Standard guidelines of care: Performing procedures in patients on or recently administered with isotretinoin
Venkataram Mysore1, Omprakash H Mahadevappa2, Shyamanta Barua3, Imran Majid4, Vishalakshi Viswanath5, Ramesh M Bhat6, Suresh Talwar7, Salim Thurakkal8, Sanjeev J Aurangabadkar9, Manas Chatterjee10, Anil Ganjoo11
1 Venkat Charmalaya, Centre for Advanced Dermatology and Postgraduate Training, Bengaluru, India
2 Department of Dermatology, Vikram Perfect Hospital, Mysuru, Karnataka, India
3 Department of Dermatology, Assam Medical College and Hospital, Dibrugarh, Assam, India
4 Cutis Skin and Laser Institute, Srinagar, Jammu and Kashmir, India
5 Disha Skin and Laser Institute, Thane, Maharashtra, India
6 Department of Dermatology, Father Muller Medical College, Mangaluru, Karnataka, India
7 Talwar Skin Centre, Lucknow, Uttar Pradesh, India
8 Department of Dermatology and Laser Surgery, Skin and Laser Clinic, Hyderabad, Telangana, India
9 Cutis Clinic, Calicut, Kozhikode, Kerala, India
10 Department of Dermatology, Institute of Naval Medicine, INHS Aswini, Mumbai, Maharashtra, India
11 Skinnovation Laser Clinic, New Delhi, India
Venkat Charmalaya, Centre for Advanced Dermatology, Bengaluru 560040, Karnataka, India.
Source of Support: None, Conflict of Interest: None
Background: Currently, the standard protocol regarding the performance of procedures on patients receiving or having recently received isotretinoin (13-cis-retinoic acid) states that the procedures should not be performed. The recommendations in standard books and drug insert require discontinuation of isotretinoin for 6 months before performing cosmetic procedures, including waxing, dermabrasion, chemical peels, laser procedures, or incisional and excisional cold-steel surgery. These recommendations have been followed for over two decades despite little evidence for the stated increased risk of scarring. Objective: The Association of Cutaneous Surgeons (I) constituted a task force to review the evidence and to recommend consensus guidelines regarding the safety of skin procedures, including resurfacing, energy-device treatments, and dermatosurgical procedures in patients with concurrent or recent isotretinoin administration. Materials and Methods: Data were extracted from the literature through a PubMed search using the keywords “isotretinoin,” “safety,” “scarring,” “keloids,” “hypertrophic scarring,” and “pigmentation.” The evidence was then labeled and circulated to all members of task force for review. Results: The task force is of the opinion that there is insufficient evidence to support the current protocol of avoiding and delaying treatments in the patient group under consideration and recommends that the current practice should be discontinued.The task force concludes that performing procedures such as laser hair removal, fractional lasers for aging and acne scarring, lasers for pigmented skin lesions, fractional radio-frequency microneedling, superficial and medium-depth peels, microdermabrasion, dermaroller, biopsies, radio-frequency ablation, and superficial excisions is safe in patients with concurrent or recent isotretinoin administration.