Acne came back after isotretinoin - what now?

By Dr Magnus Lynch
MA(Cantab) DPhil(Oxon) MRCS FRCP
Consultant Dermatologist & Dermatological Surgeon
Published November 2026

For a high proportion of patients a course of isotretinoin leads to a lasting improvement, but approximately 10 to 15% need a second course at some point, and a smaller proportion need several. Some mild acne after isotretinoin is common and can usually be managed with creams. If it returns more severely, a second course is usually effective.

Mild acne after a course

A course of isotretinoin does not mean you will never have acne again. Mild spots afterwards can usually be managed with over-the-counter or prescription creams.

Why acne comes back

• The total dose: isotretinoin is given as a course in which the total amount is based on body weight. Courses that stop early, or use a lower total dose, are more likely to be followed by relapse. See How long do I need to take isotretinoin for?
• Hormones: in women, acne around the jawline and chin may be hormonal and respond to spironolactone.
• Another diagnosis: perioral dermatitis, folliculitis and rosacea can all look like acne.

A second course

A second course follows the same MHRA rules as the first: a consultation in person, the mental health questionnaires, the Acknowledgement of Risk Form, the pregnancy prevention programme where relevant, and blood tests. Follow-ups can often be remote.

Related Articles

• How effective is isotretinoin?
• How long do I need to take isotretinoin for?
• What treatments are effective for hormonal acne?
• Isotretinoin treatment

About Dr Magnus Lynch

MA(Cantab) DPhil(Oxon) MRCS FRCP

I am a London-based Consultant Dermatologist and Dermatological Surgeon. I am highly experienced in skin cancer diagnosis, Mohs micrographic surgery, acne, rosacea, acne scarring and laser treatments. I studied at the Universities of Cambridge and Oxford, and completed my dermatology training and Mohs fellowship at the prestigious St John's Institute of Dermatology. I graduated from medical school in 2003 and have worked exclusively in Dermatology since 2012.

I lead a research team at King's College London investigating the molecular biology of skin cancer. In recent years I have been involved in Media Appearances, including the Channel 5 series 'Skin A&E', where I perform skin surgeries and treat various skin conditions.

My NHS practice is at Guy's Hospital. I consult with private patients at OneWelbeck (near to Bond Street station), on Harley Street and at The Shard (London Bridge). Book A Consultation.