical skincare, supporting internal hydration and mental well-being is important during the Accutane purge. Drinking plenty of water throughout the day helps mitigate overall dryness, a common side effect affecting skin, lips, and eyes. Adequate hydration helps the body cope with the medication’s systemic effects.
Extremely dry, chapped lips are an almost universal side effect of isotretinoin, requiring frequent care. Applying thick, occlusive balms like petroleum jelly, shea butter, or arnica can provide relief and a protective barrier. Products like Aquaphor, Vaseline, or specialized lip balms are recommended to soothe and heal cracked lips.
Dry eyes are another common discomfort, managed with lubricating eye drops. For dry nasal passages, a thin layer of petroleum jelly inside the nose or a saline nasal spray can provide relief. Cool compresses can also help soothe inflamed skin, offering temporary respite.
The visual worsening of acne during the purge can impact emotional well-being and self-confidence. It is helpful to manage expectations; this phase is temporary and typically leads to significant long-term improvement in acne. Seeking support from friends, family, or online communities of others undergoing similar treatment can provide valuable emotional encouragement.
Knowing When to Seek Medical Advice
While the Accutane purge is common and expected, certain symptoms warrant immediate attention from a dermatologist or healthcare provider. Any severe pain or unmanageable discomfort should be reported promptly. This might indicate a more serious reaction than typical purging.
Signs of infection, such as pus, fever, or spreading redness around breakouts, require urgent medical evaluation. These symptoms suggest a bacterial complication needing professional intervention. Unusual or severe side effects beyond expected dryness and temporary purging should be communicated to your doctor.
Severe side effects can include persistent headaches, significant vision changes, severe joint or muscle pain, or new or worsening mood changes. Although rare, mental health concerns like anxiety, depression, or severe irritability have been reported. The purge lasting significantly longer than two to three months, without improvement, is another reason to consult your dermatologist. Any concerns about the treatment or its effects should be discussed with your healthcare provider to ensure safe and effective management.