Isotretinoin (Roaccutane, Accutane) and hair loss: the two faces of acne treatment

“Director, I’m taking Roaccutane for acne, but my hair is falling out so 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 treatments. However, behind this effect, there is a hidden side effect called ‘hair loss’ that should not be overlooked. Given that the age group that mainly takes this drug is those in their teens and twenties, if hair loss occurs after taking the drug, hair loss that begins at too early an age can cause mental distress to the patient.

1. Isotretinoin, what kind of drug is it?

Isotretinoin is a vitamin A derivative that strongly inhibits the activity of the sebaceous glands that produce sebum in our bodies. This dramatically reduces sebum secretion, eliminates the environment for acne bacteria to inhabit, normalizes abnormal keratin formation, and reduces inflammation. As powerful as the effect is, side effects such as dry lips, dry skin and eyes are common, and what we should pay attention to here is the effect on hair.

2. Why does isotretinoin cause hair loss?

Not everyone who takes isotretinoin will experience hair loss, but in some patients, hair loss or hair loss may occur due to the following principles:

• Causes telogen effluvium:Isotretinoin affects the hair growth cycle. It shortens the 'growth phase', when hair actively grows, and quickly transitions to the 'telogen phase', the stage before hair falls out, which can cause **Telogen Effluvium**, which temporarily causes a lot of hair to fall out.
• Dry scalp and hair follicles:The action of suppressing sebum secretion applies equally to the face as well as the scalp. If the scalp becomes excessively dry, dead skin cells occur and the healthy environment of the hair follicles is disrupted, causing hair to become thinner, brittle, and break easily.
• Deterioration of hair follicle cell function:Some studies report that isotretinoin may have a direct effect on hair follicle cell proliferation and function.

It is known that telogen effluvium will recover if you stop taking isotretinoin, but the problem is in patients who already have hair loss, have a family history, or have other causes of hair loss. For these people, isotretinoin can act as a 'trigger' that turns on a dormant hair loss gene or accelerates hair loss that is already in progress. As a result, it often leads to the unfortunate situation where hair loss does not stop or worsens even if you stop taking the medication.

3. Wise use and management of isotretinoin

So should you give up this effective acne treatment? That's not true. It is necessary to use it wisely and actively manage it to minimize the side effect of hair loss when taking it.

Control of dosage and duration is key.

If possible, it is recommended to start with a low dose and keep the total dosage period short, no more than 2 months. If long-term use for more than 2 months is necessary, minimize the dose or increase the interval between doses by taking it every 2 or 3 days to prevent excessive accumulation of the drug in the body.

Lifestyle management while taking medication

• Drink enough water:It is important to drink more water than usual to prevent the medicine from drying out your entire body.
• Take hair nutrients:It is helpful to take hair nutrients containing vitamin C, zinc, iron, vitamin D, and high-quality protein.
• Gentle scalp care:Since the scalp tends to become dry and sensitive, it is also a good idea to use a mild shampoo with moisturizing properties and apply a scalp moisturizer. In particular, it is recommended to use dandruff shampoo only once or twice a week.

Isotretinoin is definitely a good acne treatment. However, when we are accurately aware of the side effects behind them, consult closely with experts to adjust the dosage and period, and make active management efforts on our own, we can kill both acne and hair loss and maintain healthy skin and hair.