Hi, this is Eloise the Community Leader. I try my best to answer every question, but you can also send me a private message if I miss your question on the forum.
Some Accutane patients experience a temporary worsening of acne during the first weeks of treatment and when the dose is increased. Sometimes Dermatologists prescribe Prednisone (an oral steroid) to reduce inflammation during this initial breakout. (Prednisone should not be used in the long term for acne, as this can actually make it worse). Occasionally a non-tetracycline antibiotic is prescribed (tetracyclines must never be taken with Accutane).
Cryospray is not something Dermatologists here in the UK commonly prescribe for Accutane patients. Maybe a member from another country could share their experience? Female Accutane patients should use two methods of birth control whilst on Accutane. Taking an anti-androgen contraceptive pill such as Diane35 (Dianette in the UK) or Yasmin will help treat the acne as well as offering birth control. So being established on such a pill prior to starting Accutane may lessen the initial breakout.
However, Accutane is usually only prescribed when other treatments have failed so taking an antibiotic or other treatment is not guaranteed to prevent an initial breakout.
People worry that the initial breakout will cause scarring. Most acne scarring is superficial and will fade with time but stubborn scarring can be removed 6 months after finishing Accutane. In the long term though, the best way to prevent scarring is to stop acne, and Accutane is the best way of doing this. Also, not everyone experiences acne flares whilst on this medicine, and it is common not to be offered anything else to minimise acne flares/initial breakouts.
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