Accutane and hair loss is a concern raised by many patients prescribed isotretinoin — the potent oral retinoid used in the UK under brand names such as Roaccutane for severe or treatment-resistant acne. Whilst isotretinoin is highly effective, hair thinning is a recognised side effect that understandably causes anxiety. This article explains why hair loss can occur during isotretinoin treatment, how common it is, what you can do to manage it, and what to expect once your course is complete — drawing on UK clinical guidance from the MHRA, NICE, and leading dermatology bodies.

Can Isotretinoin Cause Hair Loss?

Yes — isotretinoin can cause telogen effluvium, a diffuse, non-scarring hair shedding caused by premature shift of follicles into the resting phase; this is listed as a known adverse effect in the isotretinoin SmPC and recognised by the MHRA and EMA.

Experiencing these side effects? Our pharmacists can help you navigate them →

Isotretinoin — known by the former US brand name Accutane, which is not marketed in the UK — is a potent oral retinoid prescribed for severe or treatment-resistant acne. In the UK it is available as isotretinoin capsules under brand names including Roaccutane and as generic preparations; patients should refer to the Summary of Product Characteristics (SmPC) for their specific product, available via the Electronic Medicines Compendium (emc). Isotretinoin works by dramatically reducing sebaceous gland activity, normalising skin cell turnover, and decreasing inflammation within the follicle. While it is highly effective, it carries a recognised range of side effects, and hair changes are among those reported by some patients.

Hair loss associated with isotretinoin is classified medically as telogen effluvium — a diffuse, non-scarring form of hair shedding. Under normal circumstances, hair follicles cycle through growth (anagen), transition (catagen), and resting (telogen) phases. Isotretinoin is thought to prematurely shift a proportion of follicles into the telogen phase, leading to increased shedding, typically noticed as diffuse thinning across the scalp rather than patchy bald spots.

Isotretinoin does not appear to permanently damage hair follicles in the way that scarring alopecias do. The mechanism is a physiological disruption of the hair cycle rather than structural destruction of the follicle. Alopecia and hair texture changes are listed as known adverse effects in Section 4.8 (Undesirable Effects) of the isotretinoin SmPC, and are recognised by both the Medicines and Healthcare products Regulatory Agency (MHRA) and the European Medicines Agency (EMA). Patients should be counselled about this possibility before commencing treatment.

Importantly, patients taking isotretinoin should avoid vitamin A supplements and multivitamins containing vitamin A, as isotretinoin is itself a vitamin A derivative and combined use increases the risk of vitamin A toxicity. This is stated in the NHS patient information for isotretinoin capsules and in the SmPC.

How Common Is Hair Thinning During Isotretinoin Treatment?

Alopecia is classified as an uncommon adverse effect in several UK isotretinoin SmPCs, affecting 1 in 100 to 1 in 1,000 users, though mild shedding may be under-reported in clinical trials.

The frequency of alopecia listed in UK isotretinoin SmPCs varies by product; patients and clinicians should consult the SmPC for the specific preparation being used (available at emc.medicines.org.uk, Section 4.8). For several UK-licensed isotretinoin products, alopecia is listed as an uncommon adverse effect (affecting between 1 in 100 and 1 in 1,000 users), though frequency classifications differ across preparations. Observational and patient-reported data suggest that mild shedding may be under-reported in clinical trials, as it can be attributed to other causes; however, robust real-world prevalence figures are limited and this should be presented as observational rather than established fact.

Several factors may influence the likelihood and severity of hair loss during treatment, though the evidence for some of these is limited or based on expert opinion rather than high-quality clinical trials:

Not sure if this is normal? Chat with one of our pharmacists →

• Cumulative dose: Some observational data suggest higher total doses may be associated with a greater risk of hair changes, though a clear dose–response relationship has not been definitively established.

• Individual sensitivity: Some patients appear more susceptible to retinoid-induced telogen effluvium, possibly due to genetic or hormonal factors.

• Nutritional status: Deficiencies in iron, ferritin, zinc, or vitamin D — which are independently associated with hair loss — may compound the effect, though this should be assessed clinically rather than assumed.

• Pre-existing hair conditions: Those with a personal or family history of androgenetic alopecia may notice more pronounced thinning.

It is also worth acknowledging that severe acne itself, particularly when associated with hormonal fluctuations, can contribute to hair shedding independently of treatment. Disentangling the contribution of the medication from the underlying condition or other factors can therefore be clinically challenging. If hair loss is noticed, it typically begins within the first few months of starting isotretinoin. Monitoring hair changes as part of routine follow-up is advisable, and any concerns should be raised with the prescribing clinician promptly.

Managing Hair Loss While Taking Isotretinoin

There is no officially approved treatment for isotretinoin-induced hair loss, but gentle hair care, nutritional assessment, scalp moisturisation, and dose review by a dermatologist are the main supportive strategies.

For most patients, hair thinning during isotretinoin treatment is mild and manageable. There is currently no officially approved treatment specifically for isotretinoin-induced telogen effluvium, but several supportive measures may help minimise shedding and support overall hair health during the treatment course.

Practical steps that may be helpful include:

• Gentle hair care: Avoid excessive heat styling, tight hairstyles, and harsh chemical treatments. Use a mild, sulphate-free shampoo and handle wet hair carefully to reduce mechanical breakage.

• Nutritional assessment: Ensure adequate intake of protein, iron, and zinc through a balanced diet. If dietary intake may be insufficient, a GP can arrange blood tests to identify and address any deficiencies. Biotin supplementation is not routinely recommended unless a deficiency has been confirmed, as evidence for its benefit in non-deficient individuals is limited; additionally, high-dose biotin can interfere with certain laboratory assays, including thyroid function tests.

• Avoid vitamin A supplements: As noted above, vitamin A supplements — including high-dose multivitamins containing vitamin A — must be avoided during isotretinoin treatment due to the risk of additive toxicity.

• Scalp care: Keeping the scalp clean and appropriately moisturised may support a healthy follicular environment, particularly as isotretinoin commonly causes generalised skin and scalp dryness.

• Dose review: In cases of significant hair loss, a dermatologist may consider temporarily reducing the dose or adjusting the treatment schedule, balancing the benefit to acne control against the impact on quality of life.

There is no strong clinical evidence supporting the use of topical minoxidil specifically for isotretinoin-induced telogen effluvium. It is sometimes used off-label where concurrent androgenetic alopecia is present, but tolerance may be reduced due to isotretinoin-related scalp dryness and irritation. Any pharmacological treatment for hair loss during isotretinoin therapy should be clinician-supervised.

Patients should not self-prescribe additional treatments or discontinue isotretinoin without consulting their prescribing clinician, as abrupt cessation may affect acne outcomes. Emotional support should not be overlooked — hair changes can significantly affect self-esteem, and acknowledging this with patients is an important part of holistic care.

Reporting side effects: If you experience hair loss or any other suspected side effect from isotretinoin, you can report it to the MHRA via the Yellow Card scheme at yellowcard.mhra.gov.uk or through the Yellow Card app. Reporting helps the MHRA monitor the safety of medicines in the UK.

When to Speak to Your Dermatologist or GP

Seek prompt medical advice if you experience rapid, severe, or patchy hair loss, scalp pain or redness, hair loss alongside new systemic symptoms, or significant psychological distress related to hair changes.

Whilst mild, diffuse hair shedding during isotretinoin treatment is generally considered a manageable side effect, there are circumstances in which it is important to seek prompt medical advice. Patients should not feel that hair loss is simply something to tolerate in silence — open communication with the prescribing team is encouraged throughout the treatment course.

Contact your dermatologist or GP if you notice any of the following:

• Rapid or severe hair loss causing visible thinning or bald patches within a short period

• Patchy hair loss (which may suggest alopecia areata, an unrelated autoimmune condition)

• Signs that may indicate scarring alopecia, such as scalp pain or tenderness, persistent redness, scaling, or pustules around hair follicles — these warrant prompt dermatology assessment

• Hair loss accompanied by other new symptoms, such as fatigue, unexplained weight changes, or altered mood, which could indicate a thyroid disorder or other systemic condition

• Significant psychological distress related to hair changes, affecting daily functioning or wellbeing

• Hair loss that continues to worsen despite reassurance and supportive measures

At the appointment, the clinician will assess hair loss in the context of your overall health and may arrange blood tests — for example, thyroid function tests, full blood count, serum ferritin, and vitamin D levels — based on clinical judgement. This list is not exhaustive, and investigations will be guided by your individual circumstances.

In line with NICE guidance on acne management (NICE NG198) and MHRA requirements, all patients on isotretinoin should be under regular clinical review throughout their treatment course. For patients enrolled in the Pregnancy Prevention Programme (PPP) — which is mandatory for all women of childbearing potential — monthly reviews and pregnancy tests are required, as specified by the MHRA. These appointments provide a natural opportunity to raise any concerns about hair loss or other side effects.

If hair loss is felt to be directly attributable to isotretinoin and is significantly affecting quality of life, a risk–benefit discussion regarding continuing, adjusting, or stopping treatment is entirely appropriate.

Does Hair Regrow After Finishing Treatment?

For most patients, hair regrows within three to six months of completing isotretinoin, as the telogen effluvium resolves once the triggering factor is removed; full recovery can occasionally take up to twelve months.

For the majority of patients who experience hair thinning during isotretinoin treatment, the prognosis for regrowth is generally reassuring. Because isotretinoin-induced hair loss is typically a telogen effluvium — a reversible, physiological disruption of the hair cycle rather than permanent follicular damage — most individuals see meaningful regrowth within three to six months of completing their course of treatment. In some cases, full recovery may take up to twelve months. These timelines are consistent with the natural history of telogen effluvium as described in UK dermatology resources, including guidance from the Primary Care Dermatology Society (PCDS) and the British Association of Dermatologists (BAD).

The timeline for regrowth reflects the natural pace of the hair cycle. Once the triggering factor (in this case, isotretinoin) is removed, follicles gradually re-enter the anagen (growth) phase. Patients may initially notice short, fine regrowth hairs before the hair returns to its previous density and texture. Patience is therefore important, as visible improvement may lag several months behind the end of treatment.

However, it is important to be transparent about the limits of current evidence. In a small number of cases, patients have reported that hair did not fully return to its pre-treatment density. Whether this represents a true persistent effect of isotretinoin, an unmasking of underlying androgenetic alopecia, or another concurrent cause remains unclear, and there is no definitive clinical consensus on this point.

If hair has not shown signs of recovery within six to twelve months of completing treatment, further dermatological assessment is warranted to exclude other diagnoses, including androgenetic alopecia, scarring alopecia, thyroid disease, or iron deficiency.

Overall, isotretinoin remains a highly effective and well-evidenced treatment for severe acne, and for most patients the benefits substantially outweigh the risks. Being well-informed about potential side effects — including hair changes — enables patients to make shared decisions with their clinical team and to seek timely support if needed. Suspected side effects can be reported to the MHRA via the Yellow Card scheme at yellowcard.mhra.gov.uk.

Frequently Asked Questions