Isotretinoin, commonly known by its former brand name Accutane, is a potent medication prescribed for severe forms of acne that have not responded to other treatments. While highly effective, many individuals experience a temporary increase in acne breakouts, often called an “Accutane purge.” This initial worsening of skin condition is a common and expected part of the treatment process.
Understanding the Purge
Purging occurs because isotretinoin works by significantly reducing the size and activity of sebaceous glands, which produce oil, and by normalizing cell turnover within the skin’s pores. Before the skin clears, the medication accelerates the exfoliation of dead skin cells and debris already trapped deep within the pores. This process pushes existing microcomedones (microscopic clogged pores that will eventually become visible blemishes) to the surface more quickly.
This accelerated shedding brings pre-existing blockages to a head, resulting in an initial flare-up of acne lesions. The purge is not the formation of new acne but rather the rapid maturation and expulsion of existing, nascent blemishes. Individuals may observe an increase in whiteheads, blackheads, and inflammatory lesions as the skin goes through this phase.
The Typical Purging Timeline
An Accutane purge typically begins within the initial weeks of treatment. Many individuals notice increased breakouts around the first to fourth week after starting the medication. The exact timing can vary.
This purging phase is generally temporary, lasting a few weeks to a couple of months. For many, the most intense period resolves by the end of the second or third month of treatment. It is considered a sign that the medication is actively working to clear out the skin’s pores and prepare the skin for its long-term clearing effects.
Managing the Purge
Managing the Accutane purge involves a gentle and supportive skincare routine to mitigate discomfort and promote healing. Use mild, non-foaming cleansers that do not strip the skin of its natural moisture. After cleansing, applying a non-comedogenic moisturizer is helpful to combat the dryness that isotretinoin often causes.
During this period, avoid picking, squeezing, or attempting to extract blemishes, as this can worsen inflammation and increase the risk of scarring. Protecting the skin from sun exposure with a broad-spectrum sunscreen with an SPF of 30 or higher is also recommended, as isotretinoin can increase sun sensitivity. Staying well-hydrated by drinking plenty of water and maintaining a balanced diet may also support overall skin health during treatment.
When to Consult Your Dermatologist
While purging is a common side effect, consult your prescribing dermatologist in specific situations. If the severity of your purge is causing significant distress, pain, or appears to be worsening dramatically without any signs of improvement, seeking professional guidance is advisable. Signs of infection, such as increased redness, swelling, warmth, or pus, around breakout areas, also warrant immediate attention.
Additionally, if you experience any unusual or severe side effects beyond the typical purging, or if the purge seems excessively prolonged, continuing beyond two to three months without any indication of skin improvement, you should contact your doctor. Regular follow-up appointments are a standard part of isotretinoin treatment, providing opportunities to discuss any concerns or adjustments to your regimen.