What Causes Relapse After Acne Improvement
Acne often improves with treatments like isotretinoin, also known as Accutane, but it can come back for many people. This relapse happens when the factors that caused acne in the first place start acting up again after treatment ends.
One main reason is oil glands in the skin becoming active once more. These glands produce sebum, the oily substance that can clog pores and lead to breakouts. If the glands do not shrink enough during treatment, they rebound and make too much oil. Genetics play a big role here, as some people inherit skin that stays oily no matter what. Hormones, stress, and daily habits like diet also trigger this rebound.
Treatment details matter too. Doctors aim for a certain total dose of isotretinoin, often around 120 to 150 milligrams per kilogram of body weight, but higher doses like 220 milligrams per kilogram lower relapse risk. Studies show relapse drops from about 47 percent with lower doses to 26 percent with higher ones. Stopping treatment too soon raises the chance of acne returning, since full benefits often show up months later.
The type and severity of acne affect outcomes. Severe cases with deep nodules, cysts, or hormonal acne are harder to control long-term. Nodulocystic acne or acne conglobata often needs stronger or repeated care. Young age, family history of acne, and heavy seborrhea, or oily skin, increase risks. About 15 to 33 percent of patients see relapse within a year, sometimes needing another round of treatment.
Skin may hold a kind of memory from the disease. Even after clearing up, tissues keep changes in cells and inflammation pathways that make breakouts easier. Without ongoing care, like topical creams in a maintenance phase, acne can flare.
Signs of likely relapse include quick return of oiliness, painful nodules, or breakouts months after stopping treatment. Mild spots might just be normal ups and downs, not full relapse. Dermatologists check history, timing, and skin type to decide next steps.
Sources
https://dermondemand.com/accutane/is-a-second-round-of-accutane-the-right-choice-for-you/
https://www.consultant360.com/story/high-dose-isotretinoin-cuts-acne-relapse-risk-without-upping-side-effects
https://www.droracle.ai/articles/668093/what-to-do-if-acne-worsens-2-months-into
https://drgerardee.com/isotretinoin-how-it-works-and-its-side-effects/
https://www.mims.com/malaysia/disease/acne-vulgaris/management
https://www.frontiersin.org/journals/drug-discovery/articles/10.3389/fddsv.2025.1752852/full
