Dry & Brittle Hair after Using Isotretinoin

Dry hair after Isotretinoin

I’ve selected this question below for this week’s question of the week. It allows us to review some of the reasons for post isotretinoin scalp dryness.

Answer

My  hair is  so  brittle  after stopping  isotretinoin. It’s also quite dry.  What  might  be  the  cause?  Was it the drug?

Answer

Thanks for the question.

It's possible, but there  are many  causes actually.  One  needs  to  ideally have a  proper scalp  examination  and have the story reviewed from start to  finish.  (By ‘start’  I  mean not just  the start of last month  up  until  today but a full history from birth). One  needs  to  consider  many things.  

Isotretinoin can cause dryness that takes a while to settle after stopping. In many patients it does but one might need to be a bit gentler on t he hair for 3-6 months than they might have otherwise. I like my patients to reduce chemical and fragrance and potential irritants that can worsen they way the scalp feels. sometimes we switch away from a sulphate containing shampoo for a few months to allow the scalp to return back to normal.

Other causes of scalp dryness and brittleness need to be ruled out. If they are ruled out, I often consider a corticosteroid oil for my own patients along with the sulphate free shampoo. For my patients, the steroid oil is used once or twice weekly for 2-3 weeks before going down to once every two weeks for 2-3 months. Periodic use of an oil like coconut oil can also help provided there is not a lot of seborrheic dermatitis that is also on the scalp. I don’t know if that’s appropriate for you because I don’t know your story but that is something you can speak to your dermatologist about if everything else is completely ruled out.

The main issue is to be incredibly gentle on the hair and scalp for 3-6 months.

But what other conditions need to be considered ?

1) Seborrheic Dermatitis

One needs  to consider  seborrheic dermatitis that has  now  flared after stopping Accutane.   For  some people,  Accutane  treats some coexisting seborrheic dermatitis without  the  patient even knowing  and  then the  condition  flares when stopping.  

2) Hair styling Issues

One  needs  to consider  the  possibility that  overprocessing, coloring and/or heating of hair  is leading to  the  increased dryness. In  other  words, how  has  one’s  hair styling  practices  changed recently?  

3) Shampoo and Conditioner Issues

 One  also needs to consider  irritation from shampoos and conditioners and other topical products.   Has  a shampoo  or  conditioner or styling product changed?  

4) Autoimmune and inflammatory Issues

Of  course, with dryness one  needs  to  consider  inflammatory  scalp  issues  including autoimmune  issues,  psoriasis  and scarring alopecias  that have activated  or even  flared  post  stopping  Accutane. Fortunately,  they are rare  in  a situation like this.  But a dermatologist  can properly evaluate.  

5) Hormonal and Metabolic Issues

Finally, once needs to  consider  a variety  of metabolic and/or hormonal  issues  including those related to thyroid hormones,  estrogen  hormones or  androgen  hormones.  These  can  affect dryness  in  a  dramatic way.   Other  inflammatory scalp conditions  are  possible and  can be ruled  out  following proper examination.