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Review
August 2017

Isotretinoin and Timing of Procedural InterventionsA Systematic Review With Consensus Recommendations

Author Affiliations
  • 1Dermatology Department, Naval Hospital Camp Lejeune, Camp Lejeune, North Carolina
  • 2DermOne, LLC, West Conshohocken, Pennsylvania
  • 3Department of Dermatology, Northwestern University, Chicago, Illinois
  • 4DuPage Medical Group, Department of Dermatology, Northwestern University, Chicago, Illinois
  • 5Laser and Skin Surgery Center of New York, New York
  • 6Department of Dermatology, New York University School of Medicine, New York
  • 7AboutSkin Dermatology, Lone Tree, Colorado
  • 8DermSurgery, Lone Tree, Colorado
  • 9Dermatology Department, Touro University Nevada College of Health and Human Services, Henderson
  • 10Dell Children’s Medical Center, University of Texas Austin Dell Medical School, Austin
  • 11SkinCare Physicians, Chestnut Hill, Massachusetts
  • 12Department of Dermatology, University of California–San Diego
  • 13Rady Children’s Hospital, San Diego, California
  • 14Stanford University, Stanford, California
  • 15Laser and Skin Surgery Center of Indiana, Carmel
  • 16Department of Dermatology, Henry Ford Health System, Detroit, Michigan
  • 17Division of Pediatric Dermatology, Children’s Hospital of Michigan, Detroit, Michigan
  • 18University of California-Irvine
  • 19Wilmington Health, PLLC, Wilmington, North Carolina
  • 20University of Pennsylvania, Philadelphia
  • 21Institute for Stem Cell Biology and Regenerative Medicine, Stanford University School of Medicine, Stanford, California
  • 22Department of Dermatology, School of Medicine, Wake Forest University, Charlotte, North Carolina
  • 23Dermatology, Laser, and Vein Specialists of the Carolinas, PLLC, Charlotte, North Carolina
  • 24Department of Dermatology, Henry Ford Hospital, Detroit, Michigan
  • 25Westlake Dermatology, Austin, Texas
  • 26Naval Medical Center San Diego, San Diego, California
  • 27Dermatology Department, George Washington University School of Medicine, Washington, DC
  • 28Loma Linda University Medical Center, Loma Linda, California
  • 29Brigham and Women’s Hospital, Boston, Massachusetts
  • 30Section of Dermatology, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
  • 31Department of Pediatrics and Dermatology, Perelman School of Medicine, University of Pennsylvania, Philadelphia
  • 32Pennsylvania State University, Hershey
JAMA Dermatol. 2017;153(8):802-809. doi:10.1001/jamadermatol.2017.2077
Key Points

Question  What is the evidence behind the medical dictum prohibiting procedural interventions in the setting of isotretinoin therapy?

Findings  This systematic review found insufficient evidence to support delaying manual dermabrasion, superficial chemical peels, cutaneous surgery, laser hair removal, and fractional ablative and nonablative laser procedures for patients who are currently taking or have recently completed isotretinoin therapy. Mechanical dermabrasion and fully ablative laser procedures are currently not recommended.

Meaning  Previously prohibited procedures may be offered to a patient when accompanied by an evidence-based discussion of the risks and benefits of a procedure as part of gaining informed consent.

Abstract

Importance  The notion that systemic isotretinoin taken within 6 to 12 months of cutaneous surgery contributes to abnormal scarring or delayed wound healing is widely taught and practiced; however, it is based on 3 small case series from the mid-1980s.

Objective  To evaluate the body of literature to provide evidence-based recommendations regarding the safety of procedural interventions performed either concurrently with, or immediately following the cessation of systemic isotretinoin therapy.

Evidence Review  A panel of national experts in pediatric dermatology, procedural/cosmetic dermatology, plastic surgery, scars, wound healing, acne, and isotretinoin was convened. A 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.

Findings  Thirty-two relevant publications reported 1485 procedures. There was insufficient evidence to support delaying manual dermabrasion, superficial chemical peels, cutaneous surgery, laser hair removal, and fractional ablative and nonablative laser procedures for patients currently receiving or having recently completed isotretinoin therapy. Based on the available literature, mechanical dermabrasion and fully ablative laser are not recommended in the setting of systemic isotretinoin treatment.

Conclusions and Relevance  Physicians and patients may have an evidence-based discussion regarding the known risk of cutaneous surgical procedures in the setting of systemic isotretinoin therapy. For some patients and some conditions, an informed decision may lead to earlier and potentially more effective interventions.

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