Isotretinoin and hair: shedding, dryness and what to ask your doctor

Isotretinoin is one of the most effective treatments for severe acne, and many people who take it are delighted with the results for their skin. But a common worry, often picked up from online forums, is that it will make hair fall out. Some people do notice more shedding or drier hair during treatment, while many notice no change at all. Knowing what the evidence shows can help you have a calm, useful conversation with your doctor.

This guide explains what isotretinoin is, how it may affect hair, how often hair loss is reported, why the scalp and hair can feel dry, how to care for hair during a course and what to ask your doctor. It is general information, not personal medical advice. Isotretinoin is a prescription medicine that must be supervised by a doctor. Do not stop, start or change the dose on your own.

Short answer

• Isotretinoin is an oral medicine related to vitamin A, used mainly for severe or scarring acne that has not responded to other treatments ¹².
• Hair loss is a recognised but less common side effect, usually described as temporary diffuse shedding (telogen effluvium) ¹³.
• It appears to be reported more at higher daily doses. A systematic review found hair loss in about 3.2% of patients on lower doses and 5.7% on higher doses, although a formal statistical comparison was not possible ⁴.
• Many people see no measurable change. A small study using digital hair analysis found no statistically significant change in hair parameters after three months at a standard dose ⁵.
• Dryness is far more common than shedding. Isotretinoin reduces oil production, so the scalp and hair can feel drier ⁶.
• Talk to your prescribing doctor if you notice shedding. Do not stop the medicine on your own.

What isotretinoin is and how it works

Isotretinoin is a retinoid, a medicine derived from vitamin A. It is taken by mouth, usually for several months. It works on several causes of acne at once: it shrinks the oil glands and sharply reduces oil (sebum) production, helps prevent pores from clogging and reduces inflammation ¹².

Because it acts on oil glands all over the body, including those on the scalp, its effects are not limited to the face. The same action that clears acne also explains many of its common side effects, such as dry lips, dry skin and dry eyes ⁶.

Isotretinoin must not be taken during pregnancy because it can seriously harm an unborn baby, so people who could become pregnant follow a strict pregnancy prevention programme while taking it ⁶. This is one reason it is prescribed and monitored by doctors with experience in using it.

How isotretinoin may affect hair

Hair follicles are closely linked to the oil glands in the skin, and retinoids influence how skin and follicle cells grow and mature. The exact reason some people shed hair on isotretinoin is not fully understood ³.

When hair loss does occur, it is usually described as telogen effluvium: more hairs than usual move into the resting phase and shed a few weeks to months later, causing diffuse thinning rather than bald patches ⁷. For background on medicine-related hair loss more generally, see medicines that can cause hair loss and the DermNet overview of alopecia from drugs ⁸.

How common is hair loss on isotretinoin?

The research gives a reasonably reassuring picture, although it has limits:

• A 2022 systematic review pooled 22 studies of people taking isotretinoin for acne. Hair loss was reported in about 3.2% (18 of 565) of those on less than 0.5 mg/kg per day and about 5.7% (192 of 3,375) of those on 0.5 mg/kg per day or more. The authors noted that inferential statistics were not possible and called for higher-quality research ⁴.
• A retrospective review from a US hair clinic looked at 6,330 patients with hair loss. Of these, 48 had been prescribed isotretinoin at some point, and in 19 the hair loss occurred during or within two years after treatment. Compared with people who took isotretinoin without hair loss, they tended to be older and to have had higher total doses and longer courses ³.
• A small prospective study measured hair counts, density and the proportion of growing and resting hairs before and after three months of treatment at 0.5 mg/kg per day. It found no statistically significant changes ⁵.

Taken together, these suggest that hair loss affects a minority of people, may be more likely with higher doses or longer use, and is not inevitable.

Dry scalp and dry hair

For many people, the more noticeable change is dryness rather than shedding. With less oil on the scalp, you may notice:

• Hair that feels drier, rougher or more frizzy.
• A scalp that feels tight, flaky or itchy.
• Needing to wash hair less often than before, especially if you previously had an oily scalp.
• Hair that breaks more easily if it is also bleached, coloured or heat-styled.

Dry, fragile hair can snap, which may look like hair loss even when follicles are fine. See hair breakage versus hair loss to tell the difference, and dry scalp or dandruff for scalp flaking.

Caring for hair during a course

These general steps can help hair cope with dryness:

• Use a mild shampoo and avoid washing more often than you need. See how often to wash your hair.
• Use conditioner on the lengths after every wash.
• Limit heat styling, and use lower heat settings when you do.
• Postpone bleaching, rebonding or perms where possible, as these add further stress to dry hair.
• Use a wide-tooth comb and detangle gently.
• Protect your scalp from the sun with a hat or shade, as isotretinoin can make skin more sensitive to sunlight ⁶.
• Avoid waxing and laser hair removal during treatment, in line with NHS advice for people taking isotretinoin ⁶.

For more ideas, see a gentle hair care routine when losing hair.

Supplements and diet

It is tempting to add supplements to protect hair, but some can be risky with isotretinoin:

• Vitamin A supplements and supplements containing vitamin A should be avoided, because isotretinoin is related to vitamin A and the effects can add up ⁶.
• Biotin is often marketed for hair, but high doses can interfere with some blood tests that may be part of monitoring. See biotin for hair loss.
• A balanced diet with enough protein, iron and calories supports healthy hair. If you are worried about deficiency, ask your doctor rather than starting several products. See vitamin deficiencies linked to hair loss.

Always tell your doctor or pharmacist about any supplement, herbal remedy or other medicine before taking it with isotretinoin.

Comparison table

Will the hair come back?

When hair loss is related to isotretinoin and takes the form of telogen effluvium, it is generally described as temporary ¹. Telogen effluvium tends to settle once the trigger is reduced or removed, although it can take several months for hair to look fuller again because hair grows slowly ⁷.

If shedding continues long after treatment has ended, another cause may be involved. Pattern hair loss, iron deficiency, thyroid problems or a period of illness or stress can all overlap. See chronic telogen effluvium and blood tests for hair loss.

What your doctor might consider

If you notice shedding during treatment, your doctor may:

• Look at the pattern of thinning and examine your scalp. A gentle pull test may be used. See the hair pull test explained.
• Review your dose, duration and response of the acne to treatment.
• Ask about other triggers, such as recent illness, crash dieting or stress.
• Arrange blood tests if appropriate.
• Discuss options, which might include continuing with monitoring, adjusting the dose or changing the plan. These are decisions for your doctor, based on how well the acne is responding and your overall health.

Before you start a course

If you are about to start isotretinoin and are worried about hair:

• Mention any existing hair loss or family history of thinning so your doctor has a baseline.
• Take clear photos of your hairline, parting and crown in good light.
• Ask how your dose will be chosen and what monitoring is planned.
• Plan a simple hair care routine that suits a drier scalp.

Common myths

• "Isotretinoin always makes you bald." Studies suggest hair loss affects a minority of people, and when it happens it is usually temporary diffuse shedding.
• "Any hair loss during treatment is from the medicine." Other causes, such as illness, stress, diet changes or pattern hair loss, can coincide with a course.
• "Taking extra vitamin A will help hair." This is not advised, as it can add to the effects of isotretinoin.
• "Stopping the medicine immediately is the safe thing to do." Changes to treatment should be made with your doctor, who can weigh up the benefits for your acne.
• "Dry hair means the follicles are damaged." Dryness is mainly due to less oil on the scalp and hair shaft.

Common mistakes

• Stopping or changing the dose without speaking to the prescriber.
• Starting several supplements at once, including ones with vitamin A.
• Bleaching or rebonding dry hair during treatment.
• Over-washing a dry scalp with harsh products.
• Ignoring shedding that continues long after treatment ends.

Questions to ask your doctor

• Is hair shedding a likely side effect at my dose?
• Should I be concerned about the amount of hair I am losing?
• Are there other causes that should be checked, such as iron or thyroid?
• Which supplements or products should I avoid during treatment?
• How long after finishing treatment should my hair settle?

The bottom line

Isotretinoin is a highly effective acne treatment, and hair loss is a recognised but uncommon side effect, usually temporary diffuse shedding. Research suggests it may be more likely at higher doses or with longer courses, but many people see no measurable change in their hair. Dryness of the scalp and hair is much more common and can be eased with gentle care. If you notice shedding, speak to your prescribing doctor rather than stopping the medicine yourself, and ask whether other causes need checking. For related reading, see medicines that can cause hair loss and chronic telogen effluvium.

Frequently asked questions

Does isotretinoin cause hair loss?

It can, but it is a less common side effect. When it happens, it is usually temporary diffuse shedding known as telogen effluvium. Many people notice no change in their hair.

How common is hair loss on isotretinoin?

A 2022 systematic review found hair loss reported in about 3.2% of patients on lower daily doses and about 5.7% on higher doses, although a formal statistical comparison was not possible.

Does hair loss from isotretinoin last after treatment?

When it is telogen effluvium, it is generally described as temporary and settles over months. If shedding continues long after treatment, see a doctor to check for other causes.

Why does my hair feel dry on isotretinoin?

Isotretinoin reduces oil production by the oil glands, including those on the scalp, so hair and scalp can feel drier. A mild shampoo, conditioner and less heat styling can help.

Should I stop isotretinoin if my hair is shedding?

Do not stop on your own. Speak to your prescribing doctor, who can assess the shedding, check for other causes and decide whether any change to treatment is needed.

Can I take vitamin A or hair supplements with isotretinoin?

Vitamin A supplements should be avoided because isotretinoin is related to vitamin A. Check with your doctor or pharmacist before taking any supplement, including biotin.

Can I colour or rebond my hair during treatment?

Hair can be drier and more fragile, so it is sensible to postpone bleaching, rebonding and perms where possible and to limit heat.

When should I see a doctor about hair loss on isotretinoin?

If shedding is heavy, you notice patches, your scalp is sore, or hair loss continues months after the course ends.

Educational content. Not medical advice.