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.

DOI: 10.1001/jamadermatol.2017.2077

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@article{Spring2017IsotretinoinAT, title={Isotretinoin and Timing of Procedural Interventions: A Systematic Review With Consensus Recommendations.}, author={Leah K Spring and Andrew C Krakowski and Murad Alam and Ashish Bhatia and Jeremy A Brauer and Joel Cohen and James Q. Del Rosso and Lucia Z Diaz and Jeffrey S. Dover and Lawrence F. Eichenfield and Geoffrey C. Gurtner and Christoph Hanke and Marla Nicole Jahnke and Kristen M Kelly and Shilpi Khetarpal and Megan A Kinney and Moise L. Levy and James J. Leyden and Michael Thornton Longaker and Girish S. Munavalli and David Ozog and Heidi B Prather and Peter R Shumaker and Elizabeth L Tanzi and Abel O. Torres and Mara Weinstein Velez and Abigail B Waldman and Albert C Yan and Andrea L. Zaenglein}, journal={JAMA dermatology}, year={2017}, volume={153 8}, pages={802-809} }