Skin on Accutane: How It Changes During and After Treatment

How Accutane Affects the Sebaceous Glands

Accutane changes the skin by targeting one structure more powerfully than any other: the sebaceous gland. These glands sit next to hair follicles and produce sebum, the oil that keeps skin flexible but, in excess, contributes to clogged pores and inflammation. Isotretinoin shrinks these glands dramatically, often by 50–90%, and also slows down the rate at which they produce oil. This drop in oil output is why many patients notice that their skin becomes far less shiny within the first few weeks of treatment.

As sebum production decreases, the follicle environment shifts. There is less buildup of dead skin cells, fewer blockages, and less bacterial overgrowth. Inflammation also fades gradually. Together, these changes explain why Accutane is capable of clearing even severe acne that did not respond to other treatments. Those interested in the underlying pharmacology can refer to What Is Accutane?

Patients sometimes worry that Accutane “thins” the skin. In reality, isotretinoin makes the skin more delicate, not permanently thinner. It temporarily alters the way skin cells mature and shed, which is why dryness and sensitivity appear early on. Once treatment ends, the epidermis gradually returns to its normal resilience.

Why Skin May Get Worse at First — Purge

One of the most confusing early experiences on Accutane is that the skin may look worse before it gets better. This happens because isotretinoin speeds up the turnover of clogged pores. Microcomedones, which are tiny blockages that would have surfaced months later, are pushed out more quickly. The result is what many patients refer to as the “purge.” It is not a sign that Accutane is failing; it is a temporary acceleration of the clearing process.

A purge usually begins within the first two to six weeks and may involve more frequent breakouts, dryness around active lesions, and increased redness. Not everyone purges, but for those who do, the phase typically resolves as the sebaceous glands shrink and inflammation decreases. Readers who want to understand the typical month-by-month pattern can refer to Accutane Treatment Timeline.

It’s important to distinguish a purge from irritation or an adverse reaction. If acne continues worsening past the early phase, becomes unusually painful, or is accompanied by severe skin peeling, your dermatologist may adjust the dose. For guidance on common treatment reactions, see Accutane Side Effects.

Typical Skin Appearance During Treatment

Most patients notice a predictable series of changes in how their skin looks and feels while on Accutane. The first shift is usually dryness: lips that crack easily, flaking around the nose, or patches of peeling skin on the cheeks and chin. This dryness is normal and reflects the shrinking of the sebaceous glands. Because oil production decreases so dramatically, many people see their lifelong shine disappear almost overnight. For this reason, the answer to “Does Accutane help with oily skin?” is a definitive yes: it is one of the drug’s most reliable effects.

Another common observation is redness. Accutane can make the skin appear slightly pink or ruddy because the outer barrier becomes more fragile. This is temporary and not the same as permanent rosacea. Moisturizers and sunscreen help reduce the appearance of redness.

Some patients worry that Accutane will thin the skin. While it does make the skin more sensitive, it does not permanently thin the epidermis. After treatment ends, resilience gradually returns.

So, what does skin look like on Accutane? Typically, it is matte, dehydrated, more delicate, sometimes flaky, and often calmer once breakouts settle. These visible changes usually improve around the middle of the course, followed by smoother texture and fewer active lesions.

Texture, Pores & Scars

Accutane is highly effective at clearing acne, but its impact on texture, pores, and scars is often misunderstood. Many patients notice that as inflammation decreases and oil production drops, their skin begins to look smoother. Small bumps, clogged pores, and rough patches often fade because the follicles are no longer congested. This is why some people describe a post-Accutane “glow” – not a literal shine, but a clearer, more even complexion once redness subsides.

Accutane also makes pores appear smaller, though it doesn’t physically shrink them. Instead, reduced oil and fewer blockages make pores less visible. Texture irregularities caused by active acne typically improve during treatment.

However, Accutane has limitations. Many patients ask whether it helps with scars. It can prevent new scars by reducing deep, inflammatory cysts and stopping repetitive picking. It can also soften the appearance of shallow marks because the skin becomes calmer and less inflamed. But Accutane does not correct deep boxcar, ice-pick, or rolling scars. These require procedures such as microneedling, subcision, or laser treatment, usually performed several months after finishing Accutane to allow the skin to regain resilience.

Overall, Accutane creates the clean foundation on which true scar treatments work best.

Skin Care During the Course

Because Accutane makes the skin more fragile and significantly drier, skincare during treatment must be simple, gentle, and protective. A mild, fragrance-free cleanser is essential. Most patients benefit from washing only once or twice a day to avoid over-stripping the skin. A rich, non-comedogenic moisturizer should be applied morning and evening, sometimes even more often if peeling becomes noticeable. Products with ceramides, glycerin, or petrolatum tend to work best.

Sun protection is non-negotiable. Accutane reduces the skin’s natural defenses, making sunburn more likely. A broad-spectrum SPF 30–50 applied every morning helps prevent redness, irritation, and darkening of healing marks.

One of the most common questions during treatment is how to get rid of dead skin on Accutane. The answer is: very gently. Physical scrubs, exfoliating brushes, AHAs/BHAs, and retinoids should be avoided because they can tear or inflame the already delicate barrier. Instead, patients can use a soft washcloth with plenty of cleanser or add a bland, lotion-based cleanser for extra slip. Flaking is normal and does not need aggressive removal.

Lip care also becomes a daily necessity. Thick ointments such as petrolatum or healing balms prevent cracking and discomfort.

For dryness, redness, and sensitivity guidance, many patients find it helpful to revisit Accutane Side Effects. And if irritation escalates beyond mild discomfort, it’s important to discuss it during routine check-ins, described in How to Get Accutane.

After the Course: How Skin Behaves and How to Maintain Results

Once Accutane treatment ends, the skin continues to change for several weeks. The most common question patients ask is: “How long after Accutane does skin return to normal?” Oil production usually begins to recover within 1–3 months, but most people never return to their pre-treatment oiliness. Sensitivity decreases gradually as the epidermis rebuilds its barrier and cell turnover normalizes. Redness typically fades within a few weeks, although areas that were heavily inflamed during treatment may take longer.

For many patients, the skin appears clearer, smoother, and more even-toned than it has in years. However, maintaining those results requires gentle, long-term habits. After the course, dermatologists often recommend reintroducing topical retinoids, not right away, but once dryness settles, usually 4–8 weeks later. Retinoids help keep pores clear, prevent new comedones, and support healthy cell turnover.

To keep skin clear after Accutane, continue using non-comedogenic moisturizers and sunscreen, avoid aggressive scrubs, and maintain consistency with topical treatments. Hormonal acne may still require targeted therapies.

Those concerned about relapse timelines can review Accutane Treatment Timeline, which explains how to recognize true recurrence versus normal post-treatment adjustments. When used correctly, Accutane creates a foundation of long-term clarity, and the right post-care routine keeps that stability going.

FAQ

Does Accutane make skin worse?

Sometimes temporarily. Early breakouts or purging can occur during the first weeks, but this usually resolves as oil production decreases.

Does your skin purge on Accutane?

Not everyone purges, but many do. A purge typically lasts 2–6 weeks and reflects accelerated clearing of existing blockages.

Does Accutane make your skin worse before it gets better?

It can, especially in the early phase. This is normal and not a sign of treatment failure.

How long does it take Accutane to clear skin?

Most patients see major improvement between months 3 and 5, with continued refinement as the course progresses.

What does Accutane do to your skin overall?

It reduces oil production, clears clogged pores, calms inflammation, and prevents new deep lesions, resulting in clearer, smoother skin.

Does Accutane make your skin red?

Yes, temporary redness is common due to increased sensitivity and dryness. It fades once the barrier recovers.

Does Accutane improve skin texture?

Yes. Smoother texture, fewer bumps, and a more even surface are typical once inflammation subsides.

Does Accutane help with scars?

It prevents new scars and can soften shallow marks, but deep scars usually require post-treatment procedures.

How long after Accutane does skin return to normal?

Oiliness and resilience return gradually within 1–3 months.

How to keep skin clear after Accutane?

Use gentle skincare, sunscreen, and, once cleared by your dermatologist, maintenance retinoids to prevent future breakouts.

References

1. American Academy of Dermatology Association. (2023). Isotretinoin: Overview. https://www.aad.org/public/diseases/acne/derm-treat/isotretinoin
2. American Academy of Dermatology Association. (n.d.). Isotretinoin: Patient safety. https://www.aad.org/diseases/acne/isotretinoin-patient-safety
3. Layton, A. M. (2009). The use of isotretinoin in acne. Dermatology and Therapy, 22(5), 393–404. https://pmc.ncbi.nlm.nih.gov/articles/PMC2835909/
4. Zaenglein, A. L., Pathy, A. L., Schlosser, B. J., et al. (2016). Guidelines of care for acne vulgaris. Journal of the American Academy of Dermatology, 74(5), 945–973. https://pubmed.ncbi.nlm.nih.gov/26897386/