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Correct Dosage of Accutane / Isotretinoin to Avoid Bad Initial Breakout (Adult Male First Time Acne)

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I'm a 35-year-old male. I'm 6"1' and 196 lbs. I'm writing this with the hopes of helping others who might have or go through my situation which was and still is incredibly frustrating in the hopes of helping them.


I have NEVER had acne in my life. I have always had a baby face, great skin. I never had acne as a teenager, few very light blemishes here and there, never a cyst or a nodule. It would hurt to wash my face. Then I got them on the right side of my face, 2 spots total. I went to a dermatologist and was prescribed the following;


  • Doxycycline antibiotic twice a day (60 days)
  • Twice a week blue light therapy 
  • Aczone topical daytime
  • Vectrin topical night time


This basically made it better and it went away 95% within a few weeks. However, after 5 weeks it came back a lot worse. This time it was cystic acne all over my face with painful nodules. I went back to the same dermatologist and he suggested following.


  • Bactrim antibiotic twice a day
  • Continue Aczone


This did not help, it got worse and worse in 30-45 days. The dermatologist suggested Accutane, I was nervous about side effects but desperate. Here is where things went really wrong;


  • I was put on 40 mg a day Accutane (Isotretinoin) for 4 days and then upped to 60 mg. 
  • Blood tests were all normal, everything came back good.
  • I went to an endocrinologist to check hormones, everything looked good.
  • They basically could not figure out why I got severe acne for the first time in my life, all of a sudden, at the age of 35. (No prior medical conditions)


This was a BIG MISTAKE. My face broke out so bad, over 20 cysts and 50 pimples JUST on my face, nowhere on my body. Painful, I could not wash my face, so bad.


So, if you are thinking about Accutane, DO NOT go with a big does, you will breakout bad and it will cause scars 98%. Thank God, although my stuff was so bad, now that I am on a new therapy, I do not seem to have scarring. Here’s why;


  • I left it alone. DO NOT TOUCH. Do not squeeze, do not put makeup. I know it is hard, this is the main reason you get scars. If it is popping, let it do so by itself. NEVER touch or pick. YOU WILL GET SCARS which will cost you thousands to laser.
  • Wash with a light cleanser like Cetaphil Gentle Skin Cleanser for face and body. You can use the lotion from the same brand as well, it does not burn or upset no matter how bad your acne is, and trust me, mine was REALLY BAD.
  • Very light liquid vitamin E on spots where dead acne was.
  • Light moisturizing.
  • Mediate twice a day, it will do wonders. (Deepak Chopra from Spotify)


Find the BEST DAMN ACNE SPECIALIST in your area. Do not go to any dermatologist. Unfortunately, I saw 4 of them and they did not know much. I know that is bad to hear, but it is TRUE! By the time I saw the acne specialist (her) I had been taking Accutane for 15 days. I saw her on Wednesday, Sep 27th. That was my last day on Accutane. She suggested the following;


1- Stop Accutane right away

2- Take 60 mg of prednisone in the morning for 3 days.

3- Take 40 mg of prednisone in the morning for 11 days after that. DO NOT STOP prednisone. You can decrease to 20 mg if things get better, but do not stop.

4- Take Augmentin (amoxicillin) twice a day 875 mg for 14 days.

Also, take a calcium supplement 1200 mg with Vitamin D.

Zantac for gastric protection twice a day.


5- Come see me again Oct 11th. (after 14 days)

6- We will probably introduce Accutane at 10 mg daily to avoid a bad flare up if things look good.


The inflammation is significantly better. All cysts disappeared from my face. I still have a redness and a few pimples, but nothing like last week. I also do not seem to be scarring, which I am very happy about. This is in just 1 week.

I voiced my concern about a high dose of steroids and she said "let's save your face first and avoid scarring. The negative short-term effects of prednisone outweigh the risks of your face scarring.” 


Prednisone is scary, but if you get as bad as I do, short-term steroids to control things is key! Here’s what I mean by BAD so there are no confusions;


  • Over 20 cysts on my face. They would hurt and eventually give white heads. I NEVER TOUCHED IT and let them pop in the shower by themselves.
  • The whole face covered with over 50 red pimples (only on my face though) This was severe acne.
  • I could not put anything on my face. Pain from cysts were easy 8/10. I could not wash it due to pain, I could not sleep well. Redness and inflammation were just horrendous. 
  • If anybody wants to see pics, direct message me and I can send.


Again, my ideal dosage suggestion for accutane; DO NOT START with a high dose. (Over 20 mg) MORE does not mean better. It is better to start with low dose and increase gradually. I also looked at studies and there is no correlation of the acne coming back faster if you start with a low dose, do your research. 

I hope this helps. I will keep updating you guys on here regarding my experience. Contact me for any questions.

Edited by 35yearoldmalefirsttimeacne
added a detail

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Just doing an update. The combination of prednisone and Augmentin has significantly cleared my breakout from Accutane. I have zero cysts and only a few blemishes on my face now. The hyperpigmentation is still there but much lighter and the redness is going away. The initial accutane breakout seems to have caused a Staph infection on my face which came out of swam results last week. (Not MRSA, the common kind) 

The combination above works! Take control over your breakout if it's too bad and follow instructions above, or tell your Derm about this. I will update this in another 7 days. I am seeing the acne specialist again on Oct 11th and she will suggest how we need to move forward.

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