It's a bit of a confusing one, some people believe in it and some don't. I think that with Accutane it is effectively shrinking your oil glands so I guess if you have too much oil or bacteria underneath your skin then it needs to come out as the oil gland shrinks. That's just my thoughts though, nothing scientific at all. I think sometimes when it comes to topicals people think that they are having an initial break out when in fact their skin might be too sensitive to the product and most topicals are drying so the irritation to the skin may cause a few breakouts at first but I would think that if after a month things are still getting worse then it probably your skins way of saying that it doesn't like the product are perhaps to cut back a bit. I have read that a lot of people use an antibiotic at first to help with any IB from Accutane so the fact that you have already had a course should mean that you will hopefully avoid the initial breakout. Just remember to tailor your skincare to Accutane as your skin will get drier and more sensitive and using anything too harsh may cause breakouts and redness.

Good luck I'm sure you will have no problems, everyone always vents bad experiences online, for everyone with an initial breakout there are probably many more who didn't have one. x

Retinoids activate the process of skin renewal at the basement or basal membrane of skin (where the skin is technically alive). To me in my understanding is that the retinoid speeds up this process, but also corrects it by normalizing skin keratinization, skin shedding, and further strengthen the pore so that this mechanism is corrected and used to prevent further breakouts. Acne is a multistep, multistage process. Retinoids attack this area to prevent or mimize the formation of new acne but in doing so much correct the skin and remodel it.

The issue is that the process can be long 3 months of more i believe and is not always the saving grace for acne suffers.

Retinoids activate the process of skin renewal at the basement or basal membrane of skin (where the skin is technically alive). To me in my understanding is that the retinoid speeds up this process, but also corrects it by normalizing skin keratinization, skin shedding, and further strengthen the pore so that this mechanism is corrected and used to prevent further breakouts. Acne is a multistep, multistage process. Retinoids attack this area to prevent or mimize the formation of new acne but in doing so much correct the skin and remodel it.

The issue is that the process can be long 3 months of more i believe and is not always the saving grace for acne suffers.

Thanks for your detailed description of the mechanism!

Good luck I'm sure you will have no problems, everyone always vents bad experiences online, for everyone with an initial breakout there are probably many more who didn't have one. x

Hey just thought I would through my two cents worth in to the discussion!

I have no scientific evidence just experience however. My daughter was prescribed a strong topical retinoid (tazorac) about 6 months ago and at the time I asked her dermatologist about the 'Initial breakout'. He said that there should not be one with topical retinoids and he was in fact right. Improvement was very slow (several months before things got better at all) but now after 6 months she is 90% clear and very happy with the results. Everyone is different as we know and I read a lot on this site about the 'initial breakout' but it does not happen for everyone.

^Thanks for sharing, Hope7! I'm so glad that the tazorac is working for your daughter and she didn't have to go through the IB

Hi -

There is also some studies to suggest that Accutane in particular causes an initial breakout due to the damage it inflicts on sebum glands (good damage as it shrinks them and reduces the production of oil, if that makes sense). I read an article (I can find the citation if you like) that postulated, in response to the initial damage, the sebum glands will ramp up the production of oil before stopping almost completely (the cause of the extreme skin dryness often experienced by accutane users). This is one idea why some people experience more oilyness in the very beginning of the course. Since sebum is the food source of P. Acnes (the bacteria that causes acne vulgaris) it only makes sense that a massive increase in inflammation would occur during this initial increase in oil production. In addition to the reasons k3thchup described, improvement occurs when the sebum glands deteriorate to such an extent that P. Acnes cannot grow on your skin anymore, due basically to starvation.

Logically speaking (although I don't know if there is any proof to this) taking an antibiotic before beginning accutane might lessen the severity of an initial breakout by reducing the P. Acnes on your skin before the oil production ramp-up. Obviously, do not take doxycycline during your accutane course, it can cause a pretty severe interaction (I am sure your derm has already spoken to you about it).