I have a background in science and have taken Accutane; I enjoy informing others about the drug as well as dispelling common acne myths.
I Recovered From Severe Accutane Hair Loss
Accutane works very well for those with persistent, problematic acne, but noticeable hair loss is possible with this medication. Dermatologists currently class isotretinoin-induced hair loss as telogen effluvium (TE), a condition ephemeral by nature that should resolve over time as the body's energy requirements rebalance themselves, but many Accutane users are left with this problem long after stopping the medication. This brings us to question the underlying cause of the TE shedding, which is most likely an inflammation-based autoimmune cascade initially started by Accutane.
In this article, I will give you a regimen to follow including products and lifestyle changes that will reduce your systemic inflammatory load (the level of inflammatory mediators in your body) and thus put an end to your chronic hair loss and scalp pain.
Why do I want to reach out to you, when I've recovered? The answer is simple - I know the pain you are experiencing and want to bring you a real solution. I suffered from severe hair loss when I stopped taking Accutane, and lost about 70% of my previously thick, luscious hair. As a young woman, this left me devastated and made me feel like I would never be the same person again.
I have now been off Accutane for over 4 years, and am delighted to say that I have virtually regained my original hair density; my hair is 95% as thick as it was before the hair loss started. I owe this recovery to 5% topical foam minoxidil (rogaine/regaine), peppermint oil applied before washing my hair, an extremely healthy, anti-inflammatory diet and a few other crucial lifestyle choices. Keep reading!
Accutane Hair Loss: Is It Chronic Telogen Effluvium?
Dermatologists label severe Accutane-induced hair loss as telogen effluvium (TE), a condition that is triggered by a shock to the body. This shock can be anything from illness, to extreme weight loss, to a harsh medication such as Accutane. One thing these triggers all have in common is that they alter the body's energy expenditure, resulting in a period of acute hair loss. See, in the grand scheme of things, hair is a relatively unimportant mass of keratin. If the body is under intense systemic stress (calorie restriction, the postnatal period, Accutane etc.), the endocrine system releases hormones shift the body towards prioritising necessary bodily features, while shutting the rest down.
This results in heavy hair loss that should be temporary and resolve in a matter of months after the trigger has ended. However, many Accutane hair loss sufferers find that their hair loss doesn't seem to stop, even when they have long stopped taking the medication. They may experience some regrowth but lose all new hairs within a few weeks, seeming to be stuck in perpetual growth-shed cycles. A dermatologist may issue them a new diagnosis of chronic telogen effluvium and send them on their travels.
It is important to remember, that many medical diagnoses are descriptive terms rather than anything definitive or conclusive. They describe what health care professionals see, rather than explaining exact bodily mechanisms. In other words, telogen effluvium simply describes an increased daily amount of hair shedding. If you have been off Accutane for years, have lost a lot of your hair and are continually shedding too much hair with a sore scalp, your dermatologist should not be telling you that you have 'chronic telogen effluvium' and sending you away.
Why? She/he is either lazy or lacking in the ability to be biologically critical. This diagnosis doesn't provide any basis for possible treatment nor does it offer any consolation; if your dermatologist is intent on this term, it may be that they don't know enough about hair loss to inform you on some actual possible processes that are occurring and stopping your hair from recovering. I will delve into these further on in this article, particularly focusing on autoimmune hair loss and long-term follicular sensitization to stress, both of which are very much implicated in this so-called 'chronic telogen effluvium' that Accutane seems to cause.
Accutane-Induced Hair Loss: My Story
I was on Accutane (called Roaccutane here in the UK) for a total of 8 months. Initially, I was put on 20mg. My dose was eventually raised to 40mg and then 60mg; my hormonal acne cleared up extremely well and I was amazed to see my skin amazingly smooth and oil-free, for the first time since before puberty. I experienced the typical side effects (fatigue, intense dry skin and lips, and headaches), but was more than willing to persevere through those to clear my acne.
Then, I experienced what I like to refer to as the 'yin and yang' of pharmaceutical drugs - it is impossible to put the body through immense stress to obtain an outcome like synthetically, miraculously clear skin without serious possible side effects. There is a painful duality to everything in pharmacology.
I started losing a horrendous amount of hair 5 months into my Accutane course. I would shampoo my hair, rinse it, and pull out handfuls of loose hair. It just accelerated from there. Anytime I touched my hair or manipulated it in any way (e.g. I would wrap my hands around my ponytail), I would grab onto huge clumps of hair. I was losing around 700 hairs a day at this point and it absolutely broke my heart to see it thinning. My hair was my whole identity and was the one feature that I identified with completely.
The shedding eventually slowed a little and became intermittent. After being off Accutane for about 14 months, I noticed that I seemed to have the odd 2-week-long break from such heavy hair loss. During those times, I would pray that it was over, but it always did. Sure enough, my scalp would start burning and the shedding would reappear just as severe as before.
How Did I Stop Shedding From Accutane and Regrow the Hair I Lost?
I know this is what you're here for. You want relief from the misery of showering and pulling out handfuls of your own hair, and the obsession with checking your thinning hair in the mirror. You want to feel youthful, beautiful and normal once again, which you will do if you commit to following the treatment plan I am going to present you with for at least a year.
This time 4 years ago, I sincerely believed that I would never have hair I was happy with again. Now, I have a full head of long, thick, shiny hair and want to share my regimen with you.
1. Temporarily Using Topical Minoxidil (5% Strength)
Topical minoxidil (Rogaine in the USA and Regaine in the UK) is a growth stimulant, designed to strengthen and maintain hair in cases of progressive genetic balding. It works by causing vasodilation of the capillaries that supply your blood follicles, providing them with a steady flow of nutrients and minerals. It is also believed that it decreases scalp inflammation by decreasing the concentration of pro-inflammatory cytokines around the hair follicle.
I decided to try minoxidil, but suffered from some immediately-accelerated shedding. Devastated, I thought "why is the universe testing me like this", but stuck with it and hoped it was the initial, short shedding phase that everyone speaks about. It is well-known that minoxidil can induce a rapid telogen phase, meaning that some growing hairs are prematurely shed; this only lasts for 2-3 months, and the hair recovers fully.
Sure enough, the above turned out to be true, and the excess shedding stopped after 2-3 months of using Rogaine 5% foam. Within the first 8 months of using it, I experienced tremendous growth and recovered 95-100% of my hair.
After 2 years, I decided to risk stopping using it, in the hope that I'd be able to maintain my hair density with other, more natural topicals and a healthy diet. To my delight, I didn't experience a shed upon stopping and believe I owe this to the fact that I transitioned straight to using peppermint oil.
2. Use Topical Peppermint Essential Oil!
You need to buy yourself an affordable but top-quality bottle of essential peppermint oil (I have linked the one that I use just below this box of text) and apply it to your scalp regularly. I am normally very sceptical about holistic claims, but am managing to maintain thick hair 3 years after Accutane with this product. A scientific study has shown peppermint oil to be more effective in rapidly regrowing hair than minoxidil when applied to C57BL/6 mice, compared to a control and jojoba oil. It appears that peppermint oil acts as a powerful growth-stimulant and an anti-inflammatory due to the effects of L-menthol (a monoterpene) and other beneficial plant compounds.
Mammalian models do not always translate fully to human conditions, but my success convinces me that peppermint has the potential to act as a non-toxic growth stimulant and improve Accutane-induced hair loss.
I consistently use peppermint oil every single time I wash my hair, and find it an enjoyable and quick part of my routine. I add 5 drops of it to a hand-sized squirt of shampoo, and apply this mixture to my dry scalp (it should feel cool and pleasant, not irritating). I leave it soaking in for 30mins-1hour and then wash it out.
I'm delighted to have found this cheap and well-tolerated treatment, as minoxidil can be expensive. 2 years ago, I had been off Accutane for nearly 2 years yet was still suffering with heavy shedding and steadily-worsening, thin hair. Now, I have a clean, irritation-free scalp and thick hair once again.
3. Eat Lots of Healthy Fats
We need healthy fats for literally every cognitive and bodily process, including hormone regulation and hair growth, so eat meat, fish, eggs, coconut, walnuts, cashews, pecans, avocados, pumpkin seeds and chia seeds in abundance. Fear sugar, not saturated fats, as all rigorous science that relates to nutrition debunks the theory that cholesterol is dangerous.
Coconut oil is an absolutely miraculous anti-inflammatory substance that everyone should be ingesting. In addition to improving every single bodily function, the type of healthy fats that it is packed with benefit cognition immensely. I have seen marked improvements in my energy levels, skin and am certain that it is improving my hair growth and resilience on a microscopic level.
If you choose to incorporate it into your diet, please ensure that you purchase a high-quality, extra-virgin form as cheaper, refined oils are often rancid and pro-inflammatory. Here is a wonderful and cheap brand that I have been using this past year. I fry eggs, meat and fish in it, and sometimes take a spoonful alone with a cup of tea when I want to be in short-term ketosis; the result is out-of-this-world productivity levels and a heightened ability to write and speak well.
4. Don't Exercise Too Much or Starve Yourself
Regular exercise offers a plethora of benefits to your body and your mental state. However, please avoid dieting to lose weight rapidly and routinely pushing yourself too hard in the gym (i.e. don't run 10 miles a day and be eating at a calorific deficit).
Remember, Accutane caused your body to enter a state of extreme shock and distress. You want to avoid everything that might cause your body to enter a further degree of survival mode, as your ability to withstand bodily stress and cortisol spikes has decreased. What a normal athlete may be able to cope with might force YOUR body to shut down 'unnecessary processes' (including hair growth), exacerbating your delicate condition.
Not to mention that if you are female, doing too much cardio exercise can cause less estrogen to be produced which can result in amenorrhea. This temporary disbalance in hormones is enough to initiate an additional period of hair loss, which you definitely do not need.
What About Vitamins/Minerals? Are Any Worth Taking for Accutane Hair Loss?
Do not let insecurity and fear convince you to buy into the supplement game, as many companies sell ineffective hair vitamins and take advantage of people who are emotionally vulnerable and willing to dish out money. Having said that, here are some vitamins and minerals that are often scarce in vegan and non-vegan diets and actively help you regrow healthy, nourished hair.
- Biotin (essential, Accutane depletes biotin): Take about 500mcg, with a meal and lots of water. It DOES make your hair grow noticeably faster. I know that it is working because it makes my nails grow like weeds and darkens my eyelashes. Do not take a super-high dose like 10,000mcg, as this is likely to make your skin oily and make you develop cystic acne!
- B complex: As long as you are eating healthily and getting in lots of fruits and vegetables, it's unlikely you need to worry about the rest of the B vitamins. However, if you regularly feel fatigued, consider taking one as it will do no harm.
- Bamboo silica: This is a great source of silica, which aids the formation of keratin in hair strands. Silica is hard to get in any diet, and doing whatever you can to increase your hair strength and thickness is important as (like after chemotherapy), your hair may initially come in a little brittle after Accutane.
- Selenium is often under-eaten by vegans. If you eat one brazil nut a day, you will get enough selenium.
- Zinc: Even if you are not vegan, it is likely you are deficient in zinc due to the poor mineral offerings present in most of the foods available today. Make sure you take a bioavailable form of zinc like this one (zinc picolinate); most unfortunately are simply not absorbed in the gut.
- Iron: Many women experience heavy periods and need to supplement iron, albeit eating well. If your iron ferritin count is less than 60, you need to supplement because you need it to be at around 75-90 for optimal hair growth. Take it away from tea and coffee (they inhibit absorption) and with vitamin C, preferably an effervescent form of vitamin C that dissolves in water.
- Vitamin D3: The vitamin D council recommends that we all take 5000IU a day, in soft-gel form, with a meal that includes fat. This is the type of vitamin D product you want to take. As with zinc, most commercial forms (especially D2!) offer no real benefit to the body.
- NAC: a potent anti-inflammatory and anti-oxidant, this amino acid derivative modulates the immune system, decreases cytokines and promotes the production of glutathione (the body's master antioxidant). These mechanisms all promote good hair growth, decreased autoimmunity and hormonal equilibrium. I personally started taking NAC around the same time that I started my hair care regimen, and noticed that any lingering acne post-Accutane cleared up remarkably. It also stabilizes my mood and sharpens my cognition well, which shows that it promotes homeostatic balance and quietens unnecessary immune activity. This is exactly what we want, when overcoming stressor-induced hair loss; a high-fat, low-sugar diet is also in accordance with this.
I thought I would add a little update, several years after recovering from Accutane hair loss. It is genuinely surreal that I have a full head of luscious hair again, and no longer experience the devastating shedding and thin hair that made me cry my eyes out every single night.
I am incredibly passionate about helping you all recover from this traumatic life chapter too, and will keep coming back to update the products that I recommend/share any bits of additional advice that I can think of. Sending you all my love and good energy!
This content is accurate and true to the best of the author’s knowledge and does not substitute for diagnosis, prognosis, treatment, prescription, and/or dietary advice from a licensed health professional. Drugs, supplements, and natural remedies may have dangerous side effects. If pregnant or nursing, consult with a qualified provider on an individual basis. Seek immediate help if you are experiencing a medical emergency.
© 2017 Lucy
Megan on July 09, 2020:
This is one of the most informative articles I have read on permanent hair loss from accutane. I was don with accutane in summer of 2017. Had no hair problems while on it. I started shedding 6 months after being off of it.
Like you, I have had a week or two where I thought it was improving. Maybe a couple months even a couple times. However, I have now gotten used to having to cut and wear my hair a specific way because it it so thin. It is devastating. I hate combing it or showering bc I have to see all the clumps come out and it makes me feel horrible. I have started using rogaine but I always end up stopping after a week or so. I need to stick with it.
I used to take NAC because I was an obsessive skin-picker (big reason I went on accutane in the first place) But May start taking it again.
I have been to all kinds of doctors, had all the tests, all my hormone levels and panels are Normal. I know it’s from accutane. I am to the point where I am willing to start an anti-inflammatory diet and change my lifestyle, including restarting the rogaine and peppermint oil (which I love). I hate that it takes so long to see results but hopefully if I jump into this i can stick with it this time.
Diane on June 09, 2020:
Thank you so much for your quick reply. You made me feel relieved. I will pay attention to your suggestions.
Lucy (author) from Leeds, UK on June 09, 2020:
I will add that I believe the Rogaine was instrumental in giving my hair follicles the big 'kick' that they needed to start producing pigmented, thick hair again. The fact that you are producing short and fine hairs is more relevant than the fact you are shedding them. As I alluded to below, Accutane hair loss is non-selective and you'll lose what you're growing as long as your scalp is in 'hair-shedding' mode.
Remember, Accutane was a huge shock to your body and your hair follicles aren't currently being prioritised so are producing suboptimal hairs.
The way to get it out of 'hair-shedding mode':
- topical stimulants to support blood flow and activate follicles that aren't currently functioning optimally
- a high-fat, sugar-free, nutrient-dense diet full of things like coconut oil, salmon, eggs, and nuts (will significantly decrease systemic inflammation)
- supplementation of a few key things that are truly worth your money: NAC, vitamin D3, bamboo silica, zinc and (if required) iron.
Lucy (author) from Leeds, UK on June 09, 2020:
Yes, I did go to a dermatologist - it is very unlikely to be androgenetic alopecia unless you are particularly genetically prone. I had the identical experience to you and, at one point, was losing tiny, thin hairs. This stopped over a period of months as I started the Rogaine and I now maintain thick, long hair through just the peppermint and the supplements mentioned.
Do not panic - get on the topicals and boost your overall health, but remember that there are many biological pathways that can give rise to hair loss patterns that look like A.A. When your immune system is hypersensitised following Accutane and attacking the scalp, you're bound to lose tiny hairs, and this does not mean that you have A.A. or will be developing it any time soon.
Best of luck!
Diane on June 09, 2020:
Hello Lucy. I have accutane hair loss story too. It has been started last mount into accutane course. But I think I'm also losing my thin and small hairs caled telogen vellus hairs. And I'm not sure is it CTE or androgenetic alopecia. How do I know which one is? Have you been to see a dermatologist?
Lucy (author) from Leeds, UK on May 30, 2020:
Hi Mary - 5% Rogaine is stronger and works better, plus the 2% (I believe) only comes in liquid form which leaves the hair very greasy.
The 5% foam product is will get you the best results the fastest (I couldn't believe how quickly my hair started to regrow) and is very flattering, volumising and non-greasy. Genuinely makes hair look fuller than most expensive hair products can, which is really great when you've lost a little and are feeling self-conscious.
Mary on May 30, 2020:
Hi Lucy! Thanks for sharing your experience.
I was wondering why didnt you used %2 rogaine what is thier difference?
User on May 29, 2020:
@Maryem get off of Accutane right now. It's not worth it!!!! What worked for me after months of accutane which limited my acne but didn't completely rid it was using prescribed swabs of Clindamycin (cotton pads with clindamycin [the liquid only didn't work as well])
Lucy (author) from Leeds, UK on May 18, 2020:
Hello Maryem! Yes, certainly - I personally only started to use them afterwards, because I (naively) thought the hair loss would stop after I stopped the medication. To be honest, I would advise that you start using them as early as possible so as to avoid months of significant hair loss.
Maryem on May 17, 2020:
M so glad you got your hair back..
I wanted to ask if it’s allowed to use all those products during Accutane? M starting to lose my hair.. and m horrified
Namrata on March 23, 2020:
Your post was most informative. Thank you for the tips. Do you think shampoos with high SLES content makes the hair loss worse? Is there any particular shampoo you think helped you with respect to maintaining a healthy scalp?
Lucy (author) from Leeds, UK on March 04, 2020:
Hi Patrice, I mention veganism in the supplements section of the article just in case readers follow a vegan diet, but I am, myself, not vegan. I really recommend eating a nutrient-rich diet, and consumption of high-quality animal products is conducive with healing from auto-immune issues such as hair loss.
Patrice on March 03, 2020:
You mention vegan diet but then also said you cooked meats/fish. Can you clarify ?
Lucy (author) from Leeds, UK on January 06, 2020:
@Rushikesh Fortunately, peppermint oil is a very effective growth stimulant and will maintain your hair without Rogaine. I recommend starting with Rogaine and the oil, however, as it produces the fastest results. Once you've regained your hair density after several months, you can smoothly transition to just the peppermint oil (while making sure to eat a healthy, nutrient-rich, low-sugar diet to keep systemic inflammation as low as possible). Supplementing with NAC will also help keep your immune system 'quiet' and will make it far less likely that you relapse. Good luck!
Misha Tal on August 24, 2019:
I found your post after googling this problem that is affecting me. I'm just a little over 2 years out of accutane, and still my hair sucks.
So much for the thick as a rope hair I had. My hair is now thin like a spider web and weak, falls out easily. Needless to say, the sudden change to my hair left me incredibly depressed, to the point of being suicidal.
I'll just follow your tips and see what I can get. If it works for me I'll come back and tell what happened.
Rushikesh on May 06, 2019:
Does a person has to use rogaine for lifetime once he has started using it as i have heard hair shedding again starts after discontinuing rogaine