Two weeks into an Accutane (isotretinoin) course, most patients experience initial dryness of the lips and skin rather than visible acne improvement. At this early stage, the medication is just beginning to reduce sebum production, and many people actually notice their acne looking the same or even slightly worse before it gets better. The dramatic clearing that Accutane is famous for typically begins around weeks four to six, so patience during this initial phase is essential.
For example, a patient starting on a standard dose of 40mg daily might notice their lips becoming noticeably chapped by day ten, while their active breakouts remain largely unchanged. Some individuals experience what dermatologists call the “purging” phase during these first few weeks, where existing microcomedones come to the surface as new pimples. This article covers what specific changes to watch for at the two-week mark, how to manage early side effects, when to contact your dermatologist, and realistic timelines for visible improvement.
Table of Contents
- What Changes Should You Notice in Accutane Progress After 2 Weeks?
- Understanding the Accutane Purge: Why Skin May Worsen Initially
- Managing Early Side Effects During Week Two
- What Blood Work Results Indicate at the Two-Week Check
- Early Signs That May Predict Treatment Response
- Lifestyle Adjustments for the First Two Weeks
- When to Contact Your Dermatologist Before Your Scheduled Appointment
- Conclusion
What Changes Should You Notice in Accutane Progress After 2 Weeks?
The most reliable indicator that accutane is working at the two-week point is not clearer skin but rather the onset of dryness-related side effects. Approximately 90 percent of patients report chapped lips within the first two weeks, and many also notice dry nasal passages, mild facial dryness, and sometimes dry eyes. These symptoms, while uncomfortable, signal that isotretinoin is actively affecting your sebaceous glands. Sebum reduction typically becomes measurable around week two, though visible acne improvement lags behind.
Your skin may feel less oily to the touch, particularly in the T-zone, and you might find yourself needing less blotting paper throughout the day. However, existing inflammatory lesions take four to six weeks to fully resolve, and clogged pores already present before starting treatment will continue surfacing as the medication pushes them out. A patient who previously experienced extremely oily skin by midday might notice their face stays matte until evening, even while still having active breakouts. Some patients see no discernible change at all in their acne at the two-week mark, and this is completely normal. Isotretinoin works by fundamentally altering how skin cells behave and how sebum is produced, processes that require consistent medication levels over several weeks before translating to visible clearing.
Understanding the Accutane Purge: Why Skin May Worsen Initially
The so-called “Accutane purge” is one of the most discouraging aspects of early treatment, occurring in roughly 20 to 30 percent of patients during the first month. During this phase, isotretinoin accelerates skin cell turnover, bringing hidden comedones and microcomedones to the surface faster than they would have emerged naturally. This can make it appear as though the medication is causing new breakouts when it is actually clearing existing congestion. Purging differs from a true adverse reaction or treatment failure in several important ways.
Purge-related breakouts typically occur in areas where you normally experience acne, resolve relatively quickly compared to your usual breakouts, and do not spread to entirely new regions of your face or body. If you are developing acne in places you have never had it before, or if you experience symptoms like hives, severe joint pain, or unusual swelling, contact your dermatologist rather than assuming it is a normal purge. However, if you had significant subclinical congestion before starting treatment, particularly numerous closed comedones or a history of comedonal acne, your purge may be more pronounced. Dermatologists sometimes prescribe a lower starting dose or add a short course of oral steroids for patients with severe inflammatory acne to mitigate this initial flare. Knowing your baseline skin condition helps set realistic expectations for what the first weeks may bring.
Managing Early Side Effects During Week Two
Proactive management of side effects during the first two weeks can significantly improve your treatment experience. Lip care is the most immediate concern, and standard lip balms often prove inadequate. Products containing lanolin, such as Lansinoh or Aquaphor, provide more effective barrier protection than petroleum-free alternatives. Applying lip treatment before bed and keeping a tube accessible throughout the day prevents the cracking and bleeding that many patients otherwise experience. Facial moisturizers should be chosen carefully, as some ingredients that worked well before Accutane may now cause irritation.
Hyaluronic acid serums and ceramide-rich creams tend to be well-tolerated, while products containing retinol, glycolic acid, or salicylic acid should generally be discontinued during treatment. A patient who previously used a vitamin C serum without issues might find it now causes stinging and redness on Accutane-sensitized skin. Nasal dryness is often overlooked but can lead to nosebleeds if unaddressed. Saline nasal spray used twice daily and a thin application of petroleum jelly inside the nostrils before sleep helps maintain mucosal moisture. If you wear contact lenses, you may find them increasingly uncomfortable; preservative-free artificial tears and reducing lens wear time can help, though some patients need to switch to glasses temporarily during treatment.
What Blood Work Results Indicate at the Two-Week Check
Most dermatologists order baseline bloodwork before starting Accutane and repeat testing at approximately one month, though some check at two weeks, particularly for patients on higher doses or those with risk factors. The primary concerns are liver function and lipid levels, as isotretinoin can elevate liver enzymes and triglycerides in some patients. At the two-week point, mild elevations in liver enzymes or triglycerides are not uncommon and usually do not require stopping treatment. A triglyceride level that has increased from 100 to 150 mg/dL, for instance, is generally monitored rather than acted upon.
However, triglycerides exceeding 500 mg/dL or liver enzymes more than three times the upper limit of normal typically prompt dose reduction or treatment interruption. Comparison matters here: someone whose triglycerides were already 180 at baseline has less margin for increase than someone starting at 90. It is worth noting that fatty meals consumed the day before bloodwork can artificially inflate triglyceride readings. Your dermatologist may ask you to fast for 12 hours before testing or to avoid unusually high-fat meals the day prior. If your levels come back elevated, a repeat test under controlled conditions may show different results before any treatment changes are made.
Early Signs That May Predict Treatment Response
While two weeks is too early to judge overall treatment success, certain early indicators can hint at how your course may progress. Patients who experience robust dryness symptoms tend to be absorbing the medication effectively, as isotretinoin requires dietary fat for proper absorption. If you are taking your capsules with a substantial meal containing at least 20 grams of fat and still experiencing minimal side effects, discuss this with your dermatologist, as absorption issues could affect outcomes. The location and type of acne you have also influences early response patterns.
Surface-level papules and pustules often begin improving sooner than deep nodular or cystic acne, which may take six to eight weeks to show significant change. A patient with primarily comedonal acne might notice subtle textural improvements by week two or three, while someone with severe cystic acne may see little change until well into month two. However, minimal early side effects do not necessarily predict treatment failure, particularly in patients with naturally less oily skin or those on lower doses. Some individuals tolerate isotretinoin remarkably well while still achieving excellent results. The correlation between side effect severity and efficacy exists but is far from absolute, so a comfortable early experience should not cause alarm.
Lifestyle Adjustments for the First Two Weeks
The first two weeks on Accutane require several practical lifestyle modifications beyond skincare. Sun sensitivity increases significantly with isotretinoin use, making daily sunscreen application essential even on cloudy days or during winter months. A broad-spectrum SPF 30 or higher should be applied to all exposed skin, and outdoor activities during peak sun hours warrant additional precautions like hats and protective clothing. Alcohol consumption deserves careful consideration, as both isotretinoin and alcohol are processed by the liver.
While occasional light drinking is generally permitted by most dermatologists, heavy or frequent alcohol use can compound stress on the liver and increase the risk of elevated enzyme levels. A patient planning to attend a wedding during their first month of treatment should discuss this timing with their doctor rather than assuming moderate celebration drinking is automatically safe. Waxing and certain cosmetic procedures must be avoided entirely during Accutane treatment and for six months afterward due to increased skin fragility. Threading and gentle shaving remain options for hair removal. Those who regularly wax their eyebrows or other facial areas should establish alternative routines before or immediately upon starting treatment to avoid the skin damage that waxing can cause to isotretinoin-affected skin.
When to Contact Your Dermatologist Before Your Scheduled Appointment
While many early Accutane experiences fall within normal ranges, certain symptoms warrant earlier contact with your prescribing physician. Severe headaches, particularly those accompanied by visual disturbances, require prompt evaluation as they can indicate intracranial pressure issues, a rare but serious potential side effect. Similarly, significant mood changes, depression, or unusual psychological symptoms should be reported immediately rather than waiting for your next scheduled visit.
Physical symptoms like severe abdominal pain, especially on the right side, may indicate liver or gallbladder issues and need urgent assessment. Muscle or joint pain that significantly interferes with daily activities, while common at milder levels, should be discussed if it prevents normal function. The line between expected discomfort and concerning symptoms is not always clear, and dermatologists prefer patients err on the side of calling with questions rather than dismissing potentially significant symptoms.
Conclusion
The two-week mark on Accutane is characterized primarily by emerging side effects rather than visible acne improvement. Dryness of the lips, skin, and nasal passages indicates the medication is active in your system, while your actual breakouts may remain unchanged or even temporarily worsen due to purging.
This phase requires patience and proactive side effect management while understanding that the dramatic clearing most patients seek typically begins around week four to six. Focus during these early weeks should be on establishing a robust moisturizing routine, protecting your skin from sun exposure, maintaining proper medication absorption by taking doses with fatty meals, and monitoring for any symptoms that might warrant early contact with your dermatologist. The foundation you build now in managing side effects will serve you throughout your treatment course, which typically spans five to seven months for most patients.
