Is there any evidence that the drug "Accutane" works better the second
time it is taken? For example, if someone takes the drug for 5 months
at age 20, for an acne problem, then has an acne recurrance at age 22,
is taking the drug again for 5 months at age 23 likely to be more
effective, or to provide longer-lasting results, then the first course
did?

hi there.  my disclaimers - i am not a Google researcher or a medical
expert.  also, Google has a general disclaimer regarding medical
advice, which I would strongly urge you to read.  that being said,
here's some info on Accutane and second-use which I hope may prove
helpful.  I would urge you to check the websites for any new
information.  Accutane use is currently being questioned for safety in
teenagers in particular, who may be prone to depression.

IN GENERAL, one course of Accutane, which is typically five months,
results in prolonged remission of acne in up to 85 percent of
patients.  But it doesn't work for everyone, and some patients need
more than one course of treatment.  Some people may benefit from a
second course, a year or two later than the first, but may also need
periodic topical applications of an acne medication.
As powerful as Accutane can be in improving patients' lives, its
adverse effects can be just as powerful.  The drug is known to cause
miscarriage and severe birth defects.  Patients taking Accutane may
develop potentially serious problems affecting a number of organs,
including the liver, intestines, eyes, ears, and skeletal system. And
some patients taking Accutane have developed serious psychiatric
problems, including depression. More rarely, patients have developed
suicidal behavior and killed themselves.

The Center for Drug Evaluation and Research has a web page devoted to
Accutane (Isotretinoin):
<http://www.fda.gov/cder/drug/infopage/accutane/>


The manufacturer, ROCHE, has a product guide:
<http://www.rocheusa.com/products/accutane/>


An article appeared in the U.S. Food and Drug Administration [FDA]'s
Consumer magazine in March-April 2001 - "The Power of Accutane:
The Benefits and Risks of a Breakthrough Acne Drug"
By Michelle Meadows
<http://www.fda.gov/fdac/features/2001/201_acne.html>


Congressman Bart Stupak's website has a hearing in Congress regarding
Accutane linked to his web page.
<http://www.house.gov/stupak/accutane.htm>


There is also a website created by an action group for this drug:
Accutane/Roaccutane Action Group Homepage
<http://www.accutaneaction.com/>

One person has kept a diary regarding her involvement with the drug
JENN'S ACCUTANE JOURNAL
<http://jmhpr.tripod.com/accutanediary/>

A medical resource list for information regarding this drug's use has been
created by the March of Dimes:
Accutane and Other Retinoids
<http://www.marchofdimes.com/professionals/681_1168.asp>

Drug Education.net also has an Accutane page
<http://www.drugeducation.net/accutane.htm>

The Medline Plus page regarding Accutane may be found here:
Isotretinoin
<http://www.nlm.nih.gov/medlineplus/druginfo/medmaster/a681043.html>

and Hardin MD provides this page of links:
Accutane / Isotretinoin
<http://www.lib.uiowa.edu/hardin/md/accutane.html>

and there is an Accutane Survivors group that has created this page with
extensive source listings for further information:
Accutane - Is this Acne Drug Treatment Linked to Depression and Suicide?
<http://www.roaccutanesurvivors.com/Congress/ODonnel_051201.htm>

Thanks for the comments. I should add that I'm not seeking medical
advice, just medical data. If there is evidence that taking accutane
twice is particularly helpful, I'll consider asking my dermatologist
to prescribe it again. Otherwise I probably won't.

As for all the scary stuff about accutane, more than one very
respected dermatologist tells me that independent studies see no
significant correlation between suicide and accutane. Even if they
did, this doesn't establish causation. After all, accutane is a
last-ditch resort for a very frustrating, often debilitating
condition. Many patients are frustrated and depressed before starting
accutane---I certainly was---and if the drug doesn't work as hoped,
that can make the frustration even worse. Obviously doctors and
patients should be careful when using a potentially dangerous drug,
but I think some of the risks are being blown out of proportion.