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

23 Citations (Scopus)

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

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Isotretinoin
Consensus
Lasers
Dermabrasion
Dermatologic Surgical Procedures
Wound Healing
Hair Removal
Cicatrix
Dermatology
Acitretin
Hypertrophic Cicatrix
Safety
Keloid
Retinoids
Acne Vulgaris
Laser Therapy
Plastic Surgery
Therapeutics
PubMed
Cosmetics

All Science Journal Classification (ASJC) codes

  • Dermatology

Cite this

Spring, Leah K. ; Krakowski, Andrew C. ; Alam, Murad ; Bhatia, Ashish ; Brauer, Jeremy ; Cohen, Joel ; Del Rosso, James Q. ; Diaz, Lucia ; Dover, Jeffrey ; Eichenfield, Lawrence F. ; Gurtner, Geoffrey C. ; Hanke, C. William ; Jahnke, Marla N. ; Kelly, Kristen M. ; Khetarpal, Shilpi ; Kinney, Megan A. ; Levy, Moise L. ; Leyden, James ; Longaker, Michael T. ; Munavalli, Girish S. ; Ozog, David M. ; Prather, Heidi ; Shumaker, Peter R. ; Tanzi, Elizabeth ; Torres, Abel ; Velez, Mara Weinstein ; Waldman, Abigail B. ; Yan, Albert C. ; Zaenglein, Andrea L. / Isotretinoin and timing of procedural interventions : A systematic review with consensus recommendations. In: JAMA Dermatology. 2017 ; Vol. 153, No. 8. pp. 802-809.
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title = "Isotretinoin and timing of procedural interventions: A systematic review with consensus recommendations",
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.",
author = "Spring, {Leah K.} and Krakowski, {Andrew C.} and Murad Alam and Ashish Bhatia and Jeremy Brauer and Joel Cohen and {Del Rosso}, {James Q.} and Lucia Diaz and Jeffrey Dover and Eichenfield, {Lawrence F.} and Gurtner, {Geoffrey C.} and Hanke, {C. William} and Jahnke, {Marla N.} and Kelly, {Kristen M.} and Shilpi Khetarpal and Kinney, {Megan A.} and Levy, {Moise L.} and James Leyden and Longaker, {Michael T.} and Munavalli, {Girish S.} and Ozog, {David M.} and Heidi Prather and Shumaker, {Peter R.} and Elizabeth Tanzi and Abel Torres and Velez, {Mara Weinstein} and Waldman, {Abigail B.} and Yan, {Albert C.} and Zaenglein, {Andrea L.}",
year = "2017",
month = "8",
doi = "10.1001/jamadermatol.2017.2077",
language = "English (US)",
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pages = "802--809",
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issn = "2168-6068",
publisher = "American Medical Association",
number = "8",

}

Spring, LK, Krakowski, AC, Alam, M, Bhatia, A, Brauer, J, Cohen, J, Del Rosso, JQ, Diaz, L, Dover, J, Eichenfield, LF, Gurtner, GC, Hanke, CW, Jahnke, MN, Kelly, KM, Khetarpal, S, Kinney, MA, Levy, ML, Leyden, J, Longaker, MT, Munavalli, GS, Ozog, DM, Prather, H, Shumaker, PR, Tanzi, E, Torres, A, Velez, MW, Waldman, AB, Yan, AC & Zaenglein, AL 2017, 'Isotretinoin and timing of procedural interventions: A systematic review with consensus recommendations', JAMA Dermatology, vol. 153, no. 8, pp. 802-809. https://doi.org/10.1001/jamadermatol.2017.2077

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

In: JAMA Dermatology, Vol. 153, No. 8, 08.2017, p. 802-809.

Research output: Contribution to journalReview article

TY - JOUR

T1 - Isotretinoin and timing of procedural interventions

T2 - A systematic review with consensus recommendations

AU - Spring, Leah K.

AU - Krakowski, Andrew C.

AU - Alam, Murad

AU - Bhatia, Ashish

AU - Brauer, Jeremy

AU - Cohen, Joel

AU - Del Rosso, James Q.

AU - Diaz, Lucia

AU - Dover, Jeffrey

AU - Eichenfield, Lawrence F.

AU - Gurtner, Geoffrey C.

AU - Hanke, C. William

AU - Jahnke, Marla N.

AU - Kelly, Kristen M.

AU - Khetarpal, Shilpi

AU - Kinney, Megan A.

AU - Levy, Moise L.

AU - Leyden, James

AU - Longaker, Michael T.

AU - Munavalli, Girish S.

AU - Ozog, David M.

AU - Prather, Heidi

AU - Shumaker, Peter R.

AU - Tanzi, Elizabeth

AU - Torres, Abel

AU - Velez, Mara Weinstein

AU - Waldman, Abigail B.

AU - Yan, Albert C.

AU - Zaenglein, Andrea L.

PY - 2017/8

Y1 - 2017/8

N2 - 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.

AB - 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.

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