It happens. It is more common than what is reported in the literature.  It is unfortunate. It is distressing. It is self-limiting in most cases. It is co-incidental in some. It can be somewhat preventable in many cases (with early detection & intervention).

Isotretinoin induced hair loss usually occurs in young adults. In the majority of times it is self-limiting, namely hair growth will return once the medication is ceased. It can take up to 6-12 or beyond to gain normal growth & density. In some rare cases, the hair does not  return back to the normal density. This is usually due to other factors such as incidental (or rather concurrent) androgenetic alopecia. This especially applies to males. If this is the case, early intervention with medical management for male pattern baldness should be initiated. The diagnosis can be confirmed with a family history of  AGA & with an examination (bitemporal recession, vertex thinning, miniaturization of hair follicles). In females, it can be more complex. Other conditions such as telogen effluvium or iron deficiency should be considered. Be guided by your dermatologist.

A sensible method of monitoring for hair loss is not to count hairs lost on a daily basis (this will lead to more anxiety & OCD), as one typically loses up to 150 to 170 strands a day! A sane method is baseline photos prior to, or at the start of Accutane- Isotretinoin therapy.  Photos should include the frontal hairline including bitemporal areas, sides, & the crown or vertex. Part the hair in the midline as this will give an idea of baseline hair density. For females, the diameter or circumference of the ponytail is a very accurate measurement of hair density (which is proportional to hair loss/hair fall).

If you notice an objective measurement of hair loss, stop your isotretinoin & discuss this with your medical dermatologist. There are other methods to help with your acne including LLLT, PDT, & other medical options.

Intervention with PRP, low level lasers & thulium fractional lasers are novel treatments for other forms of hair loss including androgenic alopecia, alopecia areata, & other hair disorders. Whilst they are not proven to help with hair loss from isotretinoin, given the banal nature of these interventions, it may be sensible to start early. This especially applies to cases of incidental male/female pattern hair loss. In most cases supportive management is recommended; namely time, good hair care (avoid dye, avoid colours, correct grooming-combing techniques, avoid excessive drying). A hair supplement that includes vitamin B complexes, zinc, iron, & biotin can be useful for the feelgood factor.

*Disclaimer: I do not treat medical conditions such as hair loss. This includes Accutane induced hair loss/thinning. Your management should be supervised by your treating dermatologist. I do not treat acne. My elective practicing skill sets are procedural, namely I cut, laser, peel & inject. For medical management, please book an appointment with my colleagues @cliniccutis