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Isotretinoin and Timing of Procedural Interventions: A Systematic Review With Consensus Recommendations
Leah K Spring1, Andrew C Krakowski2, Murad Alam3
1Dermatology Department, Naval Hospital Camp Lejeune, Camp Lejeune, North Carolina.
JAMA Dermatology
|June 29, 2017
Summary
Systemic isotretinoin therapy does not require delaying most skin procedures like lasers or peels. However, mechanical dermabrasion and fully ablative lasers are not recommended during isotretinoin treatment.
Area of Science:
- Dermatology
- Plastic Surgery
- Wound Healing
Background:
- The common practice of delaying cutaneous surgery after systemic isotretinoin is based on outdated case series.
- Current guidelines lack robust evidence to support prolonged waiting periods post-isotretinoin therapy.
Purpose of the Study:
- To evaluate the literature on procedural interventions during or after systemic isotretinoin therapy.
- To provide evidence-based recommendations for managing procedural safety in patients on isotretinoin.
Main Methods:
- Systematic PubMed review of English-language articles (1982-2017).
- Expert panel convened to grade evidence and reach consensus.
- Searched terms included isotretinoin, surgical procedures, lasers, chemical peels, and wound healing outcomes.
Main Results:
- Insufficient evidence exists to delay manual dermabrasion, superficial chemical peels, cutaneous surgery, laser hair removal, and fractional lasers.
- Mechanical dermabrasion and fully ablative lasers are not recommended with systemic isotretinoin.
Conclusions:
- Physicians and patients can have informed discussions about procedural risks with isotretinoin.
- Earlier interventions may be possible for certain patients and conditions, based on evidence.
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