u/Dwayne_Daddy11

I’m hoping someone has experienced something similar because I’m getting to the point where I’m questioning whether I can continue isotretinoin, even though it has worked incredibly well for my acne.

For some background, this is actually my third course of Accutane. I’ve dealt with acne since my teenage years (I’m 25M now), including both facial and body acne, and Accutane has been the only treatment that has really made a significant difference.

My first course was from 2024–2025. I started at 10 mg/day and eventually increased up to 30 mg/day, but the side effects became too difficult to tolerate.

Because Accutane worked so well for my acne, I wanted to try again with a different approach. In mid-2025, I restarted at 10 mg/day as a low-dose/microdose approach, hoping that lowering the dose would allow me to maintain clear skin while avoiding the side effects I experienced previously.

Unfortunately, I still struggled with side effects. For my current course, which started in December 2025, I went even lower and started 5 mg/day as a long-term microdose. The goal was to find the lowest possible dose that would keep my acne under control while allowing my body to tolerate it.

I genuinely thought that at only 5 mg/day I would finally avoid issues like flushing. Unfortunately, it seems like my body is extremely sensitive to isotretinoin.

The first couple of months (January-February 2026) were actually amazing. My skin adjusted really well, I had minimal redness, very few breakouts and basically no noticeable side effects. I thought I had finally found the balance.

Then around March 2026, things started changing. I began developing flushing across my cheeks, nose, ears and neck. At first it wasn’t too bad, but over the following months it progressively became more frequent and intense.

My triggers include:
- Heat
- Exercise (especially at the gym)
- Sun exposure
- Anxiety/embarrassment
- Eating, especially warm food or even mild spice

The frustrating part is that I can also flush completely randomly while sitting down doing nothing.When it happens, my face feels like it is literally burning.

These episodes can last 2+ hours, and I have tried everything I can think of to calm them down:
- Cold compresses
- Washing my face with cold water
- Cooling facial sprays
- Increasing my water intake (usually 3–4L/day)

Unfortunately, nothing has made a meaningful difference.

One of the worst parts is that it also happens while I’m sleeping. I’ll wake up with my ears or face burning hot and bright red. I have switched to silk pillowcases and tried sleeping on my back to avoid friction or pressure on my cheeks, but I still wake up with intense redness.

Sometimes only one cheek will flush, but the redness on that side is much more severe than normal. I have also had some rare episodes where the flushing spreads beyond my cheeks to my jawline, sides of my face, neck and even upper torso, almost resembling an allergic reaction.

Another dermatologist suspected Demodex mites, and I started using Soolantra. However, the flushing itself never improved.

I have tried addressing this from multiple angles. My current supplements include:
- Quercetin
- Omega-3 fish oil
- Zinc
- Antihistamine
- Vitamin D
- Vitamin C
- Electrolytes

I have also been prescribed low dose beta blockers (Carvedilol) by my dermatologist, including increasing the dose slightly, but unfortunately I haven’t noticed any meaningful improvement.

My skincare routine is also extremely focused on calming inflammation, reducing irritation and supporting my skin barrier. I have deliberately avoided harsh actives and focused on gentle, soothing products because my skin is clearly very sensitive.

Morning routine:
- Cold water splash on face
- Avène Thermal Spring Water (to refresh and cool my skin after sleeping)
- Hypochlorous Acid (used instead of a morning cleanser)
- Numbuzin No.1 Pure-Full Calming Herb Toner (focused mainly on my cheeks and patted into skin)
- PURITO Hydro Wave Deep Sea Serum
- AXIS-Y Heartleaf My Type Calming Cream
- PURITO Wonder Releaf Centella Eye Cream Unscented
- Goodal Heartleaf Calming Moisture Sun Cream SPF50+

Evening routine:
- Geek & Gorgeous Jelly Joker Cleanser
- Hypochlorous Acid Spray
- Numbuzin No.1 Pure-Full Calming Herb Toner
- iUNIK Beta Glucan Power Moisture Serum
- Lion Pair Acne Cream W (only on active red spots when needed)
- Aquaphor Healing Ointment (around sides of nose, eyes and lips when needed)
- Celimax Dual Barrier Skin Wearable Cream
- PURITO Wonder Releaf Centella Eye Cream Unscented
- Soolantra (Tuesday, Thursday and Saturday)

The routine is mainly built around calming/barrier-supporting ingredients such as hypochlorous acid, heartleaf, centella, beta-glucan and barrier-repair ingredients.

However, the important thing is that the flushing started before I introduced this routine. I changed my skincare because I was hoping it would calm my redness and sensitivity, but the flushing has continued despite having a very gentle routine.

Because the flushing seems to be triggered by so many unrelated things (food, heat, exercise, stress and sometimes nothing at all), my GP has referred me to an allergist/immunologist to investigate whether there could be another contributing factor, although I am still waiting for an appointment due to being on a wait list.

The frustrating part is that Accutane itself is working perfectly. My acne is basically clear. My face is the best it has looked in years, and my body acne is also under control. I rarely get breakouts now, and if I do, they are small and disappear quickly.

That is why I feel completely stuck.
If I stop Accutane, there is a good chance the flushing improves, but my acne will likely return.If I continue Accutane, my acne stays controlled, but I have to deal with flushing multiple times a day that is noticeable to everyone around me. It genuinely feels like a pick your battle situation.

I know flushing is a recognised side effect of isotretinoin, but I’m surprised it has become this severe even on 5 mg/day, especially when I intentionally chose microdosing because I was hoping to avoid exactly this kind of issue.

I’m seeing my dermatologist again I’m a few months and I’m unsure what the next step should be:
- Reduce the dose even further (for example, 5 mg every second day or only a few times per week)?
- Try different medications to manage the flushing?
- Investigate whether something else could be contributing?

I also wonder whether anyone with severe flushing had their dermatologist investigate things like liver function or other internal causes, or whether it was simply considered an unfortunate isotretinoin side effect. My blood tests have been normal so far, so again not sure where to go from here.

Has anyone had a similar experience?
Was your flushing worse on a lower dose compared to higher doses? Did it eventually settle while continuing Accutane? Did reducing the dose further actually help? Did anyone discover it was something else (rosacea, allergies, mast cell issues, etc.)? Did anything genuinely help reduce the flushing?

I’d really appreciate hearing other people’s experiences because I feel like I’m at a crossroads. Accutane has finally given me the clear skin I’ve wanted for years, but the flushing is becoming harder to live with than the acne itself.

(Photos don’t do it justice unfortunately) Just wondering if anyone with a history of Demodex/rosacea-type issues has experienced something similar.

For context, I originally went on isotretinoin for cystic acne because I had already tried basically everything beforehand:
- topicals
- antibiotics
- diet changes
- lifestyle changes

Accutane was pretty much the only thing that actually controlled my cystic acne.

After finishing my original course, I started getting these weird persistent small bumps in late 2024/early 2025 that looked very different from my normal acne. They were small, uniform, inflamed and just wouldn’t fully go away. My dermatologist put me on Soolantra (1% ivermectin) and it ended up helping massively, which made him suspect there may have been a Demodex/rosacea component.

Then later in 2025 my cystic acne eventually came back again, so I restarted isotretinoin. I temporarily came off it because of side effects, but I’ve now been back on low-dose isotretinoin (5mg daily) since December 2025 due to the cystic acne returning.

My skin had actually been relatively stable recently, but after attending a funeral where there was a lot of close facial contact (people hugging, pressing cheeks against mine, kissing cheeks etc), I started developing clusters of tiny uniform red bumps mainly beside my nose and under my under-eye area.

The weird thing is:
- they’re very uniform/similar in size
- they’re more “tingly” or prickly than itchy
- random tingling happens throughout the day
- I’ll wake up with a new spot overnight, then get another 2–3 throughout the day
- it doesn’t feel like my normal acne
- not large cysts or classic whiteheads
- more like inflamed tiny papules
- mainly concentrated around the nose/central face area

I also haven’t changed my skincare in about 3 months. The last thing I changed was a sunscreen months ago and it never caused irritation or breakouts, so I’m struggling to pinpoint another trigger.

What’s making me doubt that this is just irritation/contact dermatitis/perioral dermatitis is that my skin isn’t really extremely itchy, flaky, peeling or rash-like. It’s more of a random prickly/tingly sensation throughout the day with these very uniform bumps continuously appearing. The bumps also seem more follicle-like/inflammatory than dry eczema-type patches.

I know isotretinoin can make skin more sensitive overall, but this genuinely feels very similar to the flare I had before Soolantra helped clear it. Because of that, I have a huge suspicion this could somehow be a Demodex/rosacea-type flare again rather than regular acne or dermatitis itself.

I know everyone naturally has Demodex, but I’m wondering if the friction/skin contact/possible irritation from a lot of face contact could have triggered a flare while my skin barrier is already more sensitive from isotretinoin.

I have a dermatologist appointment in 2 weeks, but I’m curious if anyone else with a history of Demodex issues has experienced:
- tingly uniform bumps
- “new spots appearing” throughout the day
- flares after skin irritation/contact
- recurrence after previously clearing with Soolantra

Would appreciate experiences because this feels very different to my normal acne.