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Big acne comeback after 2 years of Accutane


This is the first time that I am posting in this section of the forum, and I'd love to hear some opinions and ideas from people that are more knowledgeable or experienced than me.

I am  guy, almost 20 right now, and I had horrible acne for the most of high school. Not cystic, but the kind with terribly oily skin and big, inflamed pustules/papules, all over my face. My back and arms were in a similar state. I heard of Accutane, but like everyone considering taking it for the first time, I was reluctant. Luckily (or so I thought) for me, I got in contact with a doctor that suggested a low dose course for a long period of time. He assured me that the benefits will be the same (but will take longer to be observable), but I won't have severe side effects. I was happy with the idea, and the research that I did at the moment indicated that a low dose treatment will be indeed effective. I weigh ~60kg, and the goal was to reach a 8400mg cumulative dose.

I took 20mg per day for 5 months, then 10mg for 18 months. It took almost 1 year to reach a state were my face was 95% clean, and the oil was controllable (I did not need to wash my face for over 10 hours). So it was not perfect. I still had my nose full of blackheads, had around 1-2 new pimples per week, and my face would still get somewhat oily after a long enough period of time. But it was definitely an acceptable state, and I was finally free of any concerns regarding my skin. 

Things started to worsen after I reached the established dose. I took the last pill at the end of February this year. After only about one month, I noticed a dramatic increase in the number of pustules and their severity. My face is also much oilier. After only 2 hours of washing, I feel the need to pat my face with a piece of toilet paper or wash again (which obviously I don't do). Thing are getting out of control and I am really scared of having to fight acne again, especially since it took years to get rid of past spots and blemishes.

Some things I should mention:

- No topical has ever worked for me after a certain point, when the acne was too severe (this happened pretty early in my life). I used benzoyl peroxide for years, as well as tretinoin, in different formulations. The only effect was dryness and redness.

- I wash using cleaning products made specifically for acne. I also take all the hygiene steps necessary, always.

- During the Roaccutane treatment (and currently) I used Effaclar Duo (+) to help with the healing process. It's not effective for acne itself, but it's supposed to help treat imperfections.

- For the past 2 years, I always wore sunscreen.

- I don't eat extremely healthy, but I never eat junk food, and keep famous acne generating foods out of my diet as much as I can (diary, sweets, drinks, fried food, etc.)

- I am usually very stressed because of college life (tests, exams, assignments, etc.) as well as acne itself. There is not much I can do about the stressful life I have.

- My blood work indicated no health issues or anomalies during the Accutane treatment

- I had no visible side effects (dryness, pain, etc.); none at all

Now I am starting to wonder if this type of treatment is effective. Does the dose still accumulate over such long periods? Did I make a mistake somewhere? What can I do next?

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