Accutane experience predictability

It seemed a little quiet in here, so I thought I would post something
that was on my mind.

I've discovered that you cannot predict how your body will react to
Accutane based on your own past experiences (that is, for those of us
who've been on Accutane multiple times).

Actually, I have rediscovered this fact, since I have noted this to
myself in the past (as far back as 1991). Still, I am always confident
that I know how I will react to certain dosages based on my past
experience. I am always wrong.

The reactions I am talking about are not so much joint pain or dryness,
although those reactions seem to vary as well. Rather, I am talking
about how quickly my acne clears or whether I will have an 'Accutane
breakout'.

For example, on my first full course in 1985, I started on 40mg/day for
2 weeks, followed by 80mg/day for 4 months. After 7 days on 40mg, my
skin cleared and remained clear until several months after the full
course ended.

So, in 1991, when a dermatologist suggested putting me on 40mg for a
few months as a medium-dosage "booster", I assumed my skin would clear
right away (since 40mg cleared my skin right away in 1985). It never
cleared during the entire "booster" course.

In 1993, for my second full course, I started on 80mg/day and stayed on
it for 5 months. My skin cleared within a week and stayed clear until
several months after the full course ended.

But in 1998, for my third full course, I started on 80mg/day as well.
My skin continued to break out as normal. When the derm upped the
dosage to 120mg/day at the end of the first month, I was sure my skin
would clear. But it did not for another whole month.

That 1998 full course segued into a nearly 2-year low-dose course,
which maintained my clear skin until I stopped taking the drug.

So now, in 2006, I am embarking again on a continuous, low-dose course.
Initially I am on 40mg/day for some unknown number of months (I guess
however long that takes to clear my skin). After that, my derm will
lower the dosage each month.

So I expected 40mg to have no effect on my acne for quite some time. In
fact, it did have an effect: a negative one. Within a few days of
starting the course, my skin broke out. 8 days after the first group of
lesions, my skin continues to break out at a high rate. I am having
quantitatively 10-times worse activity than normal, and maybe
qualitatively 7-8 times worse activity than normal. This is the worst
my skin has been in possibly 20 years.

This was a shock: I had never had an 'Accutane breakout' before.
However, I have to keep reminding myself it is for the long term good
(that is, clearing my skin so the low-dose course can maintain the
results).

If you cannot predict how you will react to Accutane based on your own
past experience, you certainly can't give a third party a very accurate
picture of what they will go through.