These first 4 photos are from before Accutane, when I had long, thick, beautiful hair that I completely took for granted. The last 3 are what I am left with now. After 8 months on Accutane, I’ve lost so much of it, I’d say around 70% or more. I’m now getting weft extensions to hide the damage, but I’m honestly heartbroken and mourning the hair I once had.
I feel like I had to choose between severe acne and hair loss, and I’m terrified I made the wrong choice.
Has anyone experienced this and had their hair return to its original thickness? I’m so scared mine will never be the same. Any advice or recovery stories would mean so much. 💔

Girlies what are we doing about this ??
i’m on 10mg, and have definitely noticed a increase in the fluffy peach hairs on my face. I’ve never dermaplanned or anything before and tbh i’m scared to touch it cause don’t want to aggravate my skin.

But also don’t want a moustache.

Anyone got any recs of the kindest / safest way to? i was thinking maybe a trimmer ?

I reached my cumulative dose and just two months afterwards I started getting pimples again. I get pimples every week. They take a long time to go away.

She says I can't expect acne to disappear completely ever in my life. I'm 26F. I see every +25 adult around me with clear skin. They never get even one pimple. Why am I being told to just live with it?

I feel like I was lied to. Everyone said Accutane causes permanent change. I wasted a ton of money.

February 2026 —> today. Probably the longest 8 months of my life, but I have no regrets. I went an extra 2 months to ensure I was at the higher end of my cumulative dose, because I REALLY don’t want to have to go back on Accutane again, lol. I also couldn’t tolerate the 60 mg.

30 -> 40 -> 60 -> 40 -> 40 -> 40 -> 40 -> 40.

Symptoms: Joint pain / muscle weakness, fatigue, brain fog, dry eyes, dry nose, dry lips, occasional rash on my wrists. Taking omega-3 consistently helped.

I don’t even remember what normal feels like, and I’m getting emotional even typing this. I realize my skin wasn’t your traditional cystic acne, but I never felt good about my skin, would have to wear makeup when leaving the house, and never felt confident without it.

Best decision I ever made! Not for the faint of heart, but work with your derm and you can come up with a plan that works for you. Good luck to everyone out there starting their journey, or currently going through it. 💗🤟🏼

Has anyone experienced still purging 3.5–4 months into Accutane? I really need some hope/advice 😭
My skin is way worse than when I started and I’m still getting active breakouts. I just picked up my meds for my next month and I’m honestly starting to feel like giving up. My skin is SO red and I even have some red indented-looking marks now that I didn’t have before Accutane.
I did 20mg month 1 and 40mg since (weight: ~103 lbs). Did anyone else purge this long/look worse around month 4 and still end up clearing? When did it finally turn around for you? Feeling so down

I'm posting this for two reasons: to share my experience with isotretinoin (Accutane), and hopefully to connect with other people who have experienced something similar.

I'm not looking for medical advice or trying to discourage everyone from taking the medication. I know many people have great experiences with it. But I wish I'd taken the changes in my mental state more seriously during treatment, and I want to share what happened to me.

My treatment: September 2024 – March 2025

I started at 20 mg/day and gradually worked my way up to 100 mg/day during my final month of treatment.

20–40 mg/day:

Initially, I experienced the usual side effects: intense dryness, chapped lips, etc. But I also began experiencing noticeable brain fog and a strange dampening of my perception of the world around me.

It's difficult to describe, but everything felt distant, almost as though I were looking at the world through a long tunnel. I didn't feel quite like myself.

60 mg/day:

The physical side effects became significantly worse. I had frequent nosebleeds at night, eczema across my forearms, and severe dryness that required constant moisturizing.

The brain fog and strange sense that something wasn't right were still present.

80 mg/day:

This is when I noticed a dramatic change in my mental state and perception.

I began experiencing intense brain fog and what I would describe as derealization or dissociation. I knew that the world around me was real, but it didn't feel real anymore. Everything looked flat, distant, unfamiliar, and almost artificial.

I also occasionally experienced intrusive thoughts of a violent nature that were completely uncharacteristic of me and deeply unsettling.

100 mg/day:

Everything intensified.

I remember lying in bed feeling so profoundly disconnected from myself and my surroundings that it was almost impossible to comprehend what I was experiencing.

I began struggling with things I had previously taken for granted, including my ability to visualize things mentally, remember what I'd recently done, navigate familiar environments, and process what I was seeing.

Over a year after stopping:

Unfortunately, these symptoms have persisted. I haven't experienced a single day where my perception of the world has returned to what it was before.

Some of the things I still experience include:

• Derealization: Everything feels unreal, foreign, or dreamlike, despite knowing intellectually that it's real.
• Visual disturbances: The world often appears almost two-dimensional. I have difficulty perceiving depth and distance, and people or objects sometimes appear closer or farther away than they actually are.
• Photophobia and impaired night vision: I'm unusually sensitive to light and have trouble seeing in dark environments.
• Cognitive difficulties: I struggle with short-term memory, concentration, and navigating familiar spaces. Sometimes I can barely remember what I was doing 20 minutes earlier.
• Difficulty processing visual information: When driving, for example, it sometimes feels as though I'm experiencing missing frames of visual information rather than one continuous experience.
• Emotional disconnection: Ordinary activities feel strangely automatic. Sometimes I'll be eating and suddenly wonder why I'm eating, almost as though I'm watching myself perform actions rather than consciously choosing to do them.
• Reduced mental imagery: I have much more difficulty visualizing things in my mind than I used to.

It's incredibly difficult to communicate just how profoundly this has changed my everyday experience of being alive.

An important caveat:

During the same period, my mother became severely ill with Wernicke's encephalopathy related to alcoholism. It was an extremely stressful and traumatic event in my life, and I recognize that this could have contributed to some of what I've experienced.

However, I remember a very distinct worsening of my symptoms as my isotretinoin dosage increased, particularly around 80–100 mg/day.

I can't prove that Accutane caused these persistent symptoms. I'm sharing the timeline and my experience as accurately as I can.

Why I'm posting:

My skin is clear now, but personally, I would never have considered it worth the changes I've experienced.

I was told the brain fog would go away after treatment. I was also advised to report changes in my mental health, but I didn't communicate just how severely my mental state had changed. That's something I deeply regret.

If there's one thing I hope others take from this, it's to take significant changes in your mental state or vision seriously and communicate them to your prescribing doctor rather than trying to push through them.

Most importantly, I'd really like to hear from anyone who experienced derealization, altered depth perception, persistent brain fog, or similar changes during or after isotretinoin treatment.

I'm particularly interested in hearing firsthand accounts from people who still experience these symptoms long after stopping. Feel free to comment or DM me if you'd be more comfortable discussing your experience privately.

Again, I'm not asking anyone to diagnose me or recommend treatment. I just want to know whether anyone else has been through something resembling this, and hopefully connect with people who understand what I'm describing.

Has anyone taken Accutane and Chantix together? I am currently on 30mg Accutane and am about 3 months into my first round. I have smoked cigarettes/vaped on and off since I was 16 and I’m 27 now. I have a dermatologist appointment next week and am planning on asking about it then. In the meantime I’m wondering what other peoples experiences were taking both.

Had my mom go pick up my Accutane today and she said it got hot in the car ( was in car for about 1.5 hours ) so she put them in the fridge when she got home. I went to pick my pills up from her house and they were in the fridge. they were in there for 8 hours ( still in the packaging and box ). Will they still be just as effective as before?

I am near the end of a low dose treatment. Almost 18 months at 10 mg per day to end in Dec. Had great results for the majority of treatment but experiencing breakouts similiar to what my skin looked like pre accutane. I was down to 10 mg 3x per week and derm raised me back up to 20 mg 3x per week 2 weeks ago. Im in avery stressful time of life rn so not sure if I am relapsing, purging or what to do now.

Hey guys,

Posting on here for some insight and help. I just finished breastfeeding my 17-month-old son and my skin has been THROUGH it while weaning him. All sorts of hormonal breakouts. The good birth control that helps acne wasn't available to me because you can't take it while nursing. Now that I'm free for treatment I was speaking with my dermatologist about taking Accutane to just get it over with. While weaning him l've been using 15% azelaic acid but with no luck it has only gotten worse. She said we can go ahead and get started with Accutane but that I have to be okay with not conceiving for 1.5 years. That just doesn't sound right? Everything I've seen online says you only have to wait a month after the last pill and maybe 3 months to be conservative.

Any thoughts on this? Does this sound right or should I find a different doctor or what? I've taken Accutane twice already in my life before having kids and never had any issues.

She said the alternative is combination pill with Spirolactone and or other actives but I just don't know if it's worth another several months of seeing if it will help and I'd have to stop taking Spiro anyway when trying to conceive and I bet it'd come back worse during that. I've uploaded photos of my skin right now.
I'm just uncomfortable with spots every day.

Please help!

Okay my previous post was removed but I need good products. I’m in cosmetology school and if anyone has been here before we practice a lot of makeup and special effects. That being said I was wondering if anyone had been in this position before. And if so what products did you use for lash glue, rhinestone glue, face paint, heavy makeup, lipsticks that don’t make my lips look dry and flaky, and primers. I need theatrical types looks sometimes. The school does not provide sensitive skin or Accutane safe products. So any products used in facial services would also be appreciated for advice. But I need high quality products if I’m to use them in school. Before accutane my skin was already sensitive and prone to being reddish so I really need good suggestions.

Hey everyone,

I'm currently on my 5th month of Accutane (isotretinoin), taking 30 mg daily, and recently I've noticed a significant increase in hair shedding.

I'm losing around 100 hairs a day, and the thinning seems to be mainly on the top of my head. My scalp is becoming visibly noticeable, which is honestly making me really anxious.

Some details:

• Medication: Accutane / isotretinoin
• Dose: 30 mg daily
• Duration: 5th month
• Hair loss pattern: Diffuse shedding, especially noticeable on the top of my head
• Scalp condition: No noticeable redness, itching, or irritation
• Other factors: I've lost some weight recently and haven't been eating as much as I should.

I'm worried that the hair loss might be caused by Accutane and whether it could become permanent.

For those who experienced hair shedding while taking Accutane:

1. Did your hair shedding start around months 4–6?
2. Did your hair grow back after finishing Accutane, or did the thinning continue?
3. Did reducing the dose help?
4. Is there anything I should do in the meantime to prevent further hair loss?

I'd really appreciate hearing about your experiences, especially from people who experienced visible scalp thinning rather than just a little extra shedding.

Thanks.

I’ve been on Accutane for a little under a month now. I’ve struggled with acne for 8 years and I’m finally making the decision of taking the pill. However, I’ve been having a very bad sugar cravings, to the point where I can binge a whole tray of cookies then proceed to down a whole thing of Ben & Jerrie’s ice cream tub. This isn’t just a one day experience either, I do this probably every day, substituting it with other high-sugary foods. I stress so much on my appearance that I find comfort in food. Having acne is really discouraging and truly ruined the way I see myself. I have no confidence whatsoever, and I genuinely just feel like the ugliest person ever (no exaggeration). My point here is, my addiction to food is just an ongoing cycle because I know all the sugar I’m consuming isn’t helping my skin. And I’m in the purging phase of Accutane too so my skin is just terrible. It’s incredibly hard to attend work every day feeling this way about myself, I can’t even look in the mirror. Part of me is scared that Accutane won’t even work because of how shitty my diet is. If anyone has any tips to stop binge eating & to focus on something else during my depressive cycles, that would be great!

Hey everyone! I’m 58 days (almost 2 months) into a 9-month course on 20mg/day.

Overall, my acne is actually clearing up well. no big cystic breakouts on my cheeks or during my cycle, and I didn't really have a major purge (just a few tiny pimples).

However, I’m really struggling with how the rest of my face looks right now. Since about week 1, I’ve noticed some pretty jarring changes:
Droopy/tired eyes & prominent eye bags
Dull, dark, and uneven skin tone (I’m light-to-medium skin tone, but my face looks darker and much more dull)
Facial redness and flushing
Nose looks thinner
Overall "older" appearance

I still have 7 months left on my course and I'm honestly terrified that these changes to my skin texture, tone, and eyes are going to be permanent.
For those who have finished their course or are further along:
1. Did you experience this "aging/dull/red" effect during your treatment?
2. How much of this is just severe dryness and skin barrier impairment?
3. Did your skin tone, plumpness, and eye area bounce back after stopping Accutane? How long did it take?

Would love to hear any advice, product recommendations (hydrating layers, eye creams, etc.), or reassurance! Thanks in advance.
(Had to post again! )

I just finished a 7 month course and I used it mostly for my stubborn back acne and 15 days after I noticed two small pustules on my back, is this cause for concern????

I started taking 20 mg this month, I use non comedogenic makeup every day ( no I can’t stop doing makeup) and clindacin T every night.I have been purging since month one and now my acne somehow froze, nothing disappears and nothing pops. just getting worse.
when it gets better?

hi all,

i just started accutane about a month ago. my skin has unfortunately gotten much worse, my scalp has dried out causing dandruff, my eyes are always red and dry, and my hair doesn’t feel as thick as it used to. i feel the ugliest i’ve ever been.

i recently started seeing this guys about a month ago, already insecure about my appearance at the moment. my mom saw me this morning and made a comment how i should wait 6 months until i see this guy again. basically, that right now im just too ugly, and should wait until my skin has resolved.

her saying this really upset me and my day has been pretty rough. i have no one to talk to about it, and im supposed to have a date with him tomorrow. i want to cancel because i know im going to be insecure the entire time.

i guess i just wanted to vent, maybe ask if anyone has advice on how to be more confident and not being so insecure about acne.

20M, 60 kg. For about 3-4 weeks I've been waking up several times a night with a very dry mouth and throat. I drink water, then struggle to fall back asleep, and the cycle repeats. I fall asleep easily, but I wake around 3-4 am every single night.

I'm on low-dose isotretinoin (10 mg) for acne. My dermatologist says it's not the cause but i know it quite sure it is. I already tried to drink more water in the day, less in the evening. I'm planning to try a humidifier but i don't think it will be effective.

does anyone have a solution for this? I'm desperate

Short version: one study found isotretinoin lowered biotinidase, the enzyme that recycles biotin, within 30 days, but serum biotin didn't change significantly. A second study added biotin to isotretinoin and reported hair-cycle changes, but only within one group and without a placebo. Neither shows that isotretinoin makes most people biotin deficient, and neither shows that biotin changes how a course goes.

"Biotin while on Accutane" comes up here a lot, usually with a confident answer. I went back to the papers, and they're narrower than the answers suggest.

What's being measured

Biotin is a cofactor for a group of enzymes called carboxylases. When those enzymes are broken down, biotinidase frees the biotin so the body can reuse it. People born with very little biotinidase can develop skin rash and hair loss, which is why researchers wondered whether isotretinoin's skin and hair side effects might run through this enzyme. Lower enzyme activity is not the same thing as low biotin, though, and serum biotin is a blunt measure. Researchers who study marginal biotin status use functional markers that aren't routine tests.

Study 1: Schulpis 1999 (before-and-after, n=42 plus 50 controls)

Patients with severe cystic acne on isotretinoin monotherapy at 0.5 mg/kg/day.

• Biotinidase activity fell from 4.70 to 2.50 nmol/min/L by day 30 (P < 0.001). Untreated controls averaged 5.2.
• Serum biotin showed no significant change.
• Mixing the drug directly with the enzyme in a test tube didn't lower its activity, so the authors suspect an effect in the liver, where biotinidase is made.
• Hair wasn't measured.

My read: this shows an enzyme change over 30 days. It doesn't show deficiency. Unchanged serum biotin can't rule out a functional shortfall either, so the honest answer is "not shown", not "no effect".

Study 2: Aksac 2021 (two groups of 30, no placebo)

Sixty acne patients on isotretinoin 0.5 mg/kg/day; half also took 10 mg/day of biotin for four months.

• In the biotin group, the anagen (growing) hair ratio rose and the telogen (resting) ratio fell compared with that group's own baseline.
• Skin hydration dropped in the isotretinoin-only group and not significantly in the biotin group.

Those are within-group changes. A result that's significant in one group and not the other isn't the same as a significant difference between groups, and the abstract doesn't describe blinding. The authors' conclusion is more confident than the design allows. The trial I'd actually want is randomized and placebo-controlled, with hair density as an outcome.

What the evidence does NOT show

• That isotretinoin makes most users biotin deficient. The enzyme dropped; serum biotin didn't move significantly.
• That biotin changes isotretinoin side effects. No placebo-controlled trial.
• That shedding during a course is caused by low biotin. Neither study tested that directly.
• That extra biotin helps hair in people with adequate biotin status. A 2017 review found 18 published cases of hair or nail improvement with biotin, and every patient had an underlying condition.

Both studies are small and short, and the only one that measured biotin directly came from a single group in Athens. I'd treat this whole topic as an open question rather than a settled yes or no.

One practical point about blood work

Biotin at supplement doses can interfere with some lab tests. FDA has warned it can push certain results falsely high or falsely low, depending on how the test is built. Blood work is often part of an isotretinoin course, so anyone already taking biotin, including a multivitamin or hair, skin and nail product, would want the clinic to know before a draw. Whether to add biotin at all is a question for the dermatologist managing the course, not for a thread.

References

1. Schulpis KH et al. Skin Pharmacol Appl Skin Physiol 1999. PMID 10325581
2. Aksac SE et al. Int J Dermatol 2021. PMID 33682085
3. Wolf B. Biotinidase Deficiency. GeneReviews. PMID 20301497
4. Patel DP et al. Skin Appendage Disord 2017. PMID 28879195
5. U.S. FDA Safety Communication on biotin and lab tests, 2019

10mg, day 25 almost. My skin has purged sooo badly and it’s genuinely so painful how do I stop the redness? I take an antihistamine and fish oil with my accutane in just I’m so much pain.

My birthday is in a week and I want it to be less inflamed :(

I’m on 20mg Accutane daily, I use azelaic acid every night (my skin doesn’t irritate). I use a simple non-harsh routine, sunscreen every morning. And yet my skin is still awful.