Dermatologist explains what happens before and after Accutane

Dr. Amit Om board-certified dermatologist, discusses the “Before and After” for patients starting their Accutane journey.

Medically reviewed by:
Dr. Amit OM
Dermatologist

Table of Content:
Accutane Timeline | Ensuring the success of your treatment | What to avoid? | FAQ

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Dr. Amit Om, a board-certified dermatologist, describes Accutane (isotretinoin) as a life-changing treatment for individuals with severe, scarring acne—particularly nodular or cystic acne that hasn’t responded to conventional therapies like topical retinoids, benzoyl peroxide, or oral antibiotics¹.

Unlike other acne treatments, which primarily manage acne symptoms, Accutane works by targeting the root causes of acne, significantly reducing oil gland size, decreasing sebum production, and preventing clogged pores. It also has powerful anti-inflammatory effects, helping to heal existing breakouts and prevent future scarring.

Dr. Om says that for many of his patients, Accutane is completely worth it and a last resort after years of failed treatments, frustration, and the emotional toll that acne can cause. Severe acne can affect self-esteem, confidence, and mental health, making this medication truly life-changing for those who experience dramatic, long-term clearance. Many patients see long-lasting improvement after a single course, making Accutane one of the most effective acne treatments available.

However, due to its potency, Accutane requires careful monitoring. Patients must adhere to the iPLEDGE program (to prevent pregnancy-related birth defects)², undergo regular blood tests to monitor liver function and cholesterol levels, and manage potential side effects like dry skin, joint pain, and sun sensitivity.

Despite these considerations, for those suffering from severe acne, Accutane offers a chance at clear skin, relief from pain and scarring, and a renewed sense of confidence and well-being.

What to expect after taking Accutane (isotretinoin)?

Dr. Om says Accutane is a strong medication and it comes with significant effects—both positive and potentially negative ones. Here is a timeline of the changes that happen in the body while taking this medication.

Timeline: What happens after Accutane?

Accutane weeks 1-2: The adjustment phase

Acne may worsen temporarily (known as the initial purge).
Skin and lips begin to feel dry, so moisturizing and lip balm become essential.
Some patients notice increased skin sensitivity and mild irritation.

Accutane weeks 3-6: Early changes

Oil production significantly decreases, and skin starts feeling less greasy.
Acne continues to purge, but some breakouts may heal faster.
Lips, nose, and eyes may become noticeably drier.
Mild side effects like joint stiffness or mild headaches can appear.

Accutane weeks 7-12: Visible improvement

Fewer new breakouts, and inflammation starts to subside.
Skin texture feels smoother, and oiliness is almost nonexistent.
Post-acne marks begin to fade, though redness may persist.
Many patients feel their skin is finally clearing up.

Accutane months 4-5: Major transformation

Acne is dramatically reduced or nearly gone.
No new lesions should be appearing at this stage
Any remaining pimples are smaller and heal quickly.
Scars and dark spots continue fading, and overall skin tone improves.
Dryness remains but is manageable with the right skincare.

Accutane months 6+: The finish line

Clear skin for most patients, with little to no active acne.
Some residual redness or minor marks may take months to fade.
Oil glands remain less active, reducing the chances of future breakouts.
If acne persists, the course may be extended beyond 6 months.

After Accutane: Long-term results

Many patients experience long-lasting or permanent acne clearance.
Skin remains less oily even months after stopping treatment.
Regular skincare (moisturizing, sunscreen, gentle cleansing, and topical prescription therapy) is crucial for maintaining results.

How to ensure the success of your Accutane treatment?

Dr. Om says that to ensure the success of your Accutane treatment and achieve the best possible results, you should follow these key steps:

Follow your dermatologist’s advice

Take your medication exactly as prescribed—usually with a meal containing fat to enhance absorption.
Do not take any other pills, like doxycycline, or Vitamin A supplements (multivitamins) while taking Accutane.
Attend all follow-up appointments to monitor progress and side effects.

Manage side effects with proper skin care

Use a gentle cleanser and non-comedogenic moisturizer to combat dryness.
Apply lip balm like Vaseline or Aquaphor constantly to prevent cracked lips.
Avoid other retinoids, harsh skincare products, exfoliants, or acne treatments that can irritate your skin.
To prevent nosebleeds, apply a thin layer of petroleum jelly or a saline nasal spray inside your nostrils to keep them moisturized.
Use a thick, fragrance-free moisturizer (such as CeraVe, Eucerin, or Vanicream) all over your body at least twice daily to prevent excessive dryness and irritation.
Place a cool or warm mist humidifier in your bedroom and use it overnight while you sleep. Clean your humidifier every 2-3 days and give it a deep cleaning once a week.

Protect your skin from the sun

Accutane makes your skin extra sensitive to UV rays, so wear sunscreen (SPF 50+), a hat, long sleeves, and sunglasses when outdoors.

Stay hydrated

Drink plenty of water to help combat dryness and overall skin health.
Eat a balanced diet, including a lot of fiber.

Be aware of mood and health changes

Monitor for any mood swings or depressive symptoms, and inform your doctor if you are being treated for these prior to starting Accutane, or if they occur while on the medication.
Keep up with required blood tests to check liver function and cholesterol levels.

Be patient and stay consistent

Results take time—most patients see major improvements between months 3-5.
Avoid picking at your skin to prevent scarring and irritation.

What to avoid when taking Accutane?

Dr. Om says that the most important measure after you take Accutane is to avoid getting pregnant if you are a woman or avoid getting your partner pregnant, if you are a man as isotretinoin is highly teratogenic.

Getting pregnant – Accutane causes severe birth defects, so strict birth control measures and the iPLEDGE program are required. You must present a negative pregnancy test 1 month prior to starting, and 1 month after finishing.
Alcohol consumption – Accutane can stress the liver, and alcohol increases the risk of liver damage and high cholesterol.
Waxing or getting laser treatments – Your skin is more fragile, increasing the risk of burns, scarring, and skin damage.
Harsh skin care products – Stay away from retinoids, exfoliants, acne treatments, or strong acids that can worsen dryness and irritation.
Squeezing pimples – Your skin is more prone to scarring, so let breakouts heal naturally.
Sun exposure – Accutane makes skin extra sensitive to UV rays, increasing the risk of sunburn and hyperpigmentation. Always wear sunscreen (SPF 50).
Sharing your medication – Accutane is a serious prescription drug, and it can be dangerous if taken without medical supervision.
Taking more Vitamin A – Consume in moderation foods high in vitamin A, such as liver, egg yolks, full-fat dairy (butter, full-fat milk, cream) and certain fish (salmon, mackerel, tuna). Additionally, avoid vitamin A supplements, multivitamins indicated for skin health, cod liver oil and fish oil capsules as they can dangerously elevate vitamin A levels.

What to expect after Accutane: your most common questions answered

What happens to your skin pores after taking Accutane?

Dr. Om says that Accutane works by shrinking oil glands and pores. According to a study, patients with moderate to severe acne who took isotretinoin for six months experienced a statistically significant reduction in the size of their enlarged facial pores. Dermoscopic photos and surface area measurements confirmed that pores became smaller after treatment, particularly on the nose, where oil production is highest. This suggests that isotretinoin effectively reduces oil gland activity, leading to smaller and less visible pores over time³.

What happens to body acne after taking Accutane?

Dr. Om says that Accutane is highly effective for body acne, including on the back, chest, and shoulders. Since it works systemically, it reduces oil production throughout the entire body, helping to clear body breakouts. For most patients, body acne significantly improves or completely disappears after treatment. However, some may experience mild breakouts in the future, though they are usually much less severe than before.

What happens to acne scars after taking Accutane?

Dr. Om says that isotretinoin may improve acne scars to some extent. Some research revealed that after 90 days of treatment, patients experienced a statistically significant reduction in scar size and severity, along with increased skin elasticity and subcutaneous tissue thickness. While isotretinoin is primarily used to prevent new acne scars by controlling breakouts, these findings suggest it can also lead to some improvement in pre-existing atrophic acne scars⁴. However, for deep or severe scars, additional treatments like topical retinoids, micro needling, lasers, chemical peels, or even subcision surgery may still be needed.

Can Accutane shrink your nose?

Dr. Om says that Accutane cannot actually shrink your nose, but it can make it appear smaller due to its effects on oil glands, skin thickness, and pores. Here’s why some people claim their nose looks smaller after taking Accutane:

Reduction in oil production – Accutane shrinks sebaceous (oil) glands, leading to less oil buildup and shine, which can make the nose appear less puffy or swollen.
Pore shrinkage – Studies have shown that Accutane can reduce the size of enlarged pores, particularly on the nose, where sebaceous glands are most active. Smaller pores create a smoother, more refined look.
Skin tightening and thinning – Accutane reduces excess skin thickness caused by chronic inflammation and clogged pores. This slight skin thinning can make facial features, including the nose, look more defined.
Reduction in nasal swelling – In people with oily or acne-prone skin, chronic inflammation can cause mild swelling around the nose. Accutane reduces inflammation, which may create the illusion of a smaller nose.

Article References:
https://www.ncbi.nlm.nih.gov/books/NBK525949/
https://ipledgeprogram.com/#Main
https://ijma.journals.ekb.eg/article_317443.html#
https://pmc.ncbi.nlm.nih.gov/articles/PMC10503936/