Telemedskin by Global Dermatology

Should Oral Isotretinoin Delay Physical Treatments

Isotretinoin and Timing of Procedural Interventions: A Systematic Review With Consensus Recommendations.
Spring LK, Krakowski AC, Alam M, Bhatia A, Brauer J, Cohen J, Del Rosso JQ, Diaz L, Dover J, Eichenfield LF, Gurtner GC, Hanke CW, Jahnke MN, Kelly KM, Khetarpal S, Kinney MA, Levy ML, Leyden J, Longaker MT, Munavalli GS, Ozog DM, Prather H, Shumaker PR, Tanzi E, Torres A, Velez MW, Waldman AB, Yan AC, Zaenglein AL.
JAMA Dermatol. 2017 Aug 1;153(8):802-809. doi: 10.1001/jamadermatol.2017.2077.

Background:

  • Patients undergoing a treatment with oral isotretinoin (Accutane…) often wander what can be done about scars, brown spots, wrinkles and a physical treatment is often proposed.
    • The big question is that isotretinoin going to influence the wound healing process (+/- scarring) and should the physical treatment be delayed months or even a year after the medication is stopped ?
    • It is a theoretical risk and all the studies available have been compiled in this article published in JAMA-Dermatology.

The Evidence:

  • A one sentence summary has been put here:

1. Chemical Peels: reasonable evidence to say that “superficial chemical peels in the setting of low-dose isotretinoin treatment may not be associated with increased scarring or poor wound healing.”

2. Lasers:
Laser Hair Removal: insufficient evidence to delay treatment in patients taking or having completed treatment.
Nonablative Fractional Laser: insufficient evidence to delay treatment in patients taking or having completed treatment.
Fully Ablative Lasers not recommended.

3. Dermabrasion:
Mechanical Dermabrasion: not recommended.
Manual or Microdermabrasion: insufficient evidence to delay treatment in patients taking or having completed treatment.

4. Skin Surgery: insufficient evidence to delay surgery.

Conclusion:

Methodology: systematic PubMed review of English-language articles published from 1982 to 2017 was performed using the following search terms: isotretinoin, 13-cis-retinoic acid, Accutane, retinoids, acitretin, surgery, surgical, laser, ablative laser, nonablative laser, laser hair removal, chemical peel, dermabrasion, wound healing, safety, scarring, hypertrophic scar, and keloid. Evidence was graded, and expert consensus was obtained. 32 reviews reporting 1485 procedures were investigated.

Article selected by Saurat JH, MD

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