First, two different drugs
Tretinoin is a cream or gel you put on your face. It is a form of vitamin A used for acne, wrinkles and dark spots. Very little of it gets into your bloodstream.
Isotretinoin is a pill, once sold under the brand name Accutane. It is a much more powerful vitamin A drug for severe acne. It travels through your whole body. The two names sound alike, and that is where most of the confusion starts.
Does topical tretinoin cause hair loss?
There is no good evidence that tretinoin cream applied to the face causes hair loss. Hair loss is not listed as a side effect in the FDA prescribing information for tretinoin cream. The amount absorbed through facial skin is tiny.
If you started tretinoin and noticed shedding a few months later, the timing can make it look related. But shedding that shows up two to three months after any stressful event, illness, diet change or new medication is often telogen effluvium, a temporary shedding that resolves on its own.
One real exception is worth mentioning. If tretinoin cream gets on the hairline or eyebrows, it can irritate the skin there and cause flaking and a little localized shedding from scratching. Keep the cream a finger width away from the hairline and brows, and this is not an issue.
Does isotretinoin cause hair loss?
Isotretinoin pills can. Hair thinning is listed in the prescribing information as a possible side effect. It tends to happen at higher doses and usually improves after the course ends.
If you are on the pill form and your hair is thinning, talk to the prescriber. Sometimes a lower dose solves it.
The shedding from isotretinoin is a form of telogen effluvium. The drug shifts hair follicles into the resting phase early. It typically starts a few months into treatment and can continue for a few months after stopping before the hair fills back in. Rarely, people report lasting thinning, but that is uncommon.
Tretinoin is actually studied as a hair-growth helper
Here is the surprising part. Small studies have tested tretinoin on the scalp alongside minoxidil, the standard hair-regrowth drug. The idea is that tretinoin helps minoxidil get through the skin and may help the scalp convert it to its active form.
A randomized trial published in Dermatologic Therapy in 2019 found that 5 percent minoxidil with a low dose of tretinoin once a day worked about as well as minoxidil alone twice a day. This was a small study, so it is not proof. But it points the opposite direction from hair loss.
What else could be causing the shedding
Male or female pattern hair loss. This is the most common cause of thinning in adults and is driven by genes and hormones, not skin cream.
Telogen effluvium. A sudden shed two to three months after stress, surgery, childbirth, fast weight loss or a new drug.
Low iron, thyroid problems or low vitamin D. Simple blood tests can check these.
Scalp conditions like seborrheic dermatitis. These cause itch and flakes along with shedding.
How to tell which one you have: pull a small bunch of hair gently. If many strands come out from all over the scalp, that points to telogen effluvium. If the loss is mostly at the temples, crown or part line and has crept in over years, that points to pattern hair loss. A clinician can confirm with a quick scalp exam.
How Zen IV Spa can help
If your hair is thinning, Zen IV Spa can sort out the cause and treat it. A free video visit with our medical director comes first, and a nurse can draw labs at your home in New York and New Jersey to check iron, thyroid and hormones. Treatment options include finasteride for $49 a month, oral minoxidil for $59, a topical spray for $69, or the full program for $149. Visit /hair-loss/ to begin. And if your question was really about your face routine, our tretinoin program is $99 at /skin/.
Common Questions
Is tretinoin the same as Accutane?+
No. Tretinoin is a cream you put on your skin. Accutane is the old brand name for isotretinoin, a pill. The pill can cause hair thinning. The cream is not known to.
Will my hair grow back after isotretinoin?+
In most cases, yes. Hair usually returns within a few months of finishing the course.
Can I use tretinoin on my scalp for hair growth?+
Some clinicians combine it with minoxidil, but it can irritate the scalp. Do not try this without medical guidance.
I started tretinoin and my hair is shedding. Should I stop?+
Probably not because of the cream. See a clinician to look for the real cause, such as stress, iron, thyroid or pattern hair loss.
Does retinol in face creams cause hair loss?+
No. Over-the-counter retinol is weaker than tretinoin and there is no evidence it affects scalp hair.
Sources: FDA prescribing information for Retin-A (tretinoin) and Accutane (isotretinoin); Sharma et al., Dermatologic Therapy, 2019 randomized trial of minoxidil with tretinoin; American Academy of Dermatology guidance on hair loss causes.
All treatments are medical services. Every guest is screened, and every treatment is prescribed by a licensed provider. Nothing on this page is medical advice for you personally, and the opinions summarized here belong to the doctors named, not to Zen IV Spa. Talk to a provider before starting or stopping anything.
