Breaking Out Again After Accutane? THIS May be Why and What to Do

If you have acne-prone skin, you’re likely familiar with Accutane (a brand name for the retinoid drug isotretinoin). The medication – which is also sold under the names Amnesteem, Sotret, Claravis, and Absorica – quickly became one of the best-selling prescription drugs for treating acne after hitting the market in the 1980s. 

After being prescribed to patients for several decades, the medication doesn’t glitter so brightly. There’s a long list of potentially dangerous side effects. The company behind Accutane has also faced some revealing legal troubles, with over 8,000 lawsuits filed against the drug maker by the early 2000s (many of which are related to its negative impact on gut health).  

On top of that, researchers and past isotretinoin patients alike have begun to question the drug’s long-term efficacy. So if you’re wondering “why am I breaking out again after Accutane?”, you’re definitely not alone. 

Can Your Skin Relapse After Accutane?

While it was once considered the gold standard of acne treatments, the reality is that Accutane (as well as its generic isotretinoin counterparts) may not be as effective as it once seemed. One small study found that only 46% of patients experienced full clearance of their skin at the end of their treatment. Additionally, there have been multiple studies showing that around 10% to 60% of patients will experience an acne relapse within two years of stopping treatment.  

Beyond the evidence that acne relapses post-Accutane are more common than once thought, more light has been shed on the very serious side effects. If you’ve taken the medication, we probably don’t need to tell you that it can aggressively dry out your skin, lips, and eyes. However, there is a risk of other more severe long-lasting effects, including birth defects, inflammatory bowel diseases (including Crohn’s diseases and ulcerative colitis), and even depression and suicidal thoughts. 

Although many people take the drug with good results and with minimal side effects, it is important for each individual to fully assess the potential risks and benefits before taking any medication.

Factors That Affect Accutane Efficacy

There are numerous factors that may affect the efficacy and relapse likelihood of Accutane, including:

• Age: In one small study of 89 patients, researchers found that younger patients relapsed more frequently than older patients. 

• Gender: The same study found that men were slightly more likely to relapse than women, whereas a separate study revealed that relapse was twice as likely for the male participants.

• Dosage: In another small study (with 87 patients), researchers found an association between the long-term effectiveness and the isotretinoin dose. They revealed that around 53% to 63% of participants who took daily doses under 1.00 mg/kg of body weight relapsed within a year. By contrast, 19% of participants at a 1.00 mg/kg daily dose relapsed after a year. 

• Acne Severity: Researchers found that those who also have body acne were more likely to relapse after Accutane compared to those only with face acne. 

• Duration of Acne Prior to Treatment: The same researchers also stated that those who had acne for under six years didn’t respond as well to the medication compared to those with longer cases of acne. 

How Does Accutane Work?

It’s important to remember that Accutane doesn’t directly or effectively address what is now believed to be the primary or root cause of acne: inflammation. 

Instead, Accutane addresses breakouts in two ways. First, it shrinks the sebaceous glands in your skin to minimize oil production – and as a result, reduces pore-clogging oil on the skin. This is why people battle severe dryness during the treatment, which sometimes persists even after they stop taking the drug. 

However, while excess oil plays a role in acne development, it’s not the first domino in the chain of events that set off acne. Plus, your oil production is heavily influenced by diet and lifestyle factors, so there are plenty of simple ways you can get your oil production to normalize, without risking harsh side effects. (See ideas below). 

Secondly, isotretinoin prevents skin cells from sticking together and clogging the pores. This helps because those with acne tend to have faulty skin cell turnover. They produce an excess of dead skin cells which, when not properly shed, can clog pores and contribute to breakouts.

That said, it’s probably no surprise that a vitamin A deficiency is common amongst acne patients, as this vitamin supports healthy skin cell turnover (making it critical for clear skin!). It’s also no coincidence that isotretinoin is a synthetic derivative of vitamin A.   

Natural Alternatives to Accutane

Whether your skin has relapsed after Accutane, or you want to try a natural approach before trying it, there are many simple diet and lifestyle changes you could try that could have a huge impact on your skin. 

Identify the Root Cause

Although inflammation is believed to be the underlying root cause of acne, there are multiple causes of inflammation– and they are different for each of us. Acne Nutritionist Maria Marlowe says that the most common ones she sees in her practice are nutrient deficiencies, a pro-inflammatory diet, hormone imbalance, gut dysbiosis, stress, and overly harsh skincare. Consider working with a nutritionist who will help you identify your triggers and create a course of action for eradicating acne. By knowing what exactly is causing your blemishes, you’ll be able to effectively achieve and maintain a clear complexion by going right to the source of your skin issues. 

Try a Low Glycemic Load Diet to Reduce Excess Oil

You can naturally reduce your skin’s sebum production and control breakouts – simply by making changes to the food that you eat. 

High glycemic foods (like refined carbs and sugar) are quickly digested by the body, causing a rapid rise in glucose levels. This triggers the pancreas to create insulin, which can be problematic for acne patients. Studies have linked high insulin levels to breakouts, in part due to insulin’s impact on androgen production. Research has confirmed that a high glycemic load diet can trigger the skin to overproduce oil, making it more at risk of breakouts. 

Meanwhile, a low glycemic load diet - one that keeps your blood sugar stable, has been shown to help reverse excess oil and acne. Plus, in addition to keeping oil and breakouts in check, a low glycemic diet can aid in hormone balance. 

According to Acne Nutritionist Maria Marlowe, changes are evident in your skin in as little as a few days or weeks after making changes to your diet. “My acne clients are often astonished that they can see a difference in their skin in as little as 3 days of targeted food changes, and most people find by 8 to 12 weeks, their skin has completely transformed,” she says. 

For those with excessive oil production, she also recommends Glow Biome, the probiotic she formulated specifically for acne-prone skin. In an independent clinical trial, participants who added 1 serving (2 capsules) of Glow Biome to their routine for 12 weeks experienced a 35% reduction in excess sebum, a 41% increase in skin hydration, and 80% of participants had less frequent and less severe breakouts.

Eat More Vitamin A Rich Foods to Improve Cell Turnover

As we covered above, vitamin A deficiencies are common in those with acne-prone skin. To support healthy skin cell turnover, incorporate more foods into your diet that are packed with vitamin A. This includes dark leafy greens, bright orange veggies (like carrots and sweet potatoes), cod liver oil, and beef liver. It’s also smart to get a blood test to check your vitamin A levels. 

We also recommend following an anti-inflammatory diet to support your complexion and your overall health. Incorporate fiber, omega-3 fatty acids, antioxidants, and other nutrient-rich foods into your daily diet. 

Support Gut Health to Improve Skin Clarity

In addition to eating foods that support clear, healthy skin, one of the best ways to enhance your complexion from within is by improving your gut health. 

All acne-prone individuals (regardless of whether they’ve taken Accutane or not) should show some love to their gut, as acne patients are more likely to have gut dysbiosis than people with clear skin. One way to do this is through adding probiotic-rich foods into your diet, such as fermented foods like kimchi, sauerkraut, and kefir. 

We also highly recommend adding a probiotic supplement like Glow Biome to your routine to ensure you get your daily dose of gut-loving “good” bacteria. Research has shown that people with acne tend to lack good lactobacillus and bifidobacteria strains, and supplementing is an easy way to introduce them to your gut. 

What makes Glow Biome special is that it was formulated specifically for acne-prone skin with 6 lactobacillus and bifidobacteria probiotic strains that target the gut-skin connection. This includes L. rhamnosus SP1, L. acidophilus, L. plantarum, and B. lactis. In an independent clinical trial 80% of participants who took Glow Biome daily for 12 weeks experienced less frequent and less severe breakouts. 

Work on Managing Stress to Reduce Oil Production

Our final tip: keep your stress levels in check! Research has shown that stressful thoughts – and more specifically, the elevated cortisol levels that come with them – can increase oil production in the sebaceous glands. 

Some of our favorite stress-busting activities include spending time in nature, breathwork, yoga, and meditation, but the possibilities are endless, so find what works for you.