Abigail Waldman1, Diana Bolotin, Kenneth A Arndt, Jeffrey S Dover, Roy G Geronemus, Anne Chapas, Sanjana Iyengar, Suzanne L Kilmer, Andrew C Krakowski, Naomi Lawrence, Heidi B Prather, Thomas E Rohrer, Bethanee J Schlosser, John Y S Kim, Peter R Shumaker, Leah K Spring, Murad Alam. 1. *Department of Dermatology, Northwestern University, Chicago, Illinois; †Department of Dermatology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts; ‡Section of Dermatology, University of Chicago Medicine, Chicago, Illinois; §SkinCare Physicians, Chestnut Hill, Massachusetts; ‖Laser & Skin Surgery Center of New York, New York, New York; ¶Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York, New York; #Union Square Laser Dermatology, New York, New York; **Laser and Skin Surgery Center of Northern California, Sacramento, California; ††Department of Dermatology, University of California Davis School of Medicine, Davis, California; ‡‡Department of Dermatology, University of California San Diego Health System, San Diego, California; §§DermOne, LLC, West Conshohocken, Pennsylvania; ‖‖Division of Dermatology, Section of Procedural Dermatology, Cooper University Health Care, Marlton, New Jersey; ¶¶Westlake Dermatology and Cosmetic Surgery, Austin, Texas; ##Division of Plastic Surgery, Feinberg School of Medicine, Northwestern University, Chicago, Illinois; ***Department of Dermatology, Naval Medical Center, San Diego, California; †††Department of Dermatology, Naval Hospital Camp Lejeune, Camp Lejeune, North Carolina; Departments of ‡‡‡Otolaryngology, and §§§Surgery, Feinberg School of Medicine, Northwestern University, Chicago, Illinois.
Abstract
BACKGROUND: Currently, the isotretinoin (13-cis-retinoic acid) package insert contains language advising the discontinuation of isotretinoin for 6 months before performing cosmetic procedures, including waxing, dermabrasion, chemical peels, laser procedures, or incisional and excisional cold-steel surgery. It is common practice to follow this standard because of concerns regarding reports of sporadic adverse events and increased risk of scarring. OBJECTIVE: To develop expert consensus regarding the safety of skin procedures, including resurfacing, energy device treatments, and incisional and excisional procedures, in the setting of concurrent or recent isotretinoin use. MATERIALS AND METHODS: The American Society for Dermatologic Surgery authorized a task force of content experts to review the evidence and provide guidance. First, data were extracted from the literature. This was followed by a clinical question review, a consensus Delphi process, and validation of the results by peer review. RESULTS: The task force concluded that there is insufficient evidence to justify delaying treatment with superficial chemical peels and nonablative lasers, including hair removal lasers and lights, vascular lasers, and nonablative fractional devices for patients currently or recently exposed to isotretinoin. Superficial and focal dermabrasion may also be safe when performed by a well-trained clinician.
BACKGROUND: Currently, the isotretinoin (13-cis-retinoic acid) package insert contains language advising the discontinuation of isotretinoin for 6 months before performing cosmetic procedures, including waxing, dermabrasion, chemical peels, laser procedures, or incisional and excisional cold-steel surgery. It is common practice to follow this standard because of concerns regarding reports of sporadic adverse events and increased risk of scarring. OBJECTIVE: To develop expert consensus regarding the safety of skin procedures, including resurfacing, energy device treatments, and incisional and excisional procedures, in the setting of concurrent or recent isotretinoin use. MATERIALS AND METHODS: The American Society for Dermatologic Surgery authorized a task force of content experts to review the evidence and provide guidance. First, data were extracted from the literature. This was followed by a clinical question review, a consensus Delphi process, and validation of the results by peer review. RESULTS: The task force concluded that there is insufficient evidence to justify delaying treatment with superficial chemical peels and nonablative lasers, including hair removal lasers and lights, vascular lasers, and nonablative fractional devices for patients currently or recently exposed to isotretinoin. Superficial and focal dermabrasion may also be safe when performed by a well-trained clinician.