Reducing the dose may reduce the frequency of hair loss and allow longer use of isotretinoin for acne

Data from 22 studies were collected on hair loss reported with isotretinoin treatment, showing a hair loss frequency of 3.2% for patients receiving

Although hair loss is a documented side effect of isotretinoin in patients taking the acne treatment, there are limited data indicating the frequency of hair loss based on dosage. However, in a new study, researchers found that the frequency of hair loss varies between 3% and 6% depending on the dose.

At the higher end, the frequency of hair loss is comparable to the frequency of other side effects, such as dry eyes, which are commonly discussed with patients. Based on their findings, the researchers suggested providers discuss the side effect with patients before initiating isotretinoin and monitor the side effect during treatment.

“Hair loss in the form of telogen effluvium is a reported side effect of isotretinoin that may lead to discontinuation of treatment. Although its mechanisms are unclear, retinoids are thought to arrest the onset of the phase anagen of the hair cycle and alter hair anchorage during the telogen phase, ultimately increasing hair loss,” the researchers described, adding that “the exact frequency and dose-dependency associated with hair loss with the use of isotretinoin remains uncertain.

Data from 22 studies were collected on hair loss reported with isotretinoin treatment, showing a hair loss frequency of 3.2% for patients receiving

With current treatment recommendations suggesting that patients be cleared of acne for 1-2 months before stopping isotretinoin to reduce the risk of recurrence, the researchers recommended prescribing a lower dose for a longer period to reach the reference before the stop. While emphasizing the importance of dose reduction for the frequency of hair loss, the researchers also included intermittent dosing as a possible treatment alternative, particularly in patients with mild to moderate acne.

Only one small study offered data on time to onset of hair loss, which indicated a median time to onset of 4 weeks. The researchers noted that it is unclear whether duration or dose of isotretinoin impacts the time to onset of hair loss.

There were 2 studies that explored the reversibility of hair loss with isotretinoin treatment, one of which detailed hair loss in 150 patients who experienced persistent hair loss after stopping treatment . However, the researchers stressed that there was no data to support the finding and that the timeframe and number of patients affected were unclear. The second study was retrospective and suggested that hair loss was reversible in 30 patients receiving a high dose of treatment.

“The reversibility and extent of hair regrowth are important to consider because patients may view permanent hair thinning as a barrier to therapy,” the researchers wrote. “Although product monographs for isotretinoin formulations (Clarus, Epuris, and Accutane) warn that hair loss may persist after treatment ends, there is no definitive evidence to support this prognosis.”


Lytvyn Y, McDonald K, Mufti A, Beecker J. Comparison of the frequency of isotretinoin-induced hair loss at J Am Acad Dermatol. Published online February 10, 2022. doi:10.1016/j.jdin.2022.01.002

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