Is it All Just a Telogen Effluvium? — Donovan Hair Clinic

 Tran et al 2022

A newly published retrospective study reported on the development of alopecia in patients on isotretinoin therapy.  Authors wanted to answer two main questions:

a) what types of hair loss occur in patients who say they have hair loss while taking isotretinoin and

b) how do patients who develop hair loss while on isotretinoin differ from patients who do not develop hair loss on isotretinoin?

To do so, the authors performed a retrospective analysis of patients diagnosed with hair loss of various kinds between 2013 and 2018.  Patients were excluded if they had used isotretinoin before their hair loss started. Patients who developed hair loss following receipt of isotretinoin were further compared to other patients in the same time period who were prescribed isotretinoin and were not diagnosed with hair loss.

There were 6330 patients identified with some kind of hair loss over this 2013-2018 period. Of these 6330 patients,  48 had been prescribed isotretinoin at some time between these years. Of these 48 patients, hair loss occurred concurrently or within 2 years after taking isotretinoin in 19 patients (39.6%).

The mean age of these 19 patients was 27 and half were male and half were female. There were 4 main diagnoses in patients who said they used isotretinoin and had hair loss. These were telogen effluvium (10/19 or 52.6%), androgenetic alopecia (5/19, 26.3%), lichen planopilaris (3/19 or 15.8%) and alopecia areata (2/10 or 10.5 %).

Given that AA prevalence may be around 0.2 %, AGA prevalence around 12-36 % in this particular group and lichen planopilaris around 0.05 % maximum estimate, this would suggest an overrepresentation of LPP in patients treated with isotretinoin – and possibly alopecia areata.

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