Isotretinoin (Accutane) causes significant hair shedding in up to 10% of users. Tracking density changes during and after your treatment course creates a precise record of how severe the shedding is and how quickly recovery occurs. This documentation is essential for separating Accutane-induced shedding from underlying pattern baldness.
This guide walks you through setting up a tracking protocol before, during, and after isotretinoin treatment.
Step 1: Establish Your Baseline Before Starting Isotretinoin
The most critical step happens before your first dose. Without a documented baseline, you have no way to objectively measure how much hair you have lost or when recovery is complete.
What to document:
- Take scalp photos from 5 standard angles: front hairline, left temple, right temple, crown (top-down), and back of head
- Use consistent lighting (natural daylight near a window works best)
- Note the date and your planned isotretinoin dosage
- Record your current hair density impression and any existing thinning
Get an objective baseline stage. Use AI-powered analysis at myhairline.ai/analyze to establish your Norwood stage before treatment. This is particularly important if you have any pre-existing recession or thinning.
If you are already at Norwood 2 (800 to 1,500 grafts equivalent) or above before starting Accutane, the shedding episode may accelerate visible progression. Having this documented protects you from misinterpreting Accutane shedding as sudden-onset pattern baldness.
Step 2: Understand the Shedding Mechanism
Isotretinoin causes a specific type of hair loss called telogen effluvium. This is fundamentally different from androgenetic alopecia (pattern baldness).
How it works: Isotretinoin disrupts the hair growth cycle by pushing follicles prematurely from the anagen (growth) phase into the telogen (resting) phase. After 2 to 3 months in telogen, the resting hairs shed simultaneously, producing noticeable thinning.
Timeline:
- Weeks 1 to 8: Hair cycle disruption begins, but shedding is not yet visible
- Months 2 to 4: Shedding becomes noticeable (increased hairs in shower, on pillow)
- Months 4 to 6: Peak shedding period for most patients
- Post-treatment: Shedding gradually decreases over 1 to 3 months after the last dose
- Recovery: Full density recovery typically takes 6 to 12 months after completing treatment
Key distinction: Telogen effluvium produces diffuse, all-over thinning. It does not follow the Norwood pattern of temple recession and crown loss. If you notice patterned recession during isotretinoin treatment, this may indicate underlying androgenetic alopecia being unmasked rather than simple drug-induced shedding.
Step 3: Set Up Monthly Photo Tracking
Consistent monthly photos are the backbone of your tracking protocol. They provide visual evidence that your dermatologist can review and that you can reference during recovery.
Monthly tracking protocol:
- Choose a fixed day each month (first or fifteenth works well)
- Take photos from the same 5 angles as your baseline
- Use the same lighting conditions and camera distance
- Pull hair back from the face for hairline shots (if possible)
- Save photos in a dedicated folder labeled by date
Shedding count (optional but useful): For a more quantitative measure, count the hairs in your shower drain on 3 consecutive wash days each month. Average the three counts. A shedding count above 100 hairs per wash is generally considered elevated.
Step 4: Track Shedding Severity During Treatment
During your isotretinoin course, document these specific observations at each monthly check:
Severity scale:
| Level | Description | Action |
|---|---|---|
| Mild | Slightly more shedding than normal, no visible thinning | Continue monitoring |
| Moderate | Noticeable increase in shedding, mild visible thinning | Document, discuss with prescriber |
| Severe | Significant daily shedding, visible scalp through hair | Discuss dose reduction with prescriber |
What to share with your dermatologist:
- Monthly comparison photos showing progression
- Shedding count trends
- The specific month when shedding began (correlate with dosage)
- Whether the thinning pattern is diffuse (telogen effluvium) or patterned (possible underlying androgenetic alopecia)
Your dermatologist may adjust your dosage if shedding is severe. A lower dose (reducing from 40 mg to 20 mg daily, for example) can sometimes reduce hair impact while still treating acne effectively.
Step 5: Monitor Recovery After Treatment Ends
Once you complete your isotretinoin course, the recovery tracking begins. This phase is just as important as the treatment phase.
Recovery timeline:
- Month 1 post-treatment: Shedding should begin decreasing
- Months 2 to 3: New growth (short, fine hairs) may become visible
- Months 4 to 6: Density should show measurable improvement in photos
- Months 6 to 12: Full recovery to baseline for most patients
Continue your monthly photo protocol throughout recovery. Compare each month's photos to your pre-treatment baseline, not to the worst point of shedding. This gives you an accurate recovery percentage.
When recovery stalls: If your density has not returned to baseline by 12 months post-treatment, consult a dermatologist. Possible explanations include:
- Unmasked androgenetic alopecia that was developing independently
- Chronic telogen effluvium (rare but possible)
- Nutritional deficiencies that developed during or after treatment
- Other contributing medications
If androgenetic alopecia is confirmed, treatments like finasteride (80 to 90% halt rate, 65% regrowth) and minoxidil (40 to 60% regrowth) become relevant. At Norwood 3 (1,500 to 2,200 grafts), these medications can stabilize the loss that Accutane may have accelerated.
Step 6: Distinguish Accutane Shedding from Pattern Baldness
This is the most important clinical question for anyone tracking hair loss during isotretinoin treatment. The two conditions require entirely different treatment approaches.
Accutane-induced telogen effluvium:
- Diffuse, all-over thinning
- Begins 2 to 4 months after starting medication
- Self-resolving after treatment ends
- No patterned recession at temples or crown
Androgenetic alopecia (unmasked or coincidental):
- Follows the Norwood pattern (temple recession, crown thinning)
- May have been slowly progressing before Accutane
- Does not self-resolve
- Requires ongoing treatment (finasteride, minoxidil, or surgery)
A patient can experience both simultaneously. Accutane shedding can unmask early androgenetic alopecia that was not yet visible. This is why pre-treatment baseline documentation is so valuable: it establishes whether any patterned thinning existed before isotretinoin.
Start Tracking Today
Whether you are about to start isotretinoin or are already mid-course, begin your tracking protocol now. The earlier you establish baseline data, the more useful your tracking becomes.
Get your current Norwood stage documented with a free AI analysis at myhairline.ai/analyze. This gives you an objective reference point for all future comparisons.
Medical disclaimer: This article is for informational purposes only and does not constitute medical advice. Isotretinoin is a prescription medication with significant side effects. Decisions about dosing, continuation, or discontinuation should be made only by your prescribing dermatologist. If you experience severe hair loss during isotretinoin treatment, contact your prescriber promptly.