Isotretinoin and Hair Loss: A Clinical Perspective and Literature Review

Isotretinoin, used for the treatment of moderate-to-severe acne, has many side effects due to its potent nature. While hair loss has been reported with isotretinoin use, there is limited data on the type and extent of hair loss. As hair loss poses a significant physical and psychological side effect to patients, it is important for dermatologists to consider and discuss this risk with their patients. According to a review of the literature, telogen effluvium is the most common type of hair loss reported, with some mention of androgenetic alopecia, lichen planopilaris, alopecia areata, and Darier disease. We present the case of a 14-year-old male with moderate to severe acne, unresponsive to multiple topical and oral treatments, who was started on isotretinoin. After several months, he developed alopecia areata, which was initially treated with intralesional triamcinolone acetonide while continuing isotretinoin. Due to his worsening hair loss, isotretinoin was ultimately discontinued. Additional treatments, including topical steroids, oral dexamethasone, oral minoxidil, and an oral JAK inhibitor were introduced. While treatment remains ongoing, the patient has had near complete hair regrowth. The onset of alopecia areata in our patient highlights the development of a unique form of alopecia that is not classically associated with isotretinoin use. While it is hypothesized that retinoids mediate hair loss via effects on the hair cycle and immune system, there is no direct explanation linking isotretinoin and alopecia areata.