utd_medknow
International Journal of Trichology International Journal of Trichology
 Print this page Email this page Small font sizeDefault font sizeIncrease font size
 
 
  Home | About IJT | Editorial board | Search | Ahead of print | Current Issue | Archives | Instructions | Online submission | Subscribe | Advertise | Contact us | Login   
 


 
 Table of Contents  
ORIGINAL ARTICLE
Year : 2022  |  Volume : 14  |  Issue : 4  |  Page : 125-127  

Characteristics of patients with hair loss after isotretinoin treatment: A retrospective review study


Department of Medicine, Division of Dermatology, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA

Date of Submission21-May-2020
Date of Acceptance22-Jul-2020
Date of Web Publication16-Jul-2022

Correspondence Address:
Carolyn Goh
200 UCLA, Medical Plaza Driveway Suite 450 and 465, Los Angeles, CA 90095
USA
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijt.ijt_80_20

Rights and Permissions
   Abstract 


Background: Oral isotretinoin has been used to treat acne for decades. Although the side effects of isotretinoin are mostly predictable, one less common side effect of isotretinoin use is hair loss, typically telogen effluvium. Objective: This study is a retrospective report on the development of alopecia in patients on isotretinoin therapy. Methods: To characterize these patients, they were further compared to other patients in the same time period who were prescribed isotretinoin and did not experience hair loss. Results: Of 6330 patients with hair loss, 48 had been prescribed isotretinoin at some time between 2013 and 2018. Of these 48 patients, hair loss occurred concurrently or within two years after taking isotretinoin in 19 patients. When compared to controls, patients who experienced hair loss from isotretinoin were older, had greater cumulative isotretinoin doses, and had longer durations of treatment. Conclusion: Although the exact mechanism of how retinoids affect hair loss is still unclear, our findings suggest dosage or duration of usage may be associated. This information may be useful in counseling patients who may be concerned about hair loss when considering isotretinoin treatment.

Keywords: Alopecia, alopecia areata, isotretinoin, telogen effluvium


How to cite this article:
Tran PT, Evron E, Goh C. Characteristics of patients with hair loss after isotretinoin treatment: A retrospective review study. Int J Trichol 2022;14:125-7

How to cite this URL:
Tran PT, Evron E, Goh C. Characteristics of patients with hair loss after isotretinoin treatment: A retrospective review study. Int J Trichol [serial online] 2022 [cited 2022 Dec 9];14:125-7. Available from: https://www.ijtrichology.com/text.asp?2022/14/4/125/351245




   Introduction Top


Oral isotretinoin has been successfully used to treat acne for decades. The side effects of isotretinoin treatment are mostly predictable.[1] However, one potential and more unpredictable side effect is hair loss, typically telogen effluvium. The percentage of patients that report hair loss after isotretinoin treatment ranges from 0.28% to 12.0%.[1],[2],[3],[4] In our study, we aimed to further evaluate the association between isotretinoin use and alopecia.


   Methods Top


Following approval by the institutional review board at the University of California, Los Angeles, a retrospective analysis of patients diagnosed with hair loss (ICD-9 codes of 704.00 Alopecia, unspecified and 704.09 Other alopecia and ICD-10 codes of L64.8 Other androgenic alopecia, L64.9 Androgenic alopecia, unspecified, and L65.9 nonscarring hair loss, unspecified) between 2013 and 2018 was performed. Patients were screened for concurrent or any past use of isotretinoin and excluded from the study if their hair loss diagnosis came before isotretinoin treatment. Patients were further compared to other patients in the same time period who were prescribed isotretinoin and were not diagnosed with hair loss. Chart review was performed to confirm diagnoses and evaluate for follow-up. One-tailed t-tests were utilized for statistical analysis.


   Results Top


Of 6330 patients with hair loss, 48 had been prescribed isotretinoin at some time between 2013 and 2018. Of these 48 patients, hair loss occurred concurrently or within 2 years after taking isotretinoin in 19 patients (39.6%), isotretinoin was used to treat the hair loss, e.g., folliculitis decalvans, in 10 patients (20.8%), and hair loss was preexisting in the remaining 19 patients (39.6%).

The 19 patients in whom hair loss occurred during or after isotretinoin were further characterized. Diagnosis, age, sex, total cumulative dose, and duration of treatment were examined [Table 1]. Overall, compared to patients on isotretinoin without hair loss, patients who developed hair loss were older, had higher cumulative isotretinoin dose, and longer duration of treatment (P = 0.008, P = 0.004, and P < 0.001, respectively), summarized in [Table 2]. These relationships were still significant after removal of outliers from both groups.
Table 1: Characteristics of 19 patients who developed hair loss during or after isotretinoin course

Click here to view
Table 2: Patients on isotretinoin with hair loss vs. those without hair loss

Click here to view



   Discussion Top


In this study, very few patients experienced hair loss as a possible adverse effect of isotretinoin. When compared to controls, hair loss was associated with age, higher cumulative dose, and longer duration of treatment. This information may be useful in counseling patients who may be concerned about hair loss when considering isotretinoin treatment.

Limitations of this study include the small number of affected cases and the retrospective nature of the study. Other potential causes of hair loss were not evaluated, particularly the use of hormonal contraception and family history; however, notably, sex was not associated with risk of hair loss. Diagnosis of hair loss may also not have always been documented. Of note, some patients developed alopecia areata and lichen planopilaris. While these occurrences may be coincidental, we have reported another case of lichen planopilaris that developed after taking bexarotene (in press). In the future, a prospective study would be helpful to elucidate the potential risk factors for developing hair loss with isotretinoin.

Financial support and sponsorship

This research was supported by the NIH National Center for Advancing Translational Science (NCATS) UCLA CTSI Grant Number UL1TR001881 and by a grant from the UCLA Dermatology Research Foundation.

Conflicts of interest

There are no conflicts of interest.



 
   References Top

1.
Hull PR, Demkiw-Bartel C. Isotretinoin use in acne: Prospective evaluation of adverse events. J Cutan Med Surg 2000;4:66-70.  Back to cited text no. 1
    
2.
Goulden V, Layton AM, Cunliffe WJ. Long-term safety of isotretinoin as a treatment for acne vulgaris. Br J Dermatol 1994;131:360-3.  Back to cited text no. 2
    
3.
Sinclair R. Diffuse hair loss. Int J Dermatol 1999;38 (Suppl 1):8-18.  Back to cited text no. 3
    
4.
Tosti A, Pazzaglia M. Drug reactions affecting hair: Diagnosis. Dermatol Clin 2007;25:223-31, vii.  Back to cited text no. 4
    



 
 
    Tables

  [Table 1], [Table 2]



 

Top
 
 
  Search
 
    Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
 Related articles
    Access Statistics
    Email Alert *
    Add to My List *
* Registration required (free)  

 
  In this article
    Abstract
   Introduction
   Methods
   Results
   Discussion
    References
    Article Tables

 Article Access Statistics
    Viewed3661    
    Printed132    
    Emailed0    
    PDF Downloaded29    
    Comments [Add]    

Recommend this journal