Year: 2017
Type: article
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.
Source: JAMA Dermatology
Authors: 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
Institutions: United States Department of the Navy, Northwestern University, DuPage Medical Group, Laser and Skin Surgery Center of New York, New York University, Touro University Nevada, Dell Children's Medical Center of Central Texas, The University of Texas at Austin, University of California San Diego, Rady Children's Hospital-San Diego, Stanford University, Laser and Skin Surgery Center of Indiana, Henry Ford Health, Children's Hospital of Michigan, University of California, Irvine, University of Pennsylvania, Institute for Stem Cell Biology and Regenerative Medicine, Dermatology, Laser & Vein Specialists of the Carolinas, Wake Forest University, Henry Ford Hospital, Naval Medical Center San Diego, George Washington University, Loma Linda University Medical Center, Brigham and Women's Hospital, Children's Hospital of Philadelphia, Pennsylvania State University
Language: English
Subfield: Dermatology
Field: Medicine
Domain: Health Sciences
Open Access status: green
OpenAlex ID: W2731786563