What is the evidence behind the medical dictum prohibiting procedural interventions in the setting of isotretinoin therapy?
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.
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.
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.
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.
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.
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.
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. Isotretinoin and Timing of Procedural InterventionsA Systematic Review With Consensus Recommendations. JAMA Dermatol. 2017;153(8):802–809. doi:10.1001/jamadermatol.2017.2077