Isotretinoin Use in Adolescence Not Linked to Reduced Adult Height

Isotretinoin treatment during adolescence was not associated with a clinically meaningful reduction in adult height, according to a nationwide cross-sectional study published in JAMA Dermatology. The study analyzed height data from 379,196 Danish individuals eligible for military conscription between 2001 and 2015, including 16,739 men and 278 women who had used isotretinoin for acne. Adjusted mean height differences between isotretinoin users and a reference group without acne treatment remained well below the prespecified threshold for clinical significance in both sexes.¹

Concerns about isotretinoin's effects on growth plate physiology have persisted for decades, largely stemming from case reports involving considerably higher retinoid doses among children treated for neuroblastoma. Prior data specific to acne-range dosing came from smaller cohorts, leaving limited population-level evidence to inform shared decision-making with adolescent patients and their families. The new analysis draws on nationwide Danish health registry data to address this gap at a substantially larger scale.

Study Design and Height Assessment

The study linked Danish military conscription records collected between January 1, 2001, and December 31, 2015, with prospectively collected prescription and hospital diagnosis registries. Isotretinoin use, oral tetracycline-class antibiotic use, and topical acne therapy use were determined from prescription records before height was measured at conscription. Individuals without a recorded acne treatment or hospital diagnosis of acne served as the reference group.¹

Linear regression models adjusted for birth cohort and educational level estimated mean height differences, with a prespecified minimal clinically important difference of 5 cm or greater. Analyses were stratified by age at isotretinoin initiation and cumulative dose before conscription, with stunting examined as a secondary outcome.¹

Adult Height Differences Remain Below Clinical Threshold

Among 379,196 individuals, 368,338 were men, including 16,739 (4.5%) isotretinoin users, and 10,858 were women, including 278 (2.6%) isotretinoin users. Mean height at approximately age 19 years was 180.4 cm (SD, 6.7) among men and 168.3 cm (SD, 5.9) among women.¹

Compared with the reference group, the adjusted mean height difference among isotretinoin users was 0.31 cm (95% CI, 0.20-0.41) in men and 0.25 cm (95% CI, –0.47 to 0.96) in women, with both estimates well below the predefined threshold for clinical significance.

Isotretinoin Dosing, Age at Initiation, and Growth Stunting Risk

Findings were consistent when stratified by age at isotretinoin initiation and cumulative dose, with no evidence of a dose-response relationship overall or among individuals exposed before age 15 years. Stunting, defined as height 2 SDs or more below the mean, was examined as a secondary outcome and did not differ meaningfully by treatment exposure.¹

Among boys who initiated isotretinoin at age 13 years or younger, mean adult height differences of approximately 1 cm were observed, although the upper bounds of the confidence intervals remained below the 5-cm threshold. Data on girls who initiated isotretinoin at very young ages were limited, reducing precision for this subgroup, but no signal of a clinically meaningful effect on final height emerged.

Earlier Studies Support Findings on Final Adult Height

The findings align with 2 earlier cohort studies coauthored by members of the same investigative group.^2,3

A retrospective analysis using the Rochester Epidemiology Project found no significant difference in final height at age 18 years between adolescents treated with isotretinoin and acne controls treated with oral antibiotics (mean difference, –0.67 cm; 95% CI, –2.21 to 0.87), despite a modest reduction in height velocity following treatment initiation. The investigators found a 0.12-cm/month lower post-treatment initiation height velocity among isotretinoin-treated patients and a 0.31-cm/month greater reduction in height velocity from before to after treatment initiation.²

A separate retrospective cohort study using the TriNetX network found that male isotretinoin users aged 17 years or younger had slightly greater adult height than doxycycline-treated controls (mean difference, 0.19 in; 95% CI, 0.02-0.36), whereas no significant difference was observed among females. The investigators also found similar proportions of individuals with adult height more than 2 SDs below the mean across cohorts.³

Implications for Isotretinoin Shared Decision-Making

John S. Barbieri, MD, MBA, associate professor at Harvard Medical School and director of the Advanced Acne Therapeutics Clinic at Brigham and Women's Hospital in Boston, Massachusetts, said the results provide reassurance for shared decision-making conversations about isotretinoin.

"For patients and families who are concerned that isotretinoin could negatively affect growth, dermatologists can now point to this study, as well as two others by our group, one using TriNetX and the other using the Rochester Epidemiology Project dataset, all of which support that isotretinoin does not appear to be associated with negative effects to final height," Barbieri said. "Concern about adult height generally should not be a major barrier to using isotretinoin when it is otherwise clinically appropriate."

Severe, scarring acne can carry lasting psychosocial effects, and isotretinoin remains among the most effective treatments for severe acne. Taken together with findings from the Rochester Epidemiology Project and TriNetX cohorts, the Danish study provides further reassurance that concerns about final adult height generally should not deter isotretinoin use when treatment is otherwise clinically appropriate.^2,3

References

1. Schmidt SAJ, Grønborg TK, Gribsholt SB, Langan SM, Sørensen HT, Barbieri JS. Isotretinoin treatment in adolescence and adult height. JAMA Dermatol. 2026;162(7):685-691. doi:10.1001/jamadermatol.2026.1197
2. Xu KK, Aghazadeh N, Tebben P, Todd A, Tollefson M, Barbieri JS. The effect of isotretinoin treatment for acne vulgaris on height in adolescents: a retrospective cohort study using the Rochester Epidemiology Project. J Am Acad Dermatol. 2025;93(6):1464-1470. doi:10.1016/j.jaad.2025.08.009
3. Cole HL, Barbieri JS, Shen LY. Pediatric isotretinoin use for acne is not associated with meaningful effects on adult height: a retrospective cohort study using TriNetX. J Am Acad Dermatol. Published online November 2025. doi:10.1016/j.jaad.2025.11.054