Accutane (Isotretinoin) and Hair Loss: Causes, Patterns, and Patient Advice
Accutane (isotretinoin) is a powerful oral retinoid used to treat severe acne. While it can produce life-changing improvements in skin, it also comes with side effects.
One side effect that concerns many patients is hair loss or hair thinning on the scalp. Hair is closely tied to self-image, so noticing extra strands in the shower or a thinner ponytail can be alarming.
Here we provide a comprehensive, evidence-based look at Accutane-related hair loss, focusing on scalp hair (not eyebrows or body hair) and the context of telogen effluvium - a temporary shedding phenomenon.
We’ll cover how common this side effect is, when it typically occurs, why it happens, what it looks like, chances of regrowth, and practical tips to care for your hair.
The goal is to help you understand “Does Accutane cause hair loss?” and what to do if you’re losing hair on Accutane, all in a patient-friendly way.
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How Common Is Hair Loss on Accutane?
Hair loss is a known but uncommon side effect of isotretinoin.
Hair loss is a known but uncommon side effect of isotretinoin. Large analyses indicate that only a small percentage of Accutane users experience noticeable hair thinning or shedding. For example, a 2022 systematic review found that about 3.2% of patients on low-dose isotretinoin (<0.5 mg/kg/day) reported hair loss, compared to roughly 5.7% on higher doses (≥0.5 mg/kg/day).
sciencedirect.com
In other words, about 3–6% of people taking isotretinoin have hair loss as a side effect, with higher doses slightly increasing the risk.
goodrx.com
Some dermatology resources (e.g. the American Osteopathic College of Dermatology) put the incidence a bit higher - around 10% of Accutane users may experience temporary hair thinning.
healthline.com
The exact numbers vary by study, but it’s clear that most people (over 90%) do not have significant hair loss on Accutane.
3.2%
Patients on lower daily doses reporting hair loss (study summary).
5.7%
Patients on higher daily doses reporting hair loss (study summary).
~10%
Some resources cite temporary thinning around this level.
Risk factors:
Certain factors can make Accutane-related hair loss more likely. Research and clinical observations suggest it’s more common at higher dosages and longer treatment durations, and possibly in older patients.
goodrx.com
pmc.ncbi.nlm.nih.gov
A higher cumulative dose of isotretinoin (for example, extending treatment beyond the standard 4–5 months or using the upper end of dosing) may increase the chance of shedding. Additionally, if you have other underlying hair conditions (like a tendency toward genetic hair thinning), Accutane might exacerbate or unmask those issues.
Overall, hair loss remains an infrequent side effect, but doctors will typically mention it in counseling - it’s listed in the medication’s official prescribing information as a possible side effect (alopecia), albeit rare.
dailymed.nlm.nih.gov
When Does Hair Loss Start During Accutane Treatment?
Shedding often has a delayed onset due to the hair growth cycle.
If hair loss does occur on Accutane, it does not usually begin immediately. Isotretinoin-induced hair shedding tends to have a delayed onset due to the hair growth cycle. Reports show hair loss can start anywhere from about 1 to 24 weeks after starting Accutane.
goodrx.com
Many patients who are affected notice the shedding around the 3rd or 4th month of treatment, which aligns with the timeline of telogen effluvium (explained below). In practical terms, you might be well into your course - even nearing the end - when you observe extra hair coming out.
Why the delay?
Hair follicles cycle through phases: a long growth phase (anagen), a brief transitional phase (catagen), and a resting/shedding phase (telogen).
en.wikipedia.org
Accutane is thought to prematurely push hairs from the growing phase into the resting/shedding phase, but it takes a few months for those “resting” hairs to actually shed.
goodrx.com
That’s why hair loss often peaks a few months after the trigger is introduced. Some people may even complete their 4–5 month Accutane therapy and then notice increased shedding shortly after finishing the medication - essentially a telogen effluvium that was set in motion during treatment.
On the other hand, a minority of patients report hair changes earlier. A systematic review noted cases as early as about a week or two into treatment and others only many months in.
goodrx.com
Individual variation is large. The key point is that Accutane-related hair loss, if it happens, usually comes on gradually and often becomes noticeable by the middle of a typical course. You might first detect extra strands in your hairbrush or shower drain a couple of months into therapy rather than right away.
Telogen effluvium commonly has a delayed onset because hairs rest before they shed.
Why Does Accutane Cause Hair Loss? (Mechanisms)
Most cases behave like telogen effluvium plus dryness and fragility.
Accutane’s exact effect on hair follicles isn’t fully predictable, but several mechanisms are believed to play a role:
Telogen effluvium (hair cycle disruption):
The most common pattern of hair loss from Accutane is telogen effluvium, meaning a diffuse shedding caused by a disturbance in the hair’s growth cycle. Normally, 85–90% of scalp hairs are in the growth (anagen) phase at any time and only a small percentage are in the shedding (telogen) phase. Accutane (a vitamin A derivative) can alter this balance. Retinoids are thought to shorten the anagen phase or signal hair follicles to enter telogen prematurely.
goodrx.com
Essentially, the drug “tells” more hairs than usual to go to sleep and fall out. This mechanism is similar to what happens in other telogen effluvium triggers (like severe stress, illness, or crash diets) - a shock to the system causes a temporary uptick in hair shedding a few months later.
pmc.ncbi.nlm.nih.gov
pmc.ncbi.nlm.nih.gov
Scalp and hair dryness:
Isotretinoin dramatically reduces sebum (oil) production in the skin, and that includes the scalp’s natural oils. A drier scalp and hair shaft can lead to brittle, fragile hair that breaks more easily. Some “hair loss” on Accutane may actually be hair breakage rather than true shedding from the root.
healthline.com
Patients often notice their hair becomes drier, frizzier, or more difficult to style while on Accutane. The hair strands might snap or break mid-shaft due to dryness, contributing to overall thinning and a straw-like texture. Dry scalp can also cause itching or flaking, but it’s the weakened hair fibers that are the concern here. This is a dose-dependent effect as well - higher doses of Accutane cause more dryness, which can affect hair quality.
Nutritional factors:
Accutane can influence nutrient levels and appetite in subtle ways. Notably, some studies have found isotretinoin treatment might lead to lower levels of certain B vitamins (like folate) in patients.
healthline.com
Nutrient deficiencies (for example, low iron, zinc, biotin, or folate) are known to cause or worsen hair shedding. It’s theorized that Accutane’s effect on the liver and metabolism could contribute to a temporary drop in such vitamins. Additionally, if Accutane causes reduced appetite or other side effects that lead to poor nutrition, that could indirectly affect hair growth.
goodrx.com
On the flip side, Accutane is basically high-dose vitamin A, and excess vitamin A is a well-known cause of hair loss (this drug essentially mimics hypervitaminosis A). For this reason, patients are advised not to take vitamin A supplements while on isotretinoin - too much vitamin A can further drive hair loss and other side effects.
drdavinlim.com
Direct effects on follicles:
Beyond triggering telogen effluvium, isotretinoin may have direct impacts on hair follicles at a cellular level. Retinoids can modulate gene expression and cell differentiation in the skin. There is some evidence from dermatology that very high doses of isotretinoin could impair hair matrix cells or blood flow to the follicle, but typical doses primarily just alter the cycle timing.
healthline.com
healthline.com
One study noted that standard doses didn’t significantly affect short-term hair growth, except at very high exposures.
healthline.com
In most cases, the follicles are not permanently damaged - they are “reset” to a resting state and can resume normal growth later.
What Does Accutane-Related Hair Loss Look Like?
Most cases are diffuse thinning or shedding across the scalp.
Most hair loss from Accutane presents as diffuse thinning or shedding across the scalp, rather than patchy bald spots. In a telogen effluvium scenario, you might observe excess hair fall throughout the scalp. Patients often report seeing more hairs coming out when brushing or washing their hair. You may notice extra strands on your pillow in the morning, clogging the shower drain, or accumulating on your hairbrush. The shedding is typically evenly distributed - meaning you won’t see obvious bald patches, but overall volume (like a ponytail circumference) may decrease. Women might feel their ponytail is less full, and men or women with longer hair might see clumps of hair in the drain that were not present before.
https://www.goodrx.com/accutane/does-accutane-cause-hair-loss?srsltid=AfmBOopA2815m7aEwMtAbelKtZFjNkjuKXccxL6AoI_I3oiCioihOZde
A person noticing increased hair shedding on Accutane might see more loose hairs on their hairbrush or in the shower. Accutane-related hair loss usually appears as diffuse shedding (telogen effluvium), not distinct bald patches.
A person noticing increased hair shedding on Accutane might see more loose hairs on their hairbrush or in the shower. Accutane-related hair loss usually appears as diffuse shedding (telogen effluvium), not distinct bald patches.
Telogen effluvium pattern:
In telogen effluvium, the hairs that shed often have a white “club” at the root - a bulb indicating they exited the follicle. Because many hairs enter the resting phase around the same time, the shedding can seem dramatic, but it usually only affects a portion of your hair (often less than 50% of scalp hair is lost in telogen effluvium).
pmc.ncbi.nlm.nih.gov
The scalp generally still has plenty of growing hairs, so complete baldness from Accutane is extraordinarily unlikely. Instead, you may perceive a generalized thinning. Hair all over the head can be involved, though some people feel it’s most apparent on the crown or temples simply because those areas might show thinning more readily.
Hair texture changes:
Apart from shedding, many patients on Accutane notice changes in hair texture. Hair might become dry, brittle, or frizzy due to the lack of scalp oils. You could experience more tangles or split ends. Some describe their hair as feeling “straw-like” or less smooth than before. As a result, hairs might break off mid-length. If you’re seeing a lot of shorter broken hairs or split ends, that’s a sign the hair is dry and fragile (breakage) rather than falling out from the root. Breakage can make the ends look thin and may give the impression of hair loss as well.
Thinning vs. shedding:
It’s worth distinguishing what you might observe:
- Shedding means whole hairs are coming out from the scalp (you may see the tiny bulb at one end). This is the hallmark of telogen effluvium and is directly related to the follicle cycle.
- Thinning means the overall density of hair is reduced. Thinning can be the end result of excessive shedding (fewer hairs growing at a given time) and/or breakage making hair look wispy.
- Dryness and breakage mean the hair strands are weaker. You might see lots of broken pieces of hair that are shorter than your full hair length. The hair might snap when you run a comb through it or when you tie it back tightly.
In Accutane-induced hair loss, diffuse shedding is the primary issue, often accompanied by dryness-induced breakage. You generally will not see isolated bald spots (which would suggest alopecia areata or another condition) - if you do, inform your dermatologist, as that may be a different problem. Also, Accutane doesn’t typically cause eyebrow or eyelash loss or body hair loss in any noticeable way; it’s mainly the scalp hair that is affected in those few who experience this side effect.
Interactive: Shedding Explorer
Estimate which pattern your symptoms most resemble and a reasonable timeline. Educational only.
Shedding Explorer
Not a diagnosis. Use it to think clearly about timing, pattern, and next steps.
Timing can help distinguish telogen effluvium from breakage or pattern thinning.
Higher daily doses are linked to higher reported hair loss frequency in summaries.
Pick the closest match for what you are seeing.
Stress, illness, dieting, low iron, thyroid issues can overlap with telogen effluvium.
Most consistent with
Telogen effluvium style shedding, the most common pattern described with isotretinoin.
Suggested next step
Use gentle hair care, track one wash day per week, and discuss dose options with your prescriber if shedding is distressing.
Timeline estimate (typical, not a promise)
Telogen effluvium often appears after a delay because hairs rest before they shed.
Will My Hair Grow Back After Accutane?
In most cases, yes. Regrowth is gradual and can take months.
The reassuring news is that hair loss from Accutane is usually temporary. In the majority of cases, hair that was shed or thinned during therapy will regrow after you stop taking isotretinoin. Telogen effluvium by definition is a reversible form of hair loss - the hair follicles are not permanently damaged, they are simply “resting.” Once the drug is out of your system and your body readjusts, the follicles should return to a normal growth cycle.
Timeline for regrowth: Hair regrowth doesn’t happen overnight, so patience is key. Typically, a telogen effluvium resolves in a matter of months. After finishing Accutane, it may take a few months for the excessive shedding to stop (since hairs already pushed into telogen will still fall out). Many dermatologists cite the rule of thumb that it takes about 3 months after the trigger is removed for shedding to noticeably slow down.
goodrx.com
After that, new hairs will start to grow in. Given that scalp hair grows around 1 cm per month, you might see early signs of regrowth (like short “baby hairs” along the hairline or part line) after a couple of months, but significant filling in will take longer. Within 6 months or so after stopping Accutane, most people see their hair returning to its pre-Accutane thickness as the shed hairs grow back.
drdavinlim.com
Full recovery can vary - some individuals report it takes up to a year to feel their hair is completely back to normal density.
Evidence on reversibility:
Clinical data back up the notion that Accutane-related alopecia is usually reversible. A small study found that the hair loss from isotretinoin was temporary and hair regrew after therapy. In that study and others, patients’ hair counts or thickness returned to baseline after discontinuation.
goodrx.com
Persistent symptoms and exceptions:
That said, everyone is different. A very high dose or prolonged course might require a longer recovery period. There are also rare reports and anecdotes of people feeling that their hair never fully returned to the same volume. The official Accutane package insert even notes that alopecia “in some cases persists”.
dailymed.nlm.nih.gov
However, this appears to be the exception rather than the rule - persistent hair loss could be due to other coincidental hair conditions (for example, Accutane might unmask androgenetic alopecia that would have happened eventually anyway).
Permanent or not? For the vast majority of patients, hair regrowth is expected after Accutane. The follicles remain alive and capable of producing new hair. Once isotretinoin is cleared and the body recovers, there’s no continued trigger forcing hairs into telogen, so the cycle normalizes. New hair that grows after Accutane should be healthy, since the drug’s effect on hair was through the old hairs’ cycle. In other words, Accutane shouldn’t harm the new hairs formed after treatment.
Just keep in mind that hair growth is slow, so it requires patience and good hair care (as discussed next) to nurture the regrowth. If you have been off Accutane for several months and see no improvement or continued shedding, it’s wise to follow up with your dermatologist. They can check for other causes of hair loss that might be at play (such as thyroid issues, nutrient deficiencies, or genetic hair loss) and guide further treatment if needed. But generally, expect your hair to grow back and fill in over time once the medication is discontinued.
Tips for Managing and Preventing Hair Thinning on Accutane
Practical steps to minimize shedding and protect fragile hair during treatment.
While you can’t always completely prevent Accutane’s hair effects, there are practical steps you can take to minimize hair loss and keep your hair as healthy as possible during treatment:
Discuss dosing with your dermatologist:
If you’re concerned about hair loss, talk to your doctor about the Accutane dose. There is evidence that hair loss is dose-dependent.
sciencedirect.com
Sometimes dermatologists can use a lower daily dose over a longer period to treat acne, which may reduce side effect intensity (including hair thinning) while still being effective. Do not adjust your dose on your own, but it’s worth an honest conversation - your provider may decide that a slight dose reduction or a pause is appropriate if shedding becomes significant.
goodrx.com
healthline.com
Be gentle with your hair care:
Accutane makes hair more delicate, so treat it kindly. Avoid tight hairstyles that pull on the hair (tight ponytails, buns, braids), as these can increase breakage and fallout.
goodrx.com
If you use hair extensions or weaves, be cautious - methods that tug on the hair (glue-in extensions, very tight weaves) can exacerbate shedding; if needed, opt for gentler techniques (a sewn-in weave is less damaging than glue, for example).
goodrx.com
Use a wide-tooth comb or a detangling brush to minimize tugging, and never brush hair when it’s soaking wet, as wet hair is more elastic and prone to breakage. Instead, comb gently with your fingers or a wide-tooth comb after towel-drying.
healthline.com
Choose mild hair products and moisturize:
With the scalp producing less oil, keeping hair moisturized is crucial. Switch to a gentle, sulfate-free shampoo to avoid stripping natural oils - some shampoos containing harsh detergents or certain additives have been linked to hair breakage and shedding. Ask your dermatologist to recommend a gentle shampoo or any medicated scalp product if you have issues like flaky scalp. Follow up with a good conditioner every time you wash to add moisture back into the hair. You might also use a weekly deep conditioning treatment or hair mask to combat dryness. Natural oils (like argan oil or coconut oil) applied lightly to the hair lengths can reduce frizz and breakage - just avoid heavy oils on the scalp if you’re acne-prone there.
goodrx.com
In some cases, dermatologists might prescribe a topical corticosteroid oil or lotion for the scalp if there’s significant dryness or inflammation, but don’t use any medicated scalp product without medical guidance.
donovanmedical.com
Avoid chemical and heat stressors:
It’s wise to hold off on harsh chemical hair treatments while on Accutane. This means postponing any bleaching, perming, straightening treatments, or frequent hair coloring, as these processes can weaken the hair shaft and worsen brittleness. Likewise, try to minimize heat styling - excessive blow-dryer heat, flat irons, or curling irons can further dry out and damage your hair. If you must heat style, use a heat protectant spray and the lowest effective temperature. Embracing gentle hairstyles and air-drying more often can spare your hair additional stress during this period.
healthline.com
Protect your scalp from the sun:
Accutane can make your skin (including your scalp) more sensitive to sunlight. Too much sun can dry out hair and fade its proteins. When out in strong sun, wear a hat or scarf to shield your scalp and hair. This not only protects your skin but also prevents UV damage to the hair shafts, keeping them stronger.
healthline.com
Maintain a balanced diet and consider supplements:
Good nutrition is fundamental for healthy hair growth. Ensure you’re eating a balanced diet with adequate protein, iron, zinc, and vitamins. Because isotretinoin has been linked to lowered folate and vitamin B₁₂ levels in some patients, focus on folate-rich foods (leafy greens, beans, avocados, broccoli) or ask your doctor if a B-vitamin supplement is appropriate. Vitamin deficiencies can cause hair loss, so you want to avoid that compounding the issue.
healthline.com
goodrx.com
However, be cautious with supplements: do not take high-dose Vitamin A supplements (including fish liver oils) since Accutane is vitamin A-derived and you could risk toxicity or worsened hair loss. Some people try over-the-counter hair vitamins or biotin supplements; these are generally safe, but keep in mind that evidence for biotin helping hair thinning is limited unless you have an actual biotin deficiency. It’s best to discuss any supplement with your healthcare provider. Often, a standard multivitamin and a nutrient-rich diet can cover your bases without the need for specialized hair supplements.
drdavinlim.com
goodrx.com
Manage stress:
It’s easier said than done, but try to keep stress levels in check. High stress itself can trigger or worsen telogen effluvium - in fact, the anxiety about hair loss can create a vicious cycle where stress causes more shedding. Incorporate stress-relief practices that work for you, such as exercise, meditation, yoga, or adequate sleep. Staying calm and positive can help your overall well-being and potentially ease stress-related hair fall.
drdavinlim.com
healthline.com
Keep your dermatology team in the loop:
Don’t hesitate to tell your dermatologist early on if you notice increased hair shedding. They might check your bloodwork for things like thyroid function, iron levels, or other factors, to ensure nothing else is contributing. In some cases, if hair loss is significant, the dermatologist might decide to adjust your treatment plan - whether that’s reducing the dose, taking a short break from Accutane, or in rare cases switching to an alternative acne therapy. Never stop Accutane abruptly on your own; always consult your doctor, but know that adjustments can be made if needed to find the right balance between clearing your acne and maintaining your hair.
goodrx.com
By following these tips - gentle hair care, hydrating and protecting your hair, and working with your doctor - you can often mitigate the hair thinning during Accutane. Many patients get through their course with minimal hair changes by using these preventive measures. And remember, in most scenarios the hair changes are reversible, so any extra TLC you give your hair is essentially helping it stay in the best shape possible until it naturally rebounds post-Accutane.
When to Contact Your Dermatologist
Contact your clinician when shedding is significant, distressing, unusual, or persistent.
It’s important to keep your healthcare provider informed about side effects, especially one as distressing as hair loss. You should contact your dermatologist if:
- You notice significant hair shedding or thinning while on Accutane. If over the span of several weeks you see a substantial increase in daily hair fall (for example, clumps of hair in the drain or visibly less dense hair on your head), let your provider know sooner rather than later. Early communication is key - your dermatologist may recommend steps to manage it, such as adjusting your dose or duration.
- Hair loss is causing you anxiety or distress. Mental well-being matters. If the change in your hair is affecting your confidence or causing stress, bring it up. Your dermatologist might reassure you about the temporary nature of the shedding, or they might have interventions to help support your hair (like suggesting safe supplements, prescribing a topical treatment, or referring you to a hair specialist if needed).
- You see unusual patterns of hair loss. If you develop patchy hair loss (circular bald spots) or if hair is coming out in very large handfuls suddenly, that’s not the typical pattern for Accutane telogen effluvium. It could indicate another condition (like alopecia areata or an acute telogen effluvium from a different stressor). Let your doctor evaluate this - they might investigate other causes or co-factors beyond the Accutane itself.
- Hair loss continues long after stopping Accutane. Some shedding right after finishing treatment can be normal (since telogen effluvium can lag a bit), but if you’ve been off the medication for, say, 6–12 months and are still experiencing excessive hair loss or no regrowth, you should see your dermatologist. They can determine if something else is ongoing. They may check labs or consider treatments to jump-start hair regrowth if appropriate.
- You are considering stopping Accutane due to hair loss. Always loop in your provider before making that decision. They will weigh the pros and cons with you. In some cases of severe hair loss, a pause or discontinuation might be reasonable, but in others, understanding that it’s temporary and manageable might persuade you to continue. Either way, get professional guidance.
goodrx.com
Remember, dermatologists are very familiar with this side effect. They routinely counsel patients about the risk of telogen effluvium with Accutane. If you report hair changes, they won’t be surprised or dismissive - it’s a recognized phenomenon, and they will help monitor and manage it. Your provider may suggest switching acne treatments only if absolutely necessary (for instance, if hair loss is severe and you prefer an alternative therapy for acne). In many cases, they’ll encourage you to continue with precautions, since the shedding is likely to reverse after the course is done.
sciencedirect.com
goodrx.com
Bottom Line
Concise summary of what matters most.
Accutane can cause hair loss in a minority of patients, typically in the form of a temporary telogen effluvium leading to diffuse shedding and sometimes brittle, dry hair. The frequency is low (single-digit percentages) and often dose-related. If you do experience “Accutane hair thinning” or find you’re losing hair on Accutane, know that in most cases it is not permanent - hair growth should resume after treatment. While dealing with it, focus on gentle hair care, good nutrition, and communicate with your dermatologist. Many people who have mild hair shedding find it stabilizes with these measures and their hair fully regrows after Accutane treatment is completed. Always report any bothersome side effects to your healthcare provider. With the right precautions and support, you can get through your Accutane course while keeping your hair as healthy as possible, and look forward to both clear skin and a full head of regrown hair in the months after therapy.
goodrx.com
Medical review and editorial standards
How this content is created, reviewed, and updated.
This article is educational and does not replace medical care. Medication decisions should be made with your prescriber, especially with isotretinoin.
Sources:
References as provided in the pasted research.
- Lytvyn Y. et al. JAAD Int. (2022) - Frequency of isotretinoin-induced hair loss at different doses sciencedirect.com
- GoodRx Health - Accutane and Hair Loss article goodrx.com
- Tran P.T. et al. Int J Trichology (2022) - Accutane and alopecia retrospective study pmc.ncbi.nlm.nih.gov
- Accutane (isotretinoin) Package Insert - JG Pharma (2022) dailymed.nlm.nih.gov
- Healthline - Hair Loss on Accutane and How to Prevent It healthline.com
- Malkud S. J Clin Diagn Res. (2015) - Telogen Effluvium review pmc.ncbi.nlm.nih.gov
- Donovan Hair Clinic - Post-Accutane dry/brittle hair advice donovanmedical.com
- Dr. Davin Lim - Accutane-induced hair loss Q&A drdavinlim.com