The Accutane Purge: Timeline & How to Get Through It

If you’re here for the short version: the Accutane (isotretinoin) purge is usually described as starting within the first few weeks, peaking around weeks three and four, and settling by weeks six to eight. Reported rates run from about 5% to 27% of patients, so many don’t purge at all.

What the Purge Is and Why It Happens

The Accutane (isotretinoin) “purge phase” is a temporary period of increased breakouts, irritation, and other related side effects during the earlier stages of starting and adjusting to the medication. It is generally temporary, and while frustrating, is generally considered a sign that the medication is working as intended.

The label describes the same thing in clinical terms: “transient exacerbation (flare) of acne has been seen, generally during the initial period of therapy.”

US Food and Drug Administration (2002). Accutane (isotretinoin) prescribing information

This matters because isotretinoin is a longer term treatment, so while it can be discouraging in the short term to experience an influx of acne spots when you are trying to get clearer skin, it’s important to realize this is part of the process. It’s important to set expectations and prepare mentally and emotionally before starting, so that you aren’t surprised and stop early, before results have the chance to show.

While it’s not exactly known how the purge itself happens, there are a few commonly discussed reasons, namely the mechanisms of isotretinoin itself. Isotretinoin works through a few main mechanisms, and accelerated skin cell turnover and shrinking oil cells (oil production) are two of the biggest.

Paichitrojjana et al. (2023). Drug Design, Development and Therapy

It’s thought that this sudden increase in skin cell turnover can push acne that was already going to come up to the surface faster. Along with pre-existing acne spots, it can appear as though your skin gets drastically worse after starting the medication. It could also be due to the irritation and adjustment to the medication as well. The purge phase is also seen in topical retinoids like tretinoin.

Does Everyone Purge on Accutane?

It’s also important to note that not everyone taking isotretinoin will experience a purge phase. Across four studies in a 2023 systematic review of isotretinoin dosing, reported flare rates ranged from 5.3% of patients up to 27%.

Daly et al. (2023). JEADV Clinical Practice

The clearest risk factor in the literature is not age or gender but large closed comedones already present before starting, which the 2009 study treated beforehand precisely to remove that variable. Factors like gender, age, and acne severity are often suggested as playing a role, though the reviews measure rates and dose rather than who flares.

Borghi et al. (2009). Dermatology

Accutane Purge Timeline: When Purging Starts, Week by Week

A note on what the weeks below are. The broad arc is consistently described by patients and by clinicians, and the label supports it: a flare happens, and it is transient and early. There isn’t exact data for week by week variations. So look at the numbers as the broad shape of a typical course rather than a guaranteed schedule yours will follow, and remember, a good number of patients will never purge at all.

Weeks 1-2

During the first one to two weeks after starting Accutane (isotretinoin), the medication is just starting to take effect. You might notice some of the more common side effects like dry skin, lips, and itchiness, but no real acne related changes yet.

Towards the second week, acne spots and breakouts might worsen as skin continues to dry.

Weeks 3-4

Weeks three and four are where most people describe the peak of the purge phase, if you were to experience it. More breakouts and pimples are possible, especially in areas where you commonly had them prior to treatment. Other side effects like redness and dryness might be happening at the same time.

This period is a meaningful shift in the treatment timeline, basically the peak adjustment period. This is because you not only might still have active acne or unhealed marks from the underlying condition itself, but also more showing up due to the medication transition, the purge phase, while at the same time experiencing uncomfortable side effects like dryness and redness.

You might be wondering if it’s worth it to continue, because the combination of negative experiences might be too much all at once. The good news is that most people report being close to a turning point at this stage.

Weeks 5-6

As you head into weeks five and six, many see noticeable improvements for their skin: fewer breakouts, older spots healing, and irritation and inflammation reducing/calming down.

Weeks 6+

Beyond week six, many see clear visible improvements at this point alongside less frequent breakouts, and overall clearer, smoother, and healthier-looking skin. You might still see post-inflammatory hyperpigmentation from older acne marks, but fewer active acne spots and less oil.

During this time you’ve likely adjusted to the side effects, and to the extent they’re still there, they’ve stabilized and become manageable. The worst of the purge phase is also likely behind you.

Is Accutane Working, or Just Purging?

Even being armed with the knowledge that the purge phase exists, and can happen to some patients, it’s still very discouraging to deal with in the immediate short term, day to day. Some patients might wonder whether Accutane (isotretinoin) is even working, or if it’s just the purge phase, and they’ll eventually see results.

The main thing to note is that the purge phase is generally described as following a broadly similar arc for those who experience it. If you experience new breakouts for a period longer than what seems normal, reach out to your medical provider.

For the longer arc past the purge, see our month-by-month timeline.

How Long Does the Accutane Purge Last, and What Makes It Longer?

You might be wondering what factors can make the purge phase worse or longer. For those who have more aggressive or severe acne before starting Accutane (isotretinoin) or started on a higher dose, there may be more aggressive breakouts in the short term.

If your skincare habits are harsh, or the climate/weather you live in is harsh, that can also complicate or prolong the purge phase.

Can You Avoid the Accutane Purge?

If the Accutane (isotretinoin) purge phase scares you, it’s ok, because there are a few ways to potentially ease up this transitory period. While you can’t reliably prevent or avoid the purge phase itself, you can make it easier on your skin and minimize side effects with a few helpful tricks we’ll share with you.

For dose specifically, the evidence isn’t fully clear but can be something to ask about. A 2009 study above found roughly half the flare rate on the lower starting dose, while another study in a 2023 review found the same pattern (15.6% versus 25%). A second study in that same review found 27% of patients flared with no relationship to dose at all.

Daly et al. (2023). JEADV Clinical Practice

How to Get Through the Accutane Purge

Keeping a simple skincare routine is one of the most helpful things you can do while on isotretinoin. Active ingredients like other retinoids and vitamin C, while effective, can be harsh on the skin. The same logic applies for skincare products like exfoliants. Isotretinoin itself is harsh on your skin, so keeping a simpler routine designed to support the skin and let the medication do its work builds an environment less susceptible to irritation and breakouts.

A simple routine should include a cleanser, moisturizer, and sunscreen. Sunscreen is super important while taking isotretinoin, because your skin becomes more sensitive to the sun. Moisturizers and skin barrier support help combat the dryness isotretinoin causes. Finally, using a simple cleanser and avoiding most other active ingredients or medications lets isotretinoin work without interference or further irritation.

Antihistamines have also been studied as a potential helpful tool for isotretinoin patients. Antihistamines calm the body’s histamine response and may help manage symptoms like dryness, irritation, and itchiness.

The evidence here is one small trial, so treat it as promising rather than settled. Adding levocetirizine at night alongside isotretinoin reduced inflammatory lesions and flare-ups compared to isotretinoin alone. It looked at levocetirizine specifically, which is the active half of cetirizine (Zyrtec), not loratadine (Claritin) or fexofenadine (Allegra).

Paichitrojjana et al. (2023). Drug Design, Development and Therapy

For those with an even greater concern or who are experiencing severe acne, a lower dose might be considered under physician supervision, and gradually increased over time.

There is direct evidence for this. In a 2009 study of 274 acne patients, 7.5% of those started on 0.2 mg/kg or less flared during the first four weeks, against 15.5% of those started on 0.5 mg/kg. In every case the flare settled with short-term steroids and a dose reduction, and no patient had to stop isotretinoin altogether.

Borghi et al. (2009). Dermatology

Those actively experiencing severe breakouts after starting isotretinoin may consider discussing oral steroid prescription use, such as Prednisone, to help with acute breakouts while the skin adjusts.

The isotretinoin label notes caution when taking oral steroids and isotretinoin at the same time, due to possible bone impacts. Discuss with your provider.

US Food and Drug Administration (2002). Accutane (isotretinoin) prescribing information

As discussed earlier, tracking your progress and mentally preparing for the purge phase can be extremely useful. If you know your skin might be breaking out a bit more in the coming weeks, you can plan accordingly in every aspect: socially, mentally, etc.

How to Get Prescribed Isotretinoin (Accutane) Online

If you’re wondering how or where to get isotretinoin, Happyglow connects you with US-licensed physicians who decide whether starting isotretinoin is right for you, entirely online.

1. Start your visit. Answer a few questions about your health and goals (~5 min).
2. A physician reviews. They determine whether isotretinoin is appropriate for you or recommend a better fit.
3. Delivered to your door. If approved, your prescription ships free, with refills coordinated with your monthly check-ins.

See if isotretinoin is right for you→

Not approved? You’re refunded in full.