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lissa

Why does hair sometimes fall out on accutane?

Is it because the scalp and follicles get very dry? If so, would it help if I only washed my hair a few times a week?

Not sure if my hair is coming out at all, although I’ve noticed some hairs here and there – although hair does naturally fall out on its own! So it could be paranoia, but I’d rather be safe than sorry.

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No, it's not because it's dry. Any hair that you lose from external reasons will continue to grow unless you have an injury that damages the follicle.

I dont know the exact reason but I think it is because Accutane stresses out the body in the way an overdose on vitamin A does and the body stops putting energy into hair growth.

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No, it's not because it's dry. Any hair that you lose from external reasons will continue to grow unless you have an injury that damages the follicle.

I dont know the exact reason but I think it is because Accutane stresses out the body in the way an overdose on vitamin A does and the body stops putting energy into hair growth.

I disagree. Accutane inhibits oil production. It is very possible that the follicle dries out. With no lubrication, hair is more susceptable to fall out. Overdosing decreases energy into hair growth?? I don't know about that.

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Oh man. What to believe?

If it is due to dry hair follicles, would keeping my hair moisturized and oily help? My hair has seemed to dry out a lot - I usually have to wash it at least every other day and I haven't washed it since Saturday and it still doesn't look too greasy.

And does anyone know the average number of strands of hair a person loses per day?

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There are two reasons for hairloss on Accutane. The first is that dryness can lead to breakage. Minimize shampooing and maximize conditioning, avoid heat styling, and be very careful with chemical treatments like bleaching, coloring, or straightening to offset this effect.

The other reason is called telogen effluvium. To understand it, you have to understand the natural growth cycle of hair. Hair has both an active (anagen) phase, and a dormant (telogen) phase. At any given time, it is normal to have a mix of hairs in the anagen and telogen phases. The telogen hairs are the ones that naturally shed into your hairbrush or down the shower drain, and the common figure cited is that it is normal to lose 100 hairs a day in this way. If it doesn't get tugged out, it simply falls out when the follicle reactivates and the new anagen hair literally pushes it out of the way.

Now, when you take Accutane, it stresses the body. The body diverts resources away from hair growth, because hair is a luxury, not a necessity. So as the course progresses, more and more hairs deactivate and enter the telogen phase, where they are just sitting in the follicle, no longer rooted, and are easily dislodged. After the course is over, the body can cease diverting resources and hair growth begins to return to normal. Follicles activate en masse, and the new anagen hairs begin to push the dormant telogen hairs out of the follicles. This results in a lot of shedding, and it can be quite disturbing if you don't understand what's happening. Because it takes awhile to get all those follicles activated and growing again, it can take a few months before the shedding stops. You'll be able to see the short little anagen hairs growing in at the hairline especially. Eventually the ratio of active hairs to dormant hairs will normalize and so will the rate of shedding.

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Thank you so much for that thorough response. It all makes sense. Here’s my question – if I am experiencing TE after 2 weeks on a low dose (10 mg/day) and discontinue the course immediately, should I experience less hair loss than those who did a full course with a regular strength dose?

I am pretty sure I am seeing a form of hair loss because when I gently tug at a small section of hair about 5 hairs come out at a time. And I lost maybe 100 strands when running my fingers through it last night – in about an hour! My hair looks fine now, I am just scared for the future. I have only put in a TOTAL of 140mg of isotretinoin into my body these past 2 weeks. I’m discontinuing the accutane immediately. I’m hoping this will prevent too much additional hairloss and everything will be okay.

Oh and second question – how much time does it take for accutane to leave the body completely and does that depend on the amount you put in?

Thanks for any help you can provide.

There are two reasons for hairloss on Accutane. The first is that dryness can lead to breakage. Minimize shampooing and maximize conditioning, avoid heat styling, and be very careful with chemical treatments like bleaching, coloring, or straightening to offset this effect.

The other reason is called telogen effluvium. To understand it, you have to understand the natural growth cycle of hair. Hair has both an active (anagen) phase, and a dormant (telogen) phase. At any given time, it is normal to have a mix of hairs in the anagen and telogen phases. The telogen hairs are the ones that naturally shed into your hairbrush or down the shower drain, and the common figure cited is that it is normal to lose 100 hairs a day in this way. If it doesn't get tugged out, it simply falls out when the follicle reactivates and the new anagen hair literally pushes it out of the way.

Now, when you take Accutane, it stresses the body. The body diverts resources away from hair growth, because hair is a luxury, not a necessity. So as the course progresses, more and more hairs deactivate and enter the telogen phase, where they are just sitting in the follicle, no longer rooted, and are easily dislodged. After the course is over, the body can cease diverting resources and hair growth begins to return to normal. Follicles activate en masse, and the new anagen hairs begin to push the dormant telogen hairs out of the follicles. This results in a lot of shedding, and it can be quite disturbing if you don't understand what's happening. Because it takes awhile to get all those follicles activated and growing again, it can take a few months before the shedding stops. You'll be able to see the short little anagen hairs growing in at the hairline especially. Eventually the ratio of active hairs to dormant hairs will normalize and so will the rate of shedding.

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Any time i run my hands through my hair i have several hairs come loose at a time, even when not taking Accutane. If i sat and ran my hands through it over and over for an hour i could easily pull loose 100 hairs. Low dose treatment such as you describe can be very helpful for rosacea and i worry that you are freaking out over this side effect and will lose the benefits of isotretinoin over hairloss that is actually normal or only slightly increased. In a previous post you mentioned that you thought you might be being a bit paranoid about it, and i think that's probably what's happening here.

I would talk to your doctor and ask about perhaps moving down to an every other day dose rather than every day, and see if the hairloss normalizes or returns to near normal. Ask your doctor if there is any visible thinning - i'm betting that there is not. Significant hair loss is generally associated with high dose, long courses, you should experience very little on a low dose course. Even when someone loses a lot of hair due to this effect, the thinning is diffuse across the scalp and the only person likely to ever notice it is you and your hairdresser.

Regarding the time frame before it clears your system if you go ahead with your plan to stop - isotretinoin is a strange sort of substance. Blood serum levels return to normal (your body naturally produces a small amount of isotretinoin) within 2 to 3 weeks. However, the effects of isotretinoin can last well beyond then - the famous clearing of acne being the prime example. But as far as it's effect as a hair stressor, within a month it will no longer be effecting the hair directly, although you may see some shedding for awhile afterwards due to the process described above. But on such a short course at such a low dose it should be minimal.

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Any time i run my hands through my hair i have several hairs come loose at a time, even when not taking Accutane. If i sat and ran my hands through it over and over for an hour i could easily pull loose 100 hairs. Low dose treatment such as you describe can be very helpful for rosacea and i worry that you are freaking out over this side effect and will lose the benefits of isotretinoin over hairloss that is actually normal or only slightly increased. In a previous post you mentioned that you thought you might be being a bit paranoid about it, and i think that's probably what's happening here.

Yup I totally know! I am a worrier!! I was like on the verge of freaking out until I read this post and it actually made me feel a lot better. I’ve only taken 140 mg of this stuff TOTAL in my entire life. You’d think there’s no way that small amount could produce noticeable hair loss if others take upwards of 80 mg / day for months, right?

And I am probably being paranoid, though I really have noticed a good number of hairs coming out. But then again I never paid attention to how much I shed before all of this! So who knows?

Sigh, I’m going to check with my doctor but in the meantime I’m going to buy some Biotin cause I’ve heard that can help prevent hair loss. Perhaps that will make me feel better. I’ll let everyone know if I’m crazy (I hope so!) or if I actually experience any significant hair loss problems in the next few weeks.

Thanks for all your help.

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