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.
N1 - Publisher Copyright:
© 2017 American Medical Association. All rights reserved.
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.
UR - http://www.scopus.com/inward/record.url?scp=85027379649&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85027379649&partnerID=8YFLogxK
U2 - 10.1001/jamadermatol.2017.2077
DO - 10.1001/jamadermatol.2017.2077
M3 - Review article
C2 - 28658462
AN - SCOPUS:85027379649
SN - 2168-6068
VL - 153
SP - 802
EP - 809
JO - JAMA Dermatology
JF - JAMA Dermatology
IS - 8
ER -