Isotretinoin and Timing of Procedural Interventions

Spring, Leah K.; Krakowski, Andrew C.; Alam, Murad; Bhatia, Ashish C.; Brauer, Jeremy A.; Cohen, Joel L.; Rosso, J.Q. Del; Diaz, Lucia Z.; Dover, Jeffrey S.; Eichenfield, Lawrence F.; Gurtner, Geoffrey C.; Hanke, C. William; Jahnke, Marla N.; Kelly, Kristen M.; Khetarpal, Shilpi; Kinney, Megan A.; Levy, Moise L.; Leyden, James J.; Longaker, Michael T.; Munavalli, Girish S.; Ozog, David M.; Prather, Heidi; Shumaker, Peter R.; Tanzi, Elizabeth L.; Torres, Abel; Velez, Mara Weinstein; Waldman, Abigail; Yan, Albert C.; Zaenglein, Andrea L.

doi:10.1001/jamadermatol.2017.2077

Cited by 97 publications

(35 citation statements)

References 35 publications

(65 reference statements)

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“…There is controversy regarding this and procedures such as elective surgery, dermabrasion, chemical abrasives, CO 2 laser, and fractionated radiofrequency: some practitioners delay such procedures until more than 6 months 55 after stopping oral isotretinoin, and others wait 20 to 30 days, the normal time required for the drug to be eliminated. Two recent reviews 78,79 concluded that mechanical dermabrasion and fully ablative laser were not recommended, 78 but that there was insufficient evidence to delay manual or microdermabrasion, superficial chemical peels, cutaneous surgery, fractional ablative and fractional nonablative laser resurfacing for patients currently or recently (6-12 months) exposed to isotretinoin. 78,79 Our current practice is to wait for around 2 months after stopping isotretinoin before starting such procedures.…”

Section: Our Experience and Recommendationsmentioning

confidence: 99%

<p>Challenges and Solutions in Oral Isotretinoin in Acne: Reflections on 35 Years of Experience</p>

Bettoli¹,

Guerra‐Tapia²,

Herane³

et al. 2019

CCID

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Acne vulgaris affects more than 80% of adolescents and young adults and forms a substantial proportion of the dermatologist's and general practitioner's caseload. Severity of symptoms varies but may result in facial scarring and psychological repercussions. Oral isotretinoin is highly effective but can only be prescribed by specialists. Side effects are recognized and mostly predictable, ranging from cosmetic effects to teratogenicity. These can affect patients' quality of life and treatment adherence. This article provides a commentary on 4 key areas: the use of oral isotretinoin vs oral antibiotics, including the importance of early recognition of nonresponse to treatment, the psychological effects of acne and isotretinoin treatment, the side effects of isotretinoin therapy, and cosmetic treatment options that can help alleviate predictable side effects. The authors, who have all participated in various international expert groups, draw on relevant literature and their extensive professional experience with oral isotretinoin in the treatment of acne. The aim of this article is to provide an informative and practical approach to managing oral isotretinoin treatment in patients with acne, to help optimize treatment of this skin disease.

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Section: Our Experience and Recommendationsmentioning

confidence: 99%

<p>Challenges and Solutions in Oral Isotretinoin in Acne: Reflections on 35 Years of Experience</p>

Bettoli¹,

Guerra‐Tapia²,

Herane³

et al. 2019

CCID

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“…This will lead to the further accumulation of evidence, and the formulation of guidelines will be based on stronger evidence in the future. It is also heartening to note that two recent guidelines[ 34 35 ] have been published on this subject and the task force concurs with those recommendations. A recent textbook edited by the first author of this article also dealt with the subject and suggested that the procedures can be safely performed in these patients.…”

Section: Discussionmentioning

confidence: 76%

Standard guidelines of care: Performing procedures in patients on or recently administered with isotretinoin

Mysore¹,

Mahadevappa²,

Barua³

et al. 2017

J Cutan Aesthet Surg

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Background:Currently, the standard protocol regarding the performance of procedures on patients receiving or having recently received isotretinoin (13-cis-retinoic acid) states that the procedures should not be performed. The recommendations in standard books and drug insert require discontinuation of isotretinoin for 6 months before performing cosmetic procedures, including waxing, dermabrasion, chemical peels, laser procedures, or incisional and excisional cold-steel surgery. These recommendations have been followed for over two decades despite little evidence for the stated increased risk of scarring.Objective:The Association of Cutaneous Surgeons (I) constituted a task force to review the evidence and to recommend consensus guidelines regarding the safety of skin procedures, including resurfacing, energy-device treatments, and dermatosurgical procedures in patients with concurrent or recent isotretinoin administration.Materials and Methods:Data were extracted from the literature through a PubMed search using the keywords “isotretinoin,” “safety,” “scarring,” “keloids,” “hypertrophic scarring,” and “pigmentation.” The evidence was then labeled and circulated to all members of task force for review.Results:The task force is of the opinion that there is insufficient evidence to support the current protocol of avoiding and delaying treatments in the patient group under consideration and recommends that the current practice should be discontinued. The task force concludes that performing procedures such as laser hair removal, fractional lasers for aging and acne scarring, lasers for pigmented skin lesions, fractional radio-frequency microneedling, superficial and medium-depth peels, microdermabrasion, dermaroller, biopsies, radio-frequency ablation, and superficial excisions is safe in patients with concurrent or recent isotretinoin administration.

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“…However, a recent systematic review conducted by Spring et al, looking for evidence-based recommendations regarding the safety of cutaneous procedures during or following isotretinoin therapy, found insufficient evidence to delay chemical peels and other skin surgeries. 13 The authors con cluded that the patient and physician must weigh risks and benefits of cutaneous procedures in the setting of systemic isotretinoin.…”

Section: Patient Selectionmentioning

confidence: 99%

Chemical peels in the treatment of acne: patient selection and perspectives

Castillo

Keri

2018

CCID

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Acne vulgaris is the most common skin disorder in adolescents and young adults. It carries a significant psychological and economic burden to patients and society. A wide range of therapeutic options are available, including topicals and systemic therapies. Chemical peeling is a skin resurfacing procedure intended to regenerate normal skin from the application of exfoliative agents. It has been used for the treatment of acne vulgaris and other skin disorders for decades. There are several chemical agents with variable mechanisms of action, usually classified as superficial, medium, and deep peels. When selecting the patient and the appropriate peel, the dermatologist individualizes therapy, and performs an extensive interview, including past medical history and physical exam. Several host factors can affect the outcome of this procedure, including current psychological state, medications, history of surgery, and immune system, among others. The physician must also be confident that the peel is safe and effective for the target patient. The Fitzpatrick skin type scale is a useful tool to classify patients based on skin color and ability to tan, but also can be used to evaluate preoperative risk of postpeel response and complications. Dark-skinned patients (Fitzpatrick skin type IV–VI), including blacks, Asian, and Hispanic/Latino, are at higher risk of postinflammatory/postpeel hyperpigmentation. When treating these populations, deep chemical peels should be avoided, and preoperative preparation emphasized. There are many studies available in the literature supporting the use of superficial to medium depth peels as adjuvant therapy for acne vulgaris. This review article aims to present the most important factors when selecting a patient for a chemical peel, the evidence behind its safety and efficacy, and special considerations when choosing a specific agent.

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Isotretinoin and Timing of Procedural Interventions

Cited by 97 publications

References 35 publications

<p>Challenges and Solutions in Oral Isotretinoin in Acne: Reflections on 35 Years of Experience</p>

<p>Challenges and Solutions in Oral Isotretinoin in Acne: Reflections on 35 Years of Experience</p>

Standard guidelines of care: Performing procedures in patients on or recently administered with isotretinoin

Chemical peels in the treatment of acne: patient selection and perspectives

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