Isotretinoin not working yet? When you should see results
Isotretinoin takes time. Acne may get worse in the first few weeks, and most improvement comes after the first month or two, as the dose is increased. Judging it within the first month or two is usually too early - it is very unusual not to see significant improvement after a few months on a standard dosage.
The early flare
Acne may worsen once isotretinoin has been started, which is why treatment starts at a relatively low dose. Rarely the flare can be severe enough to cause scarring. If this happens it is important that you contact me, as I will usually decrease the dose or add in additional treatments such as antibiotics or steroid tablets to reduce the risk of permanent scarring.
Why progress can be slow
- The dose is usually increased after the first month or so.
- The average course lasts 6 to 9 months, with the total dose based on body weight. See How long do I need to take isotretinoin for?
- Nodules and cysts clear more slowly than smaller spots.
- Red and brown marks left by old spots fade over months and are not a sign that the treatment is failing.
When to ask for a review
I will always review patients after a month of treatment. However, you should contact me if the acne is getting markedly worse, if you develop painful nodules or signs of scarring, or if you notice low mood or any of the side effects described in the information leaflet.
Starting or reviewing isotretinoin?
I prescribe and monitor isotretinoin under the MHRA rules. The first appointment is in person and follow-ups can often be remote.
Related Articles
- How long do I need to take isotretinoin for?
- How effective is isotretinoin?
- What are the side effects of isotretinoin?
- Isotretinoin treatment
