Several factors have been identified as predictive factors for an acne flare during Accutane (isotreitinoin) treatment. These include: male gender, young age, and the presence of macrocomedones (large whiteheads).
Male gender and young age are generally factors that cause an individual to produce excess sebum. Macrocomedones may be identified by a doctor familiar with acne treatment prior to commencement of oral Accutane. Your doctor would then discuss treatment options with you. At times, these macrocomedones may be treated procedurally before starting Accutane, to reduce your risk of an acne flare while take Accutane.
Nevertheless, a slow response to oral Accutane and/or an acne flare during Accutane can happen. Treatment options include adding an antibiotic such as erythromycin or trimethoprim, adding a course of oral corticosteroids, or even reducing the dose of Accutane if you have very inflammatory acne while on Accutane.
Given that many factors need to be taken into account and eventual treatment plan would differ for each individual, I strongly advise you to see your doctor for his/her opinion on this, and not to increase your Accutane dosage on your own.
Hope this helps!
Regards,
Dr. Joanna Chan
