It is not uncommon for some acne sufferers to complain that they tried Accutane but it didn’t work for them.  When an acne doctor hears this complaint, many things immediately come to mind to explain why this may have occurred.

The good news is that almost all of the reasons that may have contributed to a suboptimal outcome can be fixed and Accutane can usually be tried again with good results.

Let’s look into this further.  What could account for Accutane not working?

The daily dose of Accutane is too low

The first question to ask concerns the dose of Accutane that was prescribed.  Taking a dose that is too low is one of the most common reasons that Accutane treatment may not be effective.

Accutane is typically prescribed based on the weight of each patient.  Larger patients will typically require a larger dose than smaller patients who weigh less.  Many medications are prescribed in this way, according to the weight of the patient.

Although the dose of Accutane depends on the patient’s weight, it is not a fixed dose but rather a range within which the prescriber selects the right dose for each patient.  If the dose of Accutane that is prescribed falls below the low end of the recommended range, then the effectiveness of treatment may not be optimal.

Even if Accutane is prescribed in the middle of the recommended dose range, some patients still do not respond well.  In these cases, the prescriber may need to increase the dose toward the upper limit of the dose range in order to achieve more effective results.

The total dose of Accutane is too low

Also, the total dose that a patient receives is very important in determining whether the response to Accutane will be effective and long-lasting.

This total dose is typically calculated by the prescriber each month to provide what is called the cumulative dose which represents the milligrams of Accutane per the patient’s body weight.  Typically, the goal is to reach the target cumulative dose before concluding treatment.

If Accutane treatment is discontinued before reaching the target cumulative dose, there can be a higher risk of acne returning.

Many patients think that they don’t need to continue taking Accutane once their skin is clear but that is not the case.  Even if a patient achieves clear skin very soon after starting Accutane, the treatment should be continued until the target cumulative dose is reached.  Otherwise, there will be  higher chance that acne will come back again.

That’s not to say that reaching the target cumulative use will guarantee that acne will not return.  The data show that approximately two-thirds of patients who reach the target cumulative dose will likely stay acne-free.  However, the remaining one third of patients will likely experience a relapse of their acne breakouts at some point.

Accutane is not being absorbed

Another factor that can decrease the effectiveness of acne is the amount of Accutane that gets absorbed after swallowed.  If Accutane is taken on an empty stomach much of it will not get absorbed through the digestive tract.   This will lead to a much lower amount of Accutane in the body.

Accutane depends on the presence of food, especially a meal containing some fat, in order to get absorbed through the lining of the digestive tract.  Some providers recommend taking Accutane with a spoon of peanut butter to aid in absorption.

A newer form of Accutane has been available that comes with a coating to help it pass through the digestive tract which helps to avoid the need to take Accutane with food.  However, ensuring that each dose of either form of Accutane is taken with a substantial meal will work well too.

Something is Interfering with Accutane

Sometimes a patient may have interfering factors that can prevent an optimal treatment with Accutane.  For example, consuming alcohol has been suggested to interfere with the effectiveness of Accutane.

Also, taking some herbal or “natural” products together with Accutane can sometimes have competing effects, although this is hard to predict because very little is known about many of these supplements.  Many providers typically recommend stopping nonessential supplements when starting Accutane.

The “Accutane purge”

Sometimes the “Accutane purge” can get in the way of effective treatment, especially if it becomes very severe, by disrupting the normal treatment process.

When a patient develops an “Accutane purge” it can interrupt the normal course of treatment and distract attention away from standard Accutane treatment toward the need to manage the “purge” instead.  This can lead to delays in the standard treatment protocol and can necessitate the addition of other remedies to help limit the “purging.”

Many patients who have experienced an “Accutane purge” feel that the “purge” indicates that Accutane is not effective for them.  However, this is not necessarily the case.  The “Accutane purge” does not mean that Accutane is not an effective treatment.  It is simply something that happens to a minority of patients but once it is stopped, Accutane can often work well for these patients too.

Underlying medical conditions

Underlying medical factors should always be considered if a patient is not responding well to Accutane treatment.  For example, abnormal hormone production or other medical conditions can have an impact on the success and duration of one’s response to Accutane.

This does not necessarily mean that Accutane cannot work for patients with an underlying medical condition.  In fact, Accutane can be one of the only effective treatments for some patients who have medical conditions that limit the effectiveness of other acne therapies.

Stress and hormonal changes

For patients experiencing significant stress, even Accutane is not a cure-all for acne.  This is because stress can induce breakouts through a series of bodily effects that can make acne more resistant to any treatment, even Accutane.

Similarly, successful past treatment with Accutane is not a guarantee when it comes to the possibility of acne returning when a patient subsequently experiences changes in their hormones.  The use of anabolic steroids, for example, can cause acne to return even after Accutane treatment.  Hormonal changes associated with menopause can also trigger a reoccurrence of acne.


For some, because of unique genetic predispositions, Accutane may in fact be less effective.  This, however, is very uncommon.

While it is not possible at this time to identify which patients may harbor a genetic basis for limiting the usefulness of Accutane, a genetic factor is always a remote consideration when no other explanation for a lack of response to Accutane can be identified.

The Advanced Acne Institute is a unique dermatology practice located in Miami, Florida specializing only in the treatment of acne.   We focus solely on providing the most effective treatments to help our patients achieve clear skin.

We are pleased to share our insights and perspectives in acne treatment as an educational service, however this information is provided strictly for educational purposes only and should not be considered medical advice and is not a substitute for seeking the advice and treatment by an appropriate medical professional.

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