Isotretinoin (Roaccutane, Accutane) and Hair Loss: The Two Faces of Acne Treatment

"Doctor, I've been taking Roaccutane for my acne, and my hair is falling out way too much."

Isotretinoin (brand names: Roaccutane, Accutane, etc.), prescribed by dermatologists, is an effective treatment for severe acne or seborrheic dermatitis that does not respond well to other therapies. However, behind this effectiveness lies a side effect that must not be overlooked: 'hair loss.' Given that the primary age group taking this medication is in their teens and 20s, hair loss occurring at such a young age can cause significant psychological distress to patients.

1. What Kind of Medication is Isotretinoin?

Isotretinoin is a vitamin A derivative that powerfully inhibits the activity of sebaceous glands, which produce sebum in our bodies. This dramatically reduces sebum secretion, eliminates the environment where acne bacteria thrive, normalizes abnormal keratin formation, and reduces inflammation. Because of its potency, side effects such as dry lips, skin, and eyes are common. What we must pay close attention to here is its impact on hair.

2. Why Does Isotretinoin Induce Hair Loss?

While hair loss does not occur in everyone taking Isotretinoin, some patients may experience hair loss or thinning due to the following mechanisms:

• Inducing Telogen Effluvium: Isotretinoin affects the hair growth cycle. It can shorten the 'Anagen' (active growth) phase and accelerate the transition to the 'Telogen' (resting) phase, potentially triggering **Telogen Effluvium**, a condition characterized by temporary but excessive hair shedding.
• Scalp and Follicle Dryness: The inhibition of sebum secretion applies to the scalp just as it does to the face. When the scalp becomes excessively dry, flaking occurs, and the healthy environment of the hair follicles is disrupted, causing hair to become thin, brittle, and easily broken.
• Decreased Follicle Cell Function: Some studies report that Isotretinoin may directly affect the proliferation and function of hair follicle cells.

While it is generally known that Telogen Effluvium recovers once Isotretinoin is discontinued, a problem arises for patients who already had existing hair loss, a family history, or overlapping causes. For these individuals, Isotretinoin can act as a 'trigger' or 'switch' that activates dormant hair loss genes or accelerates already progressing hair loss. Consequently, this often leads to unfortunate situations where hair loss does not stop or even worsens even after the medication is stopped.

3. Wise Ingestion and Management of Isotretinoin

Does this mean you should give up on this effective acne treatment? Not necessarily. To minimize the side effect of hair loss, it is necessary to use it wisely and manage it proactively.

Dosage and Duration are Key

If possible, it is advisable to start with a low dose and keep the total duration of use short—ideally within two months. If long-term use exceeding two months is required, one should minimize the dosage or increase the interval between doses (e.g., taking it once every two or three days) to prevent excessive accumulation of the drug in the body.

Lifestyle Management During Ingestion

• Sufficient Water Intake: It is crucial to drink more water than usual to prevent systemic dryness caused by the medication.
• Hair Supplements: Taking hair supplements containing Vitamin C, Zinc, Iron, Vitamin D, and high-quality protein can be helpful.
• Gentle Scalp Care: Since the scalp can easily become dry and sensitive, using a mild, moisturizing shampoo and applying scalp moisturizers is a good approach. In particular, it is recommended to use anti-dandruff shampoos only once or twice a week.

Isotretinoin is undoubtedly an effective acne medication. However, when we accurately recognize its underlying side effects, consult closely with experts to adjust dosage and duration, and combine these with proactive self-care efforts, we can manage both acne and hair loss while protecting healthy skin and hair.