The Safe Delivery of Fractional Ablative Carbon Dioxide Laser Treatment for Acne Scars in Asian Patients Receiving Oral Isotretinoin

Abstract

Ablative CO2 fractional laser treatment for acne scarring seems to be safe regardless of isotretinoin use (10-60 mg/d). The authors' findings contribute to the discussion of whether oral isotretinoin treatment impairs wound healing after ablative laser treatment.

Guidelines of care for the management of acne vulgaris

“…291,294 There are also retrospective studies and case reports demonstrating safety with laser hair removal, pulsed dye laser, and CO 2 laser. [295][296][297][298][299] While elective procedures should be delayed for 6 to 12 months when possible, careful consideration may be given on a case by case basis.…”

Safety of non‐ablative fractional laser for acne scars within 1 month after treatment with oral isotretinoin: A randomized split‐face controlled trial

“…Given the lack of strong scientific evidence to substantiate the claims about poor wound healing in isotretinoin patients, recent literature has challenged the current recommendation to wait 6 months after the completion of oral isotretinoin treatment. There are a few case reports and retrospective cohort studies in the literature showing lack of adverse effects after laser procedures in isotretinoin patients . Khatri and his colleagues initially published case reports supporting safety and absence of complications such as atypical scarring or keloid formation after laser hair removal using long‐pulse diode, flash lamp, and long‐pulsed Nd:YAG lasers in patients receiving oral isotretinoin .…”

“…More recently, Khatri et al published a case that reported safety of ablative and NAFL resurfacing in isotretinoin patients . In the clinical context of acne scar revision, two retrospective studies (both with at‐least 20 subjects receiving 0.5–1 mg/kg of isotretinoin per day) reported that ablative carbon dioxide (CO 2 ) resurfacing for acne scarring conducted during and/or within 1–3 months of isotretinoin treatment is safe without any adverse effects on healing . Another study that evaluated treatment of acne and acne scars with concomitant use of 1550 nm NAFL with low‐dose isotretinoin (10 mg/day) suggested improved efficacy without any adverse effects when compared with controls .…”

“…Acne scarring can be psychologically detrimental, and withholding potentially effective treatments such as laser resurfacing during and after isotretinoin therapy can negatively impact a patient's quality of life. More recent retrospective cohort studies have challenged this current recommendation and suggested that laser resurfacing (ablative and non‐ablative) may be safe for acne scarring when conducted during and/or within 1–3 months of isotretinoin treatment . However, to the authors’ knowledge there are no randomized split‐face controlled trials that have addressed this issue.…”

Observational retrospective study evaluating the effects of oral isotretinoin in keloids and hypertrophic scars

“…Normal healing has been reported after laser‐assisted hair removal during treatment with oral isotretinoin, ablative fractionated laser for scars during or at 1–3 months post‐cessation of isotretinoin therapy, non‐ablative fractionated laser, dermaroller and microneedling radiofrequency, dermabrasion of a small facial area during treatment, full‐face combined medium‐depth chemical peel (Jessner's solution plus 35% TCA), followed by manual dermabrasion in areas with depressed scars, at 1–3 months after the completion of treatment with isotretinoin …”