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

Abstract

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.

Evidence-based surgical management of post-acne scarring in skin of color

“…Concurrent isotretinoin treatment is not considered as a contraindication for laser therapy. [ 46 ] Lasers should be avoided in areas of active inflammation and infection. Choosing appropriate settings for laser taking into consideration the depth of the scar, skin type, and tendency to PIH is of utmost importance.…”

Dispelling myths in dermatologic surgery

“…Delayed intervention for moderateto-severe inflammatory acne conflicts with the current treatment paradigm for early scar intervention. Patients would benefit from open discussions regarding the safety and efficacy of isotretinoin and cutaneous procedural outcomes (59).…”

Fractional carbon dioxide laser: Optimizing treatment outcomes for pigmented atrophic acne scars in skin of color

“…[4243] Some of the recent studies suggest the safety of different procedures such as laser hair removal and dermabrasion in patients recently treated with oral isotretinoin. [44]Postprocedural delivery of vitamin C, antioxidants and emollients, and PRP acts to facilitate better healing, rejuvenation.Postprocedural emollients and sunscreen with antiviral and antibacterial prophylaxis when indicated minimize side effects.…”

“…[4243] Some of the recent studies suggest the safety of different procedures such as laser hair removal and dermabrasion in patients recently treated with oral isotretinoin. [44]…”