Accutane before and after: results and relapse

Before and after photos of isotretinoin, the drug many still call Accutane, are everywhere online. Skinli shows none. A single photo cannot tell you how many people clear, how long it took, or whether the acne came back. The trials, the FDA label and the American Academy of Dermatology (AAD) can, and this guide reports what they found. For the drug itself, see the Accutane guide.

Skinli gives general education and is not a doctor. Isotretinoin is prescribed and monitored by a doctor, and your own results depend on your acne, your dose and your course. If your acne is deep, painful or scarring, the first step is seeing a dermatologist for severe acne.

How results are measured

Studies measure isotretinoin results in a few ways, and it helps to know which one a number uses:

• Nodule counts. Nodules are the deep, painful lumps of severe acne. The trial on one FDA label counted them on the face and trunk.
• Inflamed spot counts. Red, swollen spots and pus-filled spots, counted before and after.
• Relapse. Most large studies count acne as coming back when a person needs acne treatment again.
• Quality of life. Questionnaires about how acne affects feelings and daily life.

How many people clear

Source	What it reports
FDA label trial, 925 patients, 20 weeks	Patients started with 17.7 to 18.4 nodules on average, and the average fell by more than 15. A 90 percent or greater drop in 70 percent of one group and 75 percent of the other
FDA label	A single 15 to 20-week course "has been shown to result in complete and prolonged remission of acne in many patients"
AAD, severe acne page	Estimates that 85 percent of patients see permanent clearing after one course
2018 review in the British Journal of Dermatology, 11 trials	Isotretinoin reduced acne lesions by a clinically relevant amount, and always by more than the comparison treatment
Trial of 150 people with severe acne, in the 2018 Cochrane review	After 20 weeks, 90 percent reached a 95 percent drop in inflamed spots at 1 mg per kilogram a day

The 2018 Cochrane review, which pooled 31 randomized trials, rated much of the evidence as low quality. In three trials comparing isotretinoin with antibiotic pills plus creams in moderate or severe acne, it found no clear difference in inflamed spot counts after 20 to 24 weeks, and a possible 15 percent improvement in the doctor's overall rating of severity. The Cochrane authors called for more research on isotretinoin for acne that has not responded to antibiotic pills plus creams.

Teenagers and adults

The FDA label describes a trial that compared 103 teenagers aged 13 to 17 with 197 adults, all with severe nodular acne, at 1 mg per kilogram a day. It says the drug was similarly effective in both groups. Teenagers had more back pain, joint pain and muscle pain, which the side effects guide covers.

Quality of life

Clear skin is one result; how people feel is another. A 2020 study in JAMA Dermatology followed 57 patients, with a median age of 17, who filled in a questionnaire on how their skin affected their emotions, symptoms and daily life at each monthly visit. The overall score fell from 39.4 at the start to 17.5 by month 2, where a lower score means less burden. By month 4 it was 8.9, a 4.4-fold improvement, and the emotional score went from 57.7 to 11.9. The study had no comparison group, so it shows the change during treatment without proving the drug alone caused all of it.

What affects your result

The sources name several factors, each a matter for your prescriber:

• Total dose. The label says lower daily doses led to more repeat courses, and the 2025 study linked a higher total over the course to less relapse. The low dose Accutane guide covers this.
• Sex and age. Women relapsed more often in the 2025 study. In the 2007 study, being male and being under 16 were each linked to more relapse.
• Taking it as directed. For products that must be taken with food, the older Accutane label says skipping food lowers absorption.
• Where the acne is. The label says acne mainly on the trunk may need a higher dose.

Questions to ask before you start

• How will we measure my progress, and how often?
• What result would count as success for my acne?
• What happens if my acne comes back after the course?
• What should my skin care plan be once the course ends?

How long clearing takes

The FDA label sets a normal course at 15 to 20 weeks. The AAD says acne may worsen for 1 to 2 months before it begins to clear, though this does not happen to most patients. A 2020 JAMA Dermatology study of 57 patients found their quality of life scores improved by more than half by the second month and reached their best between months 3 and 5. The how long Accutane takes to work guide sets out the timeline, and the Accutane purge guide covers the early flare.

After the course

The label says acne may continue to improve after a course, and the AAD says the skin often keeps clearing for a while after stopping. This is why the label advises waiting at least 2 months before any second course.

How often acne comes back

Study	Patients	What it found
2025, JAMA Dermatology, US insurance records from 2017 to 2020	19,907, each followed for at least a year after treatment	22.5 percent had a relapse, and 8.2 percent took a second course of isotretinoin
2007, British Journal of Dermatology, Quebec records from 1984 to 2003	17,351 first-time users	41 percent later received acne medicine again, and 26 percent a second course of isotretinoin

The two studies found different risk factors. In the 2025 study, women relapsed more often, and a higher total dose over the course was linked to less relapse. In the 2007 study, being male, being under 16, and taking a larger total amount or a longer course were linked to more relapse. The studies used different eras, doses and definitions, so their results are hard to compare directly. The 2025 authors concluded that a higher total dose may lower the risk of relapse.

A second course

The FDA label allows a second course after at least 2 months off, if severe nodular acne persists or returns, in patients who have finished growing. It says the best gap has not been defined for teenagers who are still growing. The AAD says a second course helps some patients who did not clear after the first.

The UK NICE guideline sets out what happens after a relapse. If the acne is mild to moderate, it recommends a standard treatment. If it is moderate to severe, it recommends a 12-week course of standard treatment or a return to the specialist team. After a second course of isotretinoin, further care is decided by the specialist team.

Scars

Isotretinoin's main effect on scars is prevention. The AAD says fewer breakouts lead to fewer acne scars, and that when the cysts and nodules of severe acne clear, they leave permanent scars. The 2024 AAD guideline strongly recommends isotretinoin for acne that is causing scarring.

Scars that already exist need their own treatment, later. The FDA label says to avoid waxing and skin resurfacing, such as dermabrasion and laser, during treatment and for at least 6 months after, because of a possible risk of scarring. For what can be done after that, see acne scar treatment, whether acne scars are permanent, tretinoin for acne scars and the microneedling guide, which covers the wait after isotretinoin.

Keeping skin clear afterwards

The AAD's severe acne page says that after skin is clear or nearly clear, you still need acne treatment, though the type may change. It says most people can keep acne away with proper skin care and medicine applied to the skin, and that without this treatment acne can return quickly. Ask your dermatologist at your last visit what your plan should be for the months after the course.

Your own before and after

The most useful before and after is your own, taken the same way each month. Photos in the same light, from the same angles, let you and your prescriber compare the same view each month. How to take acne progress photos shows how. For side effects to report along the way, see the Accutane side effects guide.