Isotretinoin and Timing of Procedural Interventions: A Systematic Review With Consensus Recommendations.
2017
Importance The notion that systemic
isotretinointaken 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
isotretinointherapy. Evidence Review A panel of national experts in pediatric dermatology, procedural/cosmetic dermatology,
plastic surgery, scars, wound healing, acne, and
isotretinoinwas 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
isotretinointherapy. Based on the available literature, mechanical
dermabrasionand fully ablative laser are not recommended in the setting of systemic
isotretinointreatment. 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
isotretinointherapy. For some patients and some conditions, an informed decision may lead to earlier and potentially more effective interventions.
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