Isotretinoin Does Not Always Achieve a Long-term Result, and 14.6 – 52% of Patients Relapse
The Essential Info
Isotretinoin, often known by its original brand name, Accutane®, is an oral prescription medication that dermatologists sometimes prescribe to people with severe, scarring acne that does not respond to other treatments.
It is effective, and can provide for long-term remission in some people. But for other people it provides only temporary relief. Relapse rates following isotretinoin treatment vary between 14.6% to 52%, which is higher than scientists previously believed. Several factors increase the likelihood of an acne relapse:
- Male gender
- More severe acne
- Hormonal imbalance
- Lower treatment dosage
- Not taking isotretinoin pills with fatty food
Isotretinoin comes with numerous and sometimes severe and long-term side effects. Before considering it, do your research and be certain it’s the right course of action.
My Experience: I took isotretinoin in college for the usual 15-20 week course (I forget the exact amount of time). I went from having severe acne on my face and body to perfectly clear skin within a month or so. It was glorious. However, immediately following my isotretinoin course, I relapsed and started breaking out again, albeit not quite as badly. I experienced the same side effects as most people: severely dry lips, dry skin, and irritated eyes. I also experienced cumbersome joint pain. To this day I have to use lip balm several times a day and my joints have never quite gone back to normal. Take it from me, only consider isotretinoin if you really need it.
- Factors That Increase Relapse after Isotretinoin Treatment
- Do People Need Maintenance Therapy after Isotretinoin?
- The Bottom Line
Accutane (isotretinoin) is a highly effective acne treatment. This effectiveness has led many to believe that isotretinoin acts as a cure for even the most severe acne. Research, however, has shown that 14.6% to 52% of patients experience a relapse of acne after undergoing isotretinoin therapy.
When we look at 17 studies from 1989 through 2020 that look at acne relapse after isotretinoin, we can see this relapse range of 14.6 – 52%. The reason there is such a wide range is because of different study designs and definitions of exactly what “relapse” means. Some people may not report a relapse of their acne because their acne is improved compared to how it was before isotretinoin therapy, and therefore, they do not consider themselves to have “bad acne” like they did before they took isotretinoin, even though their acne did come back to a lesser degree.
Expand to read details of studies on relapse rate of isotretinoin
Factors That Increase Relapse after Isotretinoin Treatment
Several factors may increase the rate of relapse in patients treated with isotretinoin. These include:
- Severity of acne: people with more severe acne, and acne on the body, relapse more frequently
- Treatment dosage: People receiving lower dosages relapse more frequently.
- Taking isotretinoin with food: Isotretinoin is much better absorbed when taken with an adequate amount of dietary fat. People who take isotretinoin without a meal that contains an adequate amount of fat may not absorb as much medication.
- Hormonal imbalances (especially in women): Women with hormonal imbalances relapse more often.
- Gender: Males relapse more often than females.
Here are the studies that show us how these factors can increase the chances of relapse after isotretinoin treatment:
Expand to read details of studies on factors that increase chances of relapse
Studies that identified the factors of treatment dosage and taking isotretinoin with food with relapse
A collection of seven studies published in various journals between 1983 and 1998 found that increasing the dose of isotretinoin decreased the rate of acne relapse. However, each study compared different daily and cumulative doses of isotretinoin during the treatment. These dosage inconsistencies prevent researchers from comparing the studies to identify which dosage of isotretinoin is optimal to reduce acne relapse rates.10-16
Expand to read details of studies on treatment dosage and relapse rate
Do People Need Maintenance Therapy after Isotretinoin?
Often, dermatologists prescribe other acne medications as a maintenance therapy following isotretinoin treatment. Patients using a maintenance therapy may topically apply adapalene, benzoyl peroxide, retinoids, or combinations of these medications to keep acne at bay. However, this points to the reality that to stay clear of acne after isotretinoin, ongoing medication may be required.
A 2012 study published in Dermatology Research and Practice observed 20 male patients for acne relapse following isotretinoin treatment. The researchers found that men using a maintenance therapy had, on average, 38.7 less acne lesions than men who did not use a maintenance therapy.21
A 2013 study published in Dermatology studied 70 patients with moderate acne to determine if a maintenance therapy prevented relapse after isotretinoin treatment. This study found that only 2.94% of patients experienced an acne relapse if they used adapalene and benzoyl peroxide daily for one year following isotretinoin treatment. Although this study did not look past one year, it still reported much lower rates of relapse than previous studies lacking a maintenance therapy.3
The Bottom Line
Relapse after isotretinoin may be higher than people expect. While in many cases acne is permanently reduced, in 14.6 to 52% of people, acne will return to some degree, necessitating ongoing maintenance therapy with other treatments.
Since isotretinoin is such a serious medication that changes the skin and the rest of the body forever, and can come with lifelong side effects, it is vitally important that people with acne take all of these things into consideration before embarking on isotretinoin therapy.
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- Morales-Cardona, C. & Sánchez-Vanegas, G. Acne relapse rate and predictors of relapse following treatment with oral isotretinoin. Actas Dermosifiliograf. 104, 61-66 (2013). https://www.ncbi.nlm.nih.gov/pubmed/22795452
- Bettoli, V. et al. Maintenance therapy for acne vulgaris: efficacy of a 12-month treatment with adapalene-benzoyl peroxide after oral isotretinoin and a review of the literature. Dermatology. 227, 97-102 (2013). https://www.ncbi.nlm.nih.gov/pubmed/24029411
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- Jones, D. H., King, K., Miller, A. J. & Cunliffe, W. J. A dose-response study of I3-cis-retinoic acid in acne vulgaris. Br. J. Dermatol. 108, 333-343 (1983). https://www.ncbi.nlm.nih.gov/pubmed/6219690
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- Layton, A. M., Knaggs, H., Taylor, J. & Cunliffe, W. J. Isotretinoin for acne vulgaris–10 years later: a safe and successful treatment. Br. J. Dermatol. 129, 292-296 (1993). https://www.ncbi.nlm.nih.gov/pubmed/8286227
- Stainforth, J. M., layton, A. M., Taylor, J. & Cunliffe, W. J. Isotretinoin for the treatment of acne vulgaris: which factors may predict the need for more than one course? Br. J. Dermatol. 129, 297-301 (1993). https://www.ncbi.nlm.nih.gov/pubmed/8286228
- White, G. M., Chen, W., Yao, J., & Wolde-Tsadik, G. Recurrence rates after the first course of isotretinoin. Arch. Dermatology. 134, 376-378 (1998). https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3970835/
- Borghi, A. et al. Low-cumulative dose isotretinoin treatment in mild-to-moderate acne: efficacy in achieving stable remission. J. Eur. Acad. Dermatol. Venereol. 25, 1094-1098 (2011). https://www.ncbi.nlm.nih.gov/pubmed/21198947
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- Del Rosso, J. Q., Stein Gold, L., Segal, J. & Zaenglein, A. L. An open-label, Phase IV study evaluating lidose-isotretinoin administered without food in patients with severe recalcitrant nodular acne: Low relapse rates observed over the 104-week post-treatment period. J. Clin. Aesthet. Dermatol. 12, 13‐18 (2019). https://www.ncbi.nlm.nih.gov/pubmed/32038751
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