Isotretinoin Use in Transmasculine Patients and Its Implication on Chest Masculinization Surgery: Scoping Review of the Literature (Preprint)

Abstract

BACKGROUND Acne often worsens in transmen on prolonged testosterone therapy. Isotretinoin is an oral retinoid used in the treatment of severe or refractory cases of acne, though it has been previously reported to cause hypertrophic scarring in patients undergoing some surgical procedures. Transmen may potentially be prescribed treatment for acne with isotretinoin while also planning to undergo chest masculinization surgery. OBJECTIVE To determine whether isotretinoin has a negative impact on post-operative healing in transmen undergoing chest masculinization surgery. METHODS A scoping review was performed using the PubMed database. RESULTS Acne tends to peak in transmen six months after initiation of testosterone treatment. Severe cases can be treated with isotretinoin, but may recur once treatment is discontinued, given ongoing hormone therapy. There is little to no evidence in the medical literature regarding peri-operative use of isotretinoin in transmen undergoing chest masculinization surgery specifically. In general, however, recent studies have found no evidence of increased hypertrophic scars or keloids in patients taking isotretinoin. CONCLUSIONS Further studies are required to strengthen the current evidence that suggests that isotretinoin does not need to be discontinued before or after incisional or excisional surgeries, including chest masculinization surgery in transmen.