Dropping the Delay: Safety of Procedural Interventions During and After Isotretinoin Use

Authors

  • Kim Blakely, MD, PhD, FRCPC

Abstract

Systemic isotretinoin is a commonly employed treatment for acne. Currently, the Health Canada approved product monograph contains a warning that aggressive chemical dermabrasion and cutaneous laser treatment be avoided in patients for a period of 5-6 months after the end of treatment because of the risk of hypertrophic scarring in atypical areas, and more rarely hyper- or hypo-pigmentation in treated areas. This recommendation, derived largely from case reports or studies conducted in the 1980s, is based on the belief that systemic isotretinoin therapy contributes to abnormal wound healing and increased risks for scarring. However, there is a growing body of evidence that sheds new light on these claims, and several groups have recently released consensus recommendations addressing these concerns. This paper aims to summarize our current understanding and the most recent evidence-based clinical recommendations regarding the safety of procedural interventions in the setting of systemic isotretinoin therapy.

Author Biography

Kim Blakely, MD, PhD, FRCPC

Dr. Kim Blakely is a board-certified dermatologist practicing in Toronto, Ontario. She completed her Honours BSc in Biochemistry and Biomedical Sciences at McMaster University, graduating at the top of her class and earning the award for highest academic standing. She completed both her Doctor of Medicine and dermatology residency training at the University of Toronto where she earned high accolades for her student leadership and served as co-chief resident. In addition to her clinical training. Dr. Blakely also completed her PhD in Molecular Genetics at the University of Toronto, and has participated in multiple research studies, authored numerous articles and book chapters, and has been invited to present her research at several national and international conferences.

References

Hernandez-Perez E, Khawaja HA, Alvarez TY. Oral isotretinoin as part of the treatment of cutaneous aging. Dermatol Surg. 2000;26(7):649-652.

Picosse FR, Yarak S, Cabral NC, Bagatin E. Early chemabrasion for acne scars after treatment with oral isotretinoin. Dermatol Surg. 2012;38(9):1521-1526.

Kar BR, Tripathy S, Panda M. Comparative study of oral isotretinoin versus oral isotretinoin + 20% salicylic Acid peel in the treatment of active acne. J Cutan Aesthet Surg. 2013;6(4):204-208.

Chandrashekar BS, Vadlamudi SL, Shenoy C. Safety of Performing Superficial Chemical Peels in Patients on Oral Isotretinoin for Acne and Acne-Induced Pigmentation. J Clin Aesthet Dermatol. 2021;14(11):41-43.

Gerber PA, Kukova G, Bölke E, Homey B, Diedrichson E. Severe hyperpigmentation and scarring following glycolic acid peel treatment in combination with low-dose isotretinoin. Eur J Med Res. 2014;19(1):60.

Spring LK, Krakowski AC, Alam M, et al. Isotretinoin and Timing of Procedural Interventions: A Systematic Review With Consensus Recommendations. JAMA Dermatol. 2017;153(8):802-809.

Waldman A, Bolotin D, Arndt KA, et al. ASDS Guidelines Task Force: Consensus Recommendations Regarding the Safety of Lasers, Dermabrasion, Chemical Peels, Energy Devices, and Skin Surgery During and After Isotretinoin Use. Dermatol Surg. 2017;43(10):1249-1262.

Mysore V, Mahadevappa OH, Barua S, et al. Standard Guidelines of Care: Performing Procedures in Patients on or Recently Administered with Isotretinoin. J Cutan Aesthet Surg. 2017;10(4):186-194.

Bagatin E, dos Santos Guadanhim LR, Yarak S, Kamamoto CS, de Almeida FA. Dermabrasion for acne scars during treatment with oral isotretinoin. Dermatol Surg. 2010;36(4):483-489.

Mahadevappa OH, Mysore V, Viswanath V, et al. Surgical Outcome in Patients Taking Concomitant or Recent Intake of Oral Isotretinoin: A Multicentric Study-ISO-AIMS Study. J Cutan Aesthet Surg. 2016;9(2):106-114.

Roenigk HH Jr, Pinski JB, Robinson JK, Hanke CW. Acne, retinoids, and dermabrasion. J Dermatol Surg Oncol. 1985;11(4):396-398.

Rubenstein R, Roenigk HH Jr, Stegman SJ, Hanke CW. Atypical keloids after dermabrasion of patients taking isotretinoin. J Am Acad Dermatol. 1986;15(2 Pt 1):280-285.

Zachariae H. Delayed wound healing and keloid formation following argon laser treatment or dermabrasion during isotretinoin treatment. Br J Dermatol. 1988;118(5):703-706.

Katz BE, Mac Farlane DF. Atypical facial scarring after isotretinoin therapy in a patient with previous dermabrasion. J Am Acad Dermatol. 1994;30(5 Pt 2):852-853.

Chandrashekar BS, Varsha DV, Vasanth V, Jagadish P, Madura C, Rajashekar ML. Safety of performing invasive acne scar treatment and laser hair removal in patients on oral isotretinoin: a retrospective study of 110 patients. Int J Dermatol. 2014;53(10):1281-1285.

Kim HW, Chang SE, Kim JE, Ko JY, Ro YS. The safe delivery of fractional ablative carbon dioxide laser treatment for acne scars in Asian patients receiving oral isotretinoin. Dermatol Surg. 2014;40(12):1361-1366.

Leal H, Cantu P. Fractionated erbium laser during oral isotretinoin treatment. J Am Acad Dermatol 64:AB18.

Yoon JH, Park EJ, Kwon IH, et al. Concomitant use of an infrared fractional laser with low-dose isotretinoin for the treatment of acne and acne scars. J Dermatolog Treat. 2014;25(2):142-146.

Khatri KA. Diode laser hair removal in patients undergoing isotretinoin therapy. Dermatol Surg. 2004;30(9):1205-1207.

Khatri KA, Garcia V. Light-assisted hair removal in patients undergoing isotretinoin therapy. Dermatol Surg. 2006;32(6):875-877.

Khatri KA. The safety of long-pulsed Nd:YAG laser hair removal in skin types III-V patients during concomitant isotretinoin therapy. J Cosmet Laser Ther. 2009;11(1):56-60.

Cassano N, Arpaia N, Vena GA. Diode laser hair removal and isotretinoin therapy. Dermatol Surg. 2005;31(3):380-381.

Prather HB, Alam M, Poon E, Arndt KA, Dover JS. Laser Safety in Isotretinoin Use: A Survey of Expert Opinion and Practice. Dermatol Surg. 2017;43(3):357-363.

Sarigul Guduk S, Tukenmez Demirci G. Safety of Laser Hair Removal in Patients Receiving Systemic Isotretinoin for Acne Vulgaris. Dermatol Surg. 2021;47(11):1448-1452.

Kim J, Lee YI, Kim J, Jung JY, Lee WJ, Lee JH. Safety of Combined Fractional Microneedle Radiofrequency and CO2 as an Early Intervention for Inflammatory Acne and Scarring Treated With Concomitant Isotretinoin. Dermatol Surg. 2020;46(10):e71-e77.

Ungarelli LF, Hetem CM, Farina Junior JA. Is It Safe to Operate on Patients Taking Isotretinoin?. Aesthetic Plast Surg. 2016;40(1):139-148.

Tolkachjov SN, Sahoo A, Patel NG, Lohse CM, Murray JA, Tollefson MM. Surgical outcomes of patients on isotretinoin in the perioperative period: A single-center, retrospective analysis. J Am Acad Dermatol. 2017;77(1):159-161.

Published

2022-05-01

How to Cite

1.
Blakely K. Dropping the Delay: Safety of Procedural Interventions During and After Isotretinoin Use. Can Dermatol Today [Internet]. 2022 May 1 [cited 2024 May 20];3(2):13–16. Available from: https://canadiandermatologytoday.com/article/view/3-2-blakely

Issue

Section

Articles