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. MunavalliDavid M. Ozog, Heidi Prather, Peter R. Shumaker, Elizabeth Tanzi, Abel Torres, Mara Weinstein Velez, Abigail B. Waldman, Albert C. Yan, Andrea L. Zaenglein

Research output: Contribution to journalReview article

34 Scopus citations

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.

Original languageEnglish (US)
Pages (from-to)802-809
Number of pages8
JournalJAMA Dermatology
Volume153
Issue number8
DOIs
StatePublished - Aug 2017

All Science Journal Classification (ASJC) codes

  • Dermatology

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    Spring, L. K., Krakowski, A. C., Alam, M., Bhatia, A., Brauer, J., Cohen, J., Del Rosso, J. Q., Diaz, L., Dover, J., Eichenfield, L. F., Gurtner, G. C., Hanke, C. W., Jahnke, M. N., Kelly, K. M., Khetarpal, S., Kinney, M. A., Levy, M. L., Leyden, J., Longaker, M. T., ... Zaenglein, A. L. (2017). Isotretinoin and timing of procedural interventions: A systematic review with consensus recommendations. JAMA Dermatology, 153(8), 802-809. https://doi.org/10.1001/jamadermatol.2017.2077