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Recommendation on safety of skin procedures after Tx with isotretinoin

International literature review regarding the safety of skin procedures performed either concurrently with, or immediately after, treatment with the acne medication isotretinoin.

For decades, it has been widely taught that isotretinoin causes abnormal scarring or delayed wound healing, although this notion stems from three case series published in the mid-1980s describing only a handful of patients, according to authors.

New consensus recommendations are presented in the review article by corresponding author Dr Leah K Spring, of the Naval Hospital Camp Lejeune in North Carolina, and Dr Andrew C Krakowski, of DermOne LLC, West Conshohocken, and co-authors. The medical literature review included 32 relevant articles reporting on 1,485 procedures.

The article reports “insufficient evidence” to support delaying manual dermabrasion, superficial chemical peels, skin surgery, laser hair removal, and fractional ablative and non-ablative laser procedures for patients who are currently taking or who have recently completed isotretinoin therapy. However, mechanical dermabrasion and fully ablative laser procedures are not currently recommended.

“With the information presented in this article, physicians may have an evidence-based discussion with patients regarding the known risk of cutaneous surgical procedures in the setting of systemic isotretinoin treatment. For some patients and some conditions, an informed decision may lead to earlier and potentially more effective interventions,” the article concludes.

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.

Authors
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 Munavalli; David M Ozog; Heidi Prather; Peter R Shumaker; Elizabeth Tanzi; Abel Torres; Mara Weinstein Velez; Abigail B Waldman; Albert C Yan; Andrea L Zaenglein

[link url="https://media.jamanetwork.com/news-item/consensus-recommendations-isotretinoin-timing-skin-procedures/"]JAMA material[/link]
[link url="http://jamanetwork.com/journals/jamadermatology/fullarticle/2632046"]JAMA Dermatology review[/link]

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