Can isotretinoin make acne worse before it gets better?
Yes, acne can worsen briefly after isotretinoin starts. The British Association of Dermatologists (BAD) advises that this early worsening can happen before improvement begins, but it is not a stage that every patient must go through.[1]
The important question is whether there has been a significant change in the number, depth, pain or extent of your acne. A mild worsening may be monitored, while a marked flare needs prompt review. Do not change the dose or add other acne medicines on your own.
Is an isotretinoin flare the same as “purging”?
“Purging” is a popular skincare term, but it is not a precise medical diagnosis. It is sometimes used online to describe any early breakout after starting a retinoid. NICE instead describes an acne flare as an acute significant worsening of acne after oral isotretinoin begins.[2]
That distinction matters. One or two new spots may reflect the natural variation of acne rather than a treatment-related flare. A clinically important flare may involve a rapid increase in inflamed spots, painful nodules or cysts, more areas of skin, or a greater risk of scarring.
Photographs taken in consistent lighting can help your clinical team compare your skin with its appearance before treatment.
When might the worsening happen?
BAD patient guidance says acne can become a little worse for a few weeks before improving, and that improvement is usually progressive during the course.[1] There is no reliable week-by-week timetable that applies to everyone.
The course and dose are individual. Some patients notice no early worsening; others see a temporary increase before the longer-term response becomes clear.
Do not judge the whole treatment after a few days. Equally, do not assume that severe or rapidly worsening acne is something you simply have to endure. Your prescriber needs to know if the pattern changes significantly.
Why can acne worsen at the beginning?
Isotretinoin changes activity in the oil glands and the way cells behave within hair follicles. During the early treatment period, inflammation can temporarily become more visible in some people. However, it is not accurate to describe this as the body “detoxing” or impurities being pushed out.
An apparent flare can also have another explanation, including irritating skincare, picking, hormonal change, another medicine or a different skin condition. A review helps confirm what is happening.
What should I do if my acne gets worse?
Contact the prescribing team if the change is more than mild, is painful, is spreading or concerns you. Useful information includes:
when the worsening started;
which areas are affected;
whether spots are deeper, more painful or leaving marks;
your current isotretinoin dose;
any new medicines, supplements or skincare products;
clear photographs, if requested; and
any fever, joint pain, marked tiredness or change in wellbeing.
Keep taking the medicine exactly as prescribed unless your clinician advises otherwise. Do not double, reduce or stop doses based only on social-media advice.
Do not restart leftover doxycycline, lymecycline or another tetracycline antibiotic. UK product information says tetracyclines must not be taken with isotretinoin because of the risk of raised pressure around the brain. Vitamin A supplements and additional strong or exfoliating acne treatments should also be avoided unless the prescriber has specifically recommended them.[3]
How might the clinical team manage a flare?
Management depends on severity. The clinician may compare photographs, review the diagnosis and skincare, and decide whether the dose or follow-up schedule needs changing.
For an acute significant flare after isotretinoin has started, NICE says a course of oral prednisolone may be considered.[2] This is a prescription decision with its own risks and monitoring; it is not a treatment to borrow, request automatically or start without assessment.
NICE also allows a reduced daily isotretinoin dose for people at increased risk of, or experiencing, adverse effects.[2] That does not mean reducing the dose is always the right response. The plan should be made by the clinician who knows your acne and medical history.
What can I do safely at home?
Keep the routine simple while waiting for advice:
Cleanse gently with lukewarm water and a mild, fragrance-free cleanser.
Use a bland, non-comedogenic moisturiser and regular lip balm.
Apply broad-spectrum SPF 30 or higher and avoid sunbeds.
Do not squeeze or pick inflamed lesions, as this increases irritation and scarring risk.
Avoid scrubs, peels, retinol, exfoliating acids and unapproved spot treatments.
See mySkinDoc’s simple skincare routine during isotretinoin for more practical advice.
When is worsening urgent?
Seek urgent medical assessment if acne worsens rapidly with widespread, very painful or ulcerated lesions and you also feel systemically unwell, for example with fever, marked fatigue, muscle or joint pain. This can suggest acne fulminans, a rare severe form for which NICE recommends urgent specialist assessment.[4]
Also seek urgent help for a severe persistent headache with vomiting or visual disturbance, a serious blistering rash, breathing difficulty, or severe changes in mood or behaviour. NHS guidance advises urgent help for suspected serious isotretinoin side effects or thoughts of self-harm.[5]
Does a flare mean isotretinoin is not working?
Not necessarily. A short early worsening does not predict the final result. However, worsening should not be used as proof that the medicine is “working” either. Progress should be assessed across the course by the prescriber, alongside side effects, blood tests and the effect on daily life.
Current MHRA safeguards require mental-health and sexual-function monitoring, an appropriately experienced Lead Prescriber, and the Pregnancy Prevention Programme where relevant. The first assessment must be in person, although suitable follow-ups may be remote.[6]
Frequently asked questions
Should I stop isotretinoin if I get more spots?
Do not stop or alter it solely because of a few new spots. Contact the prescribing team promptly if worsening is significant, painful, rapid or worrying, and follow their advice.
Can I use benzoyl peroxide during a flare?
Do not add benzoyl peroxide, acids or another acne treatment unless your prescriber recommends it. Isotretinoin makes skin more easily irritated, so an extra “active” product may make redness and soreness worse.[3]
How soon should isotretinoin work?
There is no exact timetable for an individual. BAD advises that improvement is progressive through the course and may follow a few weeks of early worsening.[1] Your follow-up reviews are the right place to judge progress.
Getting the right acne assessment
Oral isotretinoin is reserved for suitable patients with severe, scarring or treatment-resistant acne and is not guaranteed after a consultation. If persistent acne is painful, leaving scars or not responding to appropriate treatment, a structured acne assessment can review what you have tried, the diagnosis and the safest next options. Read about mySkinDoc’s doctor-led acne assessment and monitoring pathway.
References
Sources checked 20 October 2026.
