How Fast Does Accutane Start Working? A Dermatologist’s Insight From Years of Experience

If you’ve endured acne for a long time, you’ve likely heard about Accutane from someone who swears it changed their life. Some may even call it the “ultimate acne cure,” setting high expectations. And it’s natural to want results right away after hearing the glowing stories about this medication.

But doubt may creep in when the days pass without visible change. Worse, the uncomfortable side effects appear before any real improvements. That’s when patients naturally ask: How fast does Accutane start working?

In this article, you’ll learn how the drug soothes pimples, why it outperforms other treatments, and why noticeable results take time. But first, you need to know…

How Does Acne Form?

A pimple doesn’t just appear out of nowhere. Under every pore is a hair follicle and its oil gland. A hormonal imbalance, particularly one involving male hormones or “androgens,” can trigger fast cell buildup inside the hair follicle and abnormal activity in the oil gland.

Skin cells within the pore pile up and clump together, plugging the opening. Meanwhile, excess oil creates a breeding ground for acne bacteria, aka Cutibacterium acnes. Dysfunctional oil glands also make the skin’s natural oil lose its germ-fighting power.

Clogged pores build up pressure and leak oil, dead cells, and bacterial waste into nearby skin. This combination sparks inflammation, the final step that makes acne red, swollen, and painful.

Androgens, including testosterone, are key drivers of acne formation. That’s why women with hormonal conditions that raise androgen levels, such as polycystic ovary syndrome, are more likely to get breakouts. However, external influences like stress, the use of certain medications, poor hygiene practices, and an unhealthy lifestyle can also cause acne flare-ups.

What Is Accutane?

Accutane is the brand name of the first oral isotretinoin formulation approved by the FDA in 1982. Isotretinoin is a vitamin-A-like drug. Once inside the body, it changes into its active form, which switches on certain genes that help cells behave more normally. In the skin, isotretinoin reduces the effects of androgens and unleashes natural chemicals that promote proper cell development.

How Does Accutane Work for Acne Treatment?

Among all available acne treatments, isotretinoin stands out as the most effective because it targets every stage of acne formation. By dialing down the effects of androgens and resetting how skin cells grow, this medication helps clear clogged pores, shrink oil glands, and restore normal gland function.

Less oil means acne-causing bacteria have a harder time thriving. Isotretinoin also boosts your skin’s immune system, reducing bacterial growth and the inflammation that triggers breakouts.

The FDA has approved oral isotretinoin for stubborn, severe acne with large, deep bumps called “nodules,” which often cause scar formation. But at BHSkin Dermatology, we may also prescribe it for patients whose acne hasn’t improved with strong treatments like antibiotic pills, even if their breakouts are milder, and people with bad scarring or emotional distress due to pimples.

Accutane Timeline: How Long Does It Take to See Results?

Although isotretinoin was first studied and approved decades ago, the findings on how quickly it works still hold true today.

• Week 1: Reduced oiliness and thinning of the outer skin layer make the lips, eyes, and other moist surfaces feel dry.
• Weeks 3-4: About 25% of facial pimples and roughly 30% of lesions on the chest and back may disappear.
• End of month 2: Clearance on the torso lags slightly behind the face, with up to 58% of facial pimples and 41% of chest and back lesions gone.
• End of month 5 (typical treatment duration): Only around 10-20% of facial lesions and 30-50% of upper body lesions remain.
• End of month 3 after finishing the treatment: Facial acne continues to improve, leaving fewer than 5% of lesions, while 20-25% may persist on the chest and back.

This timeline gives a realistic picture of how acne clears over time with isotretinoin. Note that patients often see faster or more complete results at higher doses. Some people may need a longer treatment course to achieve complete clearance.

Around weeks 3 to 6, some patients may experience the “Accutane purge”—a temporary flare-up of pimples before symptoms start improving. The exact reason isn’t fully understood, but possible explanations include the following:

• Changes in skin oils: Isotretinoin alters the type of oils your skin makes. Some of these oils normally help produce chemicals that control inflammation, so changing them can temporarily trigger redness and swelling.
• Overreaction to bacteria: At the start of therapy, the pores can become more sensitive to waste products produced by acne-causing bacteria. People with large or multiple tiny blackheads or whiteheads, severe acne at baseline, or a high initial isotretinoin dose are at greater risk.
• Altered immune activity: Isotretinoin changes how immune cells behave in the skin, which can briefly make pimples worse before calming inflammation later.

The Accutane purge is usually short-lived and often a sign that the drug is starting to work. Preventive measures may include removing blackheads and whiteheads through simple procedures like extraction or cautery (burning) or starting isotretinoin at a low dose.

Inflammation may be eased with short-term treatments such as steroids, azithromycin, antihistamines, and intense pulsed light. For patients who cannot tolerate the flare or other isotretinoin side effects, alternatives like photodynamic therapy and oral dapsone may be considered.

Isotretinoin usually provides lingering results. However, acne may relapse in people with severe acne before treatment, lower overall doses, increased androgen activity, younger age, or recent onset of the condition. At BHSkin Dermatology, we may recommend an additional course of isotretinoin to help such patients clear their skin fully.

Why Does Accutane Work Slowly, and Why Is That a Good Thing?

Isotretinoin’s complex effects on hair follicle and oil gland cells mean changes happen slowly—matching the skin’s renewal cycle, which takes about a month. This gradual improvement helps the skin adjust layer by layer.

Pimple-causing germs diminish as oil levels drop, reducing inflammation. The slow process targets every major stage of acne formation—something other treatments can’t do as completely—producing longer-lasting benefits.

Why Do Some People See Accutane Results Sooner?

Everyone’s experience with isotretinoin varies, influenced by many factors that affect how quickly and effectively the drug works. Being aware of these factors helps you set reasonable expectations and stay confident during your journey toward clearer, healthier skin.

The severity of acne plays a big role. People with more severe acne often take longer to see significant changes because deeper, more stubborn lesions need more time to heal.

Dose matters, too. Higher doses generally produce faster results, but weight impacts the effective blood levels for each person. Since isotretinoin is fat-soluble, taking it with food improves absorption. Substances and medications that affect liver metabolism, like cannabis and the immunosuppressant methotrexate, can alter how much of the drug actually reaches the bloodstream.

The total amount of isotretinoin a person takes over their treatment course is closely linked to long-term success. Achieving the target cumulative dose reduces the risk of relapse and ensures more complete clearance.

Following the prescribed dose schedule ensures the drug works effectively. If side effects force you to stop or reduce your dose, your dermatologist can help manage the uncomfortable symptoms so you can stay on track safely.

The way isotretinoin interacts with a person’s skin at the cellular level varies. Your genes can determine how sensitive your oil glands and hair follicles are to the drug.

People with higher androgen levels—whether due to natural factors, such as sex differences, or health issues related to hormonal imbalance—may see slower responses. Androgens influence all stages of acne formation, so the drug must overcome stronger hormonal effects in some individuals.

Your skin’s natural bacteria can make a difference during isotretinoin treatment. A balanced mix can speed up healing, but an imbalance can slow it down. Meanwhile, the growth of some skin-inhabiting bacteria, particularly Staphylococcus aureus, can keep acne inflammation active even after pimple-causing bacteria numbers drop.

Combining other acne treatments with isotretinoin can quicken results if used as recommended. Gentle cleansing, applying the right topical medications, moisturizing, and protecting the skin from sunlight all help this vitamin-A-like drug work more efficiently.

When Should You Call Your Dermatologist While on Accutane Treatment?

You’ll typically see your dermatologist once a month while on isotretinoin therapy to track your progress and adjust your dose if needed. However, you may contact them sooner for the following reasons:

• You experience severe or intolerable reactions to the drug. Our previous article on isotretinoin side effects explains what to watch for and how to handle them.
• Your acne worsens after the second month, beyond what’s normal for the Accutane purge.
• You plan to start another medication or skin treatment, which may impact how you use isotretinoin.
• Pregnancy occurs or is suspected.

Obtaining medical help promptly ensures your treatment stays safe and effective. Importantly, following your dermatologist’s instructions closely helps you get the best results.

What This Means for Your Accutane Journey

Isotretinoin is a powerful treatment that works gradually by addressing all four stages of acne formation, making it more effective than many alternatives. Being consistent with your treatment, staying patient, and paying attention to how your body reacts are important to ensure the best outcomes.

Your dermatologist is your best ally during therapy. Reach out if you develop severe side effects, notice worsening acne beyond the expected flare, plan to start another treatment, or face a possible pregnancy.

Finally, acne is a challenging condition that deserves more than quick fixes. To make sure your acne treatment fits your specific needs, it’s best to trust a board-certified dermatologist, the most qualified medical expert to keep your skin always selfie-ready.

Wishing on a Star Won’t Get You Clear Skin, but LA’s Top Acne Specialists Can

Everywhere you scroll, someone’s selling the next acne cure-all. You’ve tried every trend, hearing the same glow-up promises but facing the same heartbreak. Who can finally help you change your skincare story for good?

At BHSkin Dermatology, our team of board-certified dermatologists specializes in advanced acne treatments and is regarded as among the best in California. They’ve built a solid track record of helping patients get real, lasting pimple relief. Get started with an in-person consultation at our Glendale or Encino clinic or an online session via our telederm platform.

You’ve wished on the stars long enough. Book your appointment today!

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Author: Don Mehrabi

Don Mehrabi, MD, FAAD, is LA's leading board-certified dermatologist is the president of BHSkin Dermatology and proud father of 3 wonderful children. He treats patients in both Encino-Tarzana and Glendale. This blog builds on medical studies combined with Dr. Mehrabi's first-hand experiences from his practice.