Isotretinoin

Is it effective against hair loss?

It may seem contradictory to recommend using isotretinoin on a website whose purpose is to help people treat their hair loss. However, it is primarily the misuse of isotretinoin that causes hair loss.

I will try to clarify this topic, as some of you may already be using this medication and suffering from hair loss, so this could be helpful for you.

Isotretinoin causes Effluvium Anagen type hair loss

The hair loss caused by isotretinoin is precisely called effluvium anagen.  

You have probably heard of telogen effluvium, but few are familiar with anagen effluvium. In reality, even dermatologists sometimes struggle to distinguish between them, but there are significant differences.

Take a look at this illustration:

It might sound complicated, but to simplify, anagen effluvium causes a rapid and massive hair loss, while telogen effluvium is less severe and occurs more slowly.

How isotretinoin causes hair loss ?

It is known that isotretinoin can cause hair loss, but it is all a question of dosage. Indeed, isotretinoin causes liver intoxication when used at high doses. This intoxication provokes a very significant stress and reaction from the body. This kind of reaction often translates into anagen effluvium, which is a very rapid and severe hair loss.

In addition, isotretinoin reduces the absorption of certain vitamins and minerals such as vitamin E, zinc and selenium. And as you certainly know, these deficiencies can cause hair loss.

There is also a close link between biotin and isotretinoin. Indeed, the use of isotretinoin quickly depletes biotin. Biotin being a B vitamin that must be provided by diet, it is possible that this drug reduces its absorption or that it uses the available reserves, causing hair loss.

Now, there are two problems:

• The intoxication causes anagen effluvium
• The deficiencies cause telogen effluvium

Therefore, it is important to use isotretinoin very intelligently. It is necessary, first of all, to avoid high doses that may cause intoxication, then it is necessary to ensure to avoid any deficiencies that isotretinoin could cause.

Low dose isotretinoin reduces seborrhea and seborrheic dermatisis ?

Seborrhea and seborrheic dermatitis are skin conditions that are frequently associated with hair loss. Specifically, when these conditions affect the scalp, they can potentially exacerbate or even trigger hair loss.

For those unfamiliar with these conditions:

• Seborrhea is the overproduction of sebum
• Seborrheic dermatitis is a condition known to induce various skin issues associated with inflammation.

Here is an example of seborrheic dermatisis :

Due to the association of these conditions with an excess production of  sebum and inflammation, isotretinoin proves effective in reducing them. Numerous studies have established the efficacy of isotretinoin in decreasing seborrhea and seborrheic dermatitis (source) (source).

Therefore, if hair loss is triggered or exacerbated by these conditions, isotretinoin may be a viable option. However, it’s crucial to use it in low doses to prevent hair loss. Some studies also support this notion (source). 

What is low dose isotretinoin ?

Typically, isotretinoin is prescribed at doses from 10mg up to 50mg per day for severe acne. However, even a dose as low as 10mg daily can cause liver toxicity for some people. Long-term use of isotretinoin is also known to potentially damage the liver.

In Japan, doctors often prescribe much lower doses of isotretinoin, around 5mg per day, to effectively treat acne. But in Europe and the United States, the minimum prescribed dose is usually 10mg.

I personally used isotretinoin to treat my acne and seborrheic dermatitis. After trying a dose of 10mg that rapidly destroyed 70% of my hair in just 1 week, I experimented to find the ideal dose for me.

Through trial and error, I found that taking 1.8mg every 8 hours (for a total of 5.4mg per day) worked well without side effects. Given my weight of 70kg, this low dose may need to be adjusted slightly for other individuals based on their body weight.

The key for me was splitting the daily amount into smaller doses spaced evenly throughout the day. I discovered that spacing the doses by 8 hours worked best in my case. Doses above 2.5mg at one time seemed to provoke side effects.

To prevent potential vitamin deficiencies, I also took a daily multivitamin supplement while using isotretinoin.

This is my personal experience. If you’re considering drawing inspiration from it, make sure to consult with your dermatologist before making any decisions.

Closing thoughts and verdict

Although isotretinoin can cause rapid and severe hair loss of the anagen effluvium type, it can also help reduce hair loss by treating seborrheic dermatitis and seborrhea.

In order to avoid hair loss, the best solution is to distinguish if your hair loss is related to any skin condition and also, use isotretinoin at a low dose and avoid any deficiencies it may cause.

I have other theories about isotretinoin and its potential efficacy on androgenetic hair loss, but I need more research before publishing them.

Precautions & side effects

You can find isotretinoin under many brands : 

Most Common:

• Endocrine & metabolic: Increased serum triglycerides (25%)
• Neuromuscular & skeletal: Back pain ( 29%)
• Ophthalmic: Conjunctivitis (4%), blepharitis (1%), chalazion (1%), hordeolum (1%)
• Dry skin and lips
• Joint and muscle pain
• Headaches
• Dry eyes and eye irritation
• Nosebleeds
• Depression, mood changes
• Skin rash
• Increased sun sensitivity

Rare:

• Liver inflammation
• Permanent hair loss
• Decreased night vision
• Decreased bone mineral density
• High blood pressure
• Erectile dysfunction
• Birth defects if used during pregnancy
• Changes in blood sugar levels
• Gastrointestinal issues like nausea, diarrhea
• Decreased white blood cell count
• Increased bruising or bleeding
• Allergic reactions
• Hearing impairment, tinnitus
• Vision changes
• Skin peeling/redness
• Increase in creatine phosphokinase levels

Very important :  Isotretinoin must not be used by women and adolescents who are pregnant or who may become pregnant.

There is an extremely high risk that severe birth defects can result if pregnancy occurs while taking isotretinoin in any amount, even for short periods of time. Potentially, any fetus exposed during pregnancy can be affected. There are no accurate means of determining whether an exposed fetus has been affected.