A taskforce of cutaneous surgeons in India suggests that performing several common cosmetic procedures, from laser hair removal to fractional laser treatment for aging and acne scarring, is safe in patients currently or recently on isotretinoin. That’s despite widespread recommendations to avoid doing many common cosmetic procedures in these patients, unless the acne drug has been discontinued for at least six months.
The concern for more than two decades has been that isotretinoin (13-cis-retinoic acid), a retinol derivative of vitamin A commonly used to treat severe acne vulgaris, has pharmacological actions that affect epidermis, sebaceous gland and collagen formation. This has led to questions about whether isotretinoin use might lead to poor wound healing, keloid development and hypertrophic scarring after common cosmetic and dermatologic procedures, according to the review, published online February 2018 in the Journal of Cutaneous and Aesthetic Surgery.
Despite the recommendation to avoid doing many procedures, a number of studies have documented that performing cutaneous procedures in current and former isotretinoin patients is safe.
The Association of Cutaneous Surgeons, made up of clinicians in India, reviewed the literature and, based on their findings, released new guidelines appropriate to brown skin.
They found insufficient evidence to support the current approach to avoid or delay several cosmetic and dermatologic treatments on these patients. The procedures they found to be safe for patients on isotretinoin and those having taken the drug in the last six months include laser hair removal; fractional laser treatment for aging and acne scarring; laser treatment for pigmented skin lesions; fractional radiofrequency microneedling; superficial and medium-depth peels; microdermabrasion; dermaroller; biopsies; radiofrequency ablation; and superficial excisions.
They advise caution, however, when using ablative lasers for full face resurfacing or deep peels.
“The… review shows rather overwhelmingly that the risks of hypertrophic scarring, keloid formation, delayed wound healing and pigmentation are not significant in most dermatological procedures. As such, the recommendation to avoid procedures in these patients was, in our opinion, based on flawed reasoning,” they authors write.