Isotretinoin and Timing of Procedural Interventions: A Systematic Review With Consensus Recommendations.

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

Journal: JAMA dermatology 2017;153(8):802-809

PMID: 28658462

Free Full Text on eScholarship, University of California - Access Free Full Text View on PubMed

Abstract

IMPORTANCE

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.

OBJECTIVE

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.

EVIDENCE REVIEW

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.

FINDINGS

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.

Address: Dermatology Department, Naval Hospital Camp Lejeune, Camp Lejeune, North Carolina.; DermOne, LLC, West Conshohocken, Pennsylvania.; Department of Dermatology, Northwestern University, Chicago, Illinois.; DuPage Medical Group, Department of Dermatology, Northwestern University, Chicago, Illinois.; Laser and Skin Surgery Center of New York, New York.; Department of Dermatology, New York University School of Medicine, New York.; AboutSkin Dermatology, Lone Tree, Colorado.; DermSurgery, Lone Tree, Colorado.; Dermatology Department, Touro University Nevada College of Health and Human Services, Henderson.; Dell Children's Medical Center, University of Texas Austin Dell Medical School, Austin.; SkinCare Physicians, Chestnut Hill, Massachusetts.; Department of Dermatology, University of California-San Diego.; Rady Children's Hospital, San Diego, California.; Stanford University, Stanford, California.; Laser and Skin Surgery Center of Indiana, Carmel.; Department of Dermatology, Henry Ford Health System, Detroit, Michigan.; Division of Pediatric Dermatology, Children's Hospital of Michigan, Detroit, Michigan.; University of California-Irvine.; Wilmington Health, PLLC, Wilmington, North Carolina.; University of Pennsylvania, Philadelphia.; Institute for Stem Cell Biology and Regenerative Medicine, Stanford University School of Medicine, Stanford, California.; Department of Dermatology, School of Medicine, Wake Forest University, Charlotte, North Carolina.; Dermatology, Laser, and Vein Specialists of the Carolinas, PLLC, Charlotte, North Carolina.; Department of Dermatology, Henry Ford Hospital, Detroit, Michigan.; Westlake Dermatology, Austin, Texas.; Naval Medical Center San Diego, San Diego, California.; Dermatology Department, George Washington University School of Medicine, Washington, DC.; Loma Linda University Medical Center, Loma Linda, California.; Brigham and Women's Hospital, Boston, Massachusetts.; Section of Dermatology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.; Department of Pediatrics and Dermatology, Perelman School of Medicine, University of Pennsylvania, Philadelphia.; Pennsylvania State University, Hershey.

DOI: 10.1001/jamadermatol.2017.2077