Accutane- Isotretinoin Induced Hair Loss

Asian Skin Rejuvenation at a glance

  • Best Results10-16 months after stopping
  • Treatment Recovery4-8 months
  • Procedure TimeNA
  • Skin SpecialistMedical dermatologist
  • Duration of ResultsRegrowth probable
  • AnaestheticNA
  • Back to WorkNA
  • Cost$

Accutane- Isotretinoin Induced Hair Loss

Hair loss on Accutane is more common than what is reported in the literature. Early identification & intervention will prevent & in the vast majority of cases reverse hair shedding. In the vast majority of times, hair loss is self-limiting. Correct hair care will reduce chances of hair breakage/loss.

FactsFacts on Accutane Induced Hair Loss

  • Skin, nails & hair side effects are experienced by over 80% of people on isotretinoin
  • The majority of side effects can be mitigated with a little knowledge
  • Hair fragility & thinning can be seen in up to 8% of users
  • Tips on how to monitor for hair loss are discussed on this page
  • Hair loss on Accutane/Roaccutane is more common in females
  • Basic hair care including correct drying, combing & moisturizing can markedly decrease the chances of hair fall
  • The majority of Accutane induced hair loss will improve
  • It can take up to 10-16 months to recover

How common is hair loss from Accutane/Isotretinoin?

Very, however it is under-reported, the stats are 932 times between 1997 to 2017. Hair loss accounts for 9% of all adverse events from this medication.

The true figure in clinical practice would far exceed the reported cases to the FDA. The majority of cases are female (about 70%) , with males accounting for the rest.

How does hair loss occur on Accutane/Isotretinoin?

This is controversial as new research in 2019/2020 have challenged the notion of Accutane-Accutane induced hair loss.

The general consensus is that isotretinoin is due to telogen effluvium. Namely this drug slows down the growing phase of hair follicles (anagen), with defective anchoring of the hairs in telogen. This accounts for hair shedding.

Recent publications have shown no increase in hair loss on doses up to 0.5 mg per day for up to 3 months duration. Personally, I think that paper is crap, as the majority of patients will be on this medication for up to 6-12 months. The authors should have extended the study to 12 months.

Does Accutane cause permanent hair loss?

The absolute majority of cases are not permanent, however caveats are present- see below -’other factors that contribute to hair loss.’

Hair regrowth will begin at 3-4 months, & it can take 10-16 months for full regrowth. In some cases, stressing about hair loss can lead to telogen effluvium, namely rebound delayed hair loss that occurs months after stress, hence the cycle continues.

Does the dose of Accutane correlate with hair loss?

In the context of evidence-based research, no. The biggest study (as of 2021) does not suggest that being on a whacking big dose of isotretinoin increases the risk.

Many clinical dermatologists (including me) would disagree. Our experience has shown that ‘mini’ doses of Roaccutane/ Accutane anecdotally give less chances of hair fall compared to traditional dosing. Discuss this with your dermatologist.

Davin’s Viewpoint- Accutane Induced Hair Loss

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

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