FROM JAMA DERMATOLOGY
Skin procedures including superficial chemical peels, laser hair removal, minor cutaneous surgery, manual dermabrasion, and fractional ablative and fractional nonablative laser procedures can be performed safely on patients who have recently been or are currently being treated with isotretinoin, according to new recommendations from a consensus panel.
The recommendations were published online in JAMA Dermatology.
Postponing surgical procedures in patients taking isotretinoin because of the potential for keloid formation and delayed wound healing “has persisted despite increasing reports to the contrary,” wrote Leah K. Spring, DO, of Naval Hospital Camp Lejeune, Camp Lejeune, N.C., and her colleagues (JAMA Dermatol. 2017. doi: 10.1001/jamadermatol.2017.2077 ).
This protocol is based on 11 patients with delayed healing and keloids, the researchers noted. “In our consensus-based assessment, these initial cases presented a hypothesis to be tested, rather than the foundation for medical dogma on which more than 30 years of clinical practice was built,” they wrote.
To establish the current level of evidence for delaying procedures in isotretinoin patients and to make recommendations, an expert panel reviewed data from 32 publications and more than 1,485 procedures. The literature was divided into five areas: dermabrasion, chemical peels, cutaneous surgery, laser hair removal, and ablative/nonablative laser treatments.
The researchers determined that evidence does not support the safety of mechanical dermabrasion or fully ablative laser surgeries for current or recent isotretinoin users. Manual dermabrasion and microdermabrasion were deemed safe for isotretinoin patients based on the latest evidence, however, as were fractional ablative and fractional nonablative procedures.
In addition, the evidence did not support refraining from chemical peels, laser hair removal, or cutaneous surgery for current and recent isotretinoin patients, although the panel recommended additional prospective, controlled clinical trials in these areas.
In the area of cutaneous surgery, the consensus panel also noted the need for “a rigorous evaluation of the aforementioned specific warning that muscle flap insertion should be delayed until the patient displays normal [creatine phosphokinase (CPK)] levels or, at least, CPK levels below twofold of normal.”
The recommendations can be a resource for discussions with patients about the risks of procedures concurrent with isotretinoin, Dr. Spring and her associates emphasized. “For some patients and some conditions, an informed decision may lead to earlier and potentially more effective interventions.”
Lead author Dr. Spring had no relevant financial conflicts to disclose. Several members of the consensus group disclosed relationships with multiple companies including Allergan, Merz, Leo, Promius, Lumenis, Cynosure, and Valeant.