Isotretinoin and skin procedures: new recommendations

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A new report says there is insufficient evidence to support delaying certain procedures in patients who are or were recently receiving systemic isotretinoin.

Traditionally systemic isotretinoin taken within six to 12 months of cutaneous surgery has been thought to contribute to abnormal scarring or delayed wound healing. However, experts are now suggesting that this may not be the case.

The authors of a new set of consensus recommendations published in JAMA Dermatology , have argued that such previously prohibited procedures may be offered to patients when accompanied by an evidence-based discussion of the risks and benefits of the procedure.

The recommendations were developed by a panel of dermatology and plastic surgery experts following a review of 32 relevant publications reporting 1,485 procedures. The authors said, based on the literature, there is insufficient evidence to support delaying procedures such as cutaneous surgery, fractional ablative and nonablative laser procedures, and manual dermabrasion, for patients currently receiving or having recently completed isotretinoin therapy. However, mechanical dermabrasion and fully ablative laser procedures are not currently recommended.

The authors say the information contained in their recommendations will allow physicians to “have an evidence-based discussion with patients regarding the known risk of cutaneous surgical procedures in the setting of systemic isotretinoin treatment”. They add, “for some patients and some conditions, an informed decision may lead to earlier and potentially more effective interventions”.

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