Is Isotretinoin Use Safe Before And After Cosmetic Procedures? New Guidelines For Managing Use
The current recommendation for isotretinoin (13-cis-retinoic acid) use suggests discontinuation of isotretinoin for 6 months before performing cosmetic procedures, including waxing, dermabrasion, chemical peels, laser procedures, or surgery. The language is in place to prevent adverse events and to address any increased risk of scarring. Recently, the American Society for Dermatologic Surgery authorized a task force of content experts to review the evidence and come to consensus regarding the safety of skin procedures with concurrent or recent isotretinoin use. The expert panel first examined data extracted from the literature followed by a clinical question review, a consensus Delphi process, and validation of the results by peer review.
The panel sought to determine whether there is an increased risk of pathological scarring or developing other adverse effects when procedures such as dermabrasion, chemical peels, laser treatments, or incisional or excisional are performed within 6 months of isotretinoin use.
The panel was tasked with formulating recommendations based on the available literature for whether it would be safe to consider cutaneous surgery and other nonsurgical procedures within 6 months of isotretinoin use; they were additionally asked which skin procedures could be considered safe within 6 months of isotretinoin and what dosage of isotretinoin may be considered safe when administered within 6 months of cosmetic procedure or surgery.
The major conclusions include the following:
• Dermabrasion to treat localized areas of the face while on isotretinoin or within 6 months after isotretinoin cessation is not associated with increased risks and there is no evidence in the literature that supports a need to delay treatment. Full-face dermabrasion and mechanical dermabrasion with rotary devices is not recommended within 6 months of isotretinoin use.
• There is no evidence to justify delaying treatment with hair removal lasers and lights, vascular lasers, nonablative fractional devices, and ablative fractional devices. Nonfractional treatment should generally be avoided until 6 months after completion of isotretinoin treatment.
• Superficial chemical peels can be safely administered to patients taking isotretinoin or within 6 months after isotretinoin therapy.
• Isotretinoin should be stopped before LASIK surgery because of risk of dry eyes.
• The data for incisional and excisional cutaneous surgery on isotretinoin are insufficient to make any recommendations.
Byline: Martha L. Sikes, MS, RPh, PA-C
Posted: June 28, 2017
Adapted from the original article.