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Hey guys, I just began accutane 9 days ago. About 5 days in, the initial breakout really hit me. Hit me HARD. I am not too concerned about the many scabby, dry spots spread out around my mouth. My forehead is pretty clear and really nothing on my cheeks or below my eyes. Everything is on my chin and around my mouth, even on the edge of my lips.
The one area I'm very concerned with is the left corner of my mouth. A massive conglomeration of deep acne formed in this one area. They began leaking puss by themselves, and it has now formed into a massive area of scabbing. I cant even open my mouth without feeling pain. The very corner of my mouth becomes bloody and rips apart when i try to open my mouth. I'm sure there is still more puss underneath the scabbing.
Is there anything I should do to help this area heal? It is extremely painful and I can barely eat.
I had a pretty bad initial breakout too. Yours sounds pretty painful though due to the location. I freaked out a little and called my dermatologist, when I broke out badly, but they just said to wait it out. On month 2 and the Initial breakout is over and skin is starting to looks better. Hang in there! This Accutane journey is rough, but it'll be worth it! 
Neosporin wont hurt if you want to try it, but I wouldn't recommend bandaging it or anything. Like another poster said, you may also try a topical steroid if your doctor is willing to prescribe it, it will help with the inflammation. A short course of prednisone is definitely an option too.
Additionally, you can try erythromicen or azythomicen (Z-pack) to reduce the severity of the inflammation and infection. My doctor prescribed it at the beginning of my course to reduce the initital breakout severity. It doesn't interact with accutane and it would be a very short course (in the case of a Z-pack, only 5 days). Although you do need to "hang in there" in terms of not stopping accutane, there is absolutely no reason why you cant do something to reduce the pain and chances of scarring. You should definitely discuss the issue with your dermatologist right away, you don't have to grin and bear it if you don't want to.
Neosporin wont hurt if you want to try it, but I wouldn't recommend bandaging it or anything. Like another poster said, you may also try a topical steroid if your doctor is willing to prescribe it, it will help with the inflammation. A short course of prednisone is definitely an option too.
Additionally, you can try erythromicen or azythomicen (Z-pack) to reduce the severity of the inflammation and infection. My doctor prescribed it at the beginning of my course to reduce the initital breakout severity. It doesn't interact with accutane and it would be a very short course (in the case of a Z-pack, only 5 days). Although you do need to "hang in there" in terms of not stopping accutane, there is absolutely no reason why you cant do something to reduce the pain and chances of scarring. You should definitely discuss the issue with your dermatologist right away, you don't have to grin and bear it if you don't want to.
I ended up muscling through this past week and things are looking up. Skin is very dry but I'm slowly beginning to heal. Scabs are falling off and there aren't many left. I now know that the initial breakout can be horrendous for some... luckily my skin has always seemed to heal very quickly. I get cystic acne on my face but I've never had problems with scarring fortunately. I just hope I will slowly improve from this point on.
What dosage are you on?
My starting dose is 40 mg a day. I am about 18 days in, and currently my skin is looking great after the terrible initial breakout. Pretty much no visible blemishes. Only thing is dryness around the lips mainly. Body acne is still present and hasn't changed TOO much, but it is fading. Hopefully everything continues to improve as it has been and I don't go downhill at all.
Something I'm really enjoying is that fact that I'm not COVERED in grease by late afternoon / evening. I used to have a lot of oil on my face by the end of the day. I now virtually have none at any point of the day.
My dosage is 20mg once a day
Should I use a toner and should I exfoliate?
Based on my current experience, I would advise not using a toner or exfoliating. Your skin is very sensitive on this medication. There are some nights where I do not even use my face wash (Cetaphil) and simply splash water onto my face.