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Isotretinoin and Timing of Procedural Interventions: A Systematic Review With Consensus Recommendations

IMPORTANCE: The notion that systemic isotretinoin taken within 6 to 12 months of cutaneous surgery contributes to abnormal scarring or delayed wound healing is widely taught and practiced; however, it is based on 3 small case series from the mid-1980s. OBJECTIVE: To evaluate the body of literature t... Full description

Journal Title: JAMA Dermatology 01 August 2017, Vol.153(8), pp.802-809
Main Author: Spring, Leah K
Other Authors: Krakowski, Andrew C , Alam, Murad , Bhatia, Ashish , Brauer, Jeremy , Cohen, Joel , Del Rosso, James Q , Diaz, Lucia , Dover, Jeffrey , Eichenfield, Lawrence F , Gurtner, Geoffrey C , Hanke, C. William , Jahnke, Marla N , Kelly, Kristen M , Khetarpal, Shilpi , Kinney, Megan A , Levy, Moise L , Leyden, James , Longaker, Michael T , Munavalli, Girish S , Ozog, David M , Prather, Heidi , Shumaker, Peter R , Tanzi, Elizabeth , Torres, Abel , Velez, Mara Weinstein , Waldman, Abigail B , Yan, Albert C , Zaenglein, Andrea L
Format: Electronic Article Electronic Article
Language: English
Subjects:
ID: ISSN: 2168-6068 ; E-ISSN: 2168-6084 ; DOI: 10.1001/jamadermatol.2017.2077
Link: http://dx.doi.org/10.1001/jamadermatol.2017.2077
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recordid: ama2632046
title: Isotretinoin and Timing of Procedural Interventions: A Systematic Review With Consensus Recommendations
format: Article
creator:
  • Spring, Leah K
  • Krakowski, Andrew C
  • Alam, Murad
  • Bhatia, Ashish
  • Brauer, Jeremy
  • Cohen, Joel
  • Del Rosso, James Q
  • Diaz, Lucia
  • Dover, Jeffrey
  • Eichenfield, Lawrence F
  • Gurtner, Geoffrey C
  • Hanke, C. William
  • Jahnke, Marla N
  • Kelly, Kristen M
  • Khetarpal, Shilpi
  • Kinney, Megan A
  • Levy, Moise L
  • Leyden, James
  • Longaker, Michael T
  • Munavalli, Girish S
  • Ozog, David M
  • Prather, Heidi
  • Shumaker, Peter R
  • Tanzi, Elizabeth
  • Torres, Abel
  • Velez, Mara Weinstein
  • Waldman, Abigail B
  • Yan, Albert C
  • Zaenglein, Andrea L
subjects:
  • Medicine
ispartof: JAMA Dermatology, 01 August 2017, Vol.153(8), pp.802-809
description: IMPORTANCE: The notion that systemic isotretinoin taken within 6 to 12 months of cutaneous surgery contributes to abnormal scarring or delayed wound healing is widely taught and practiced; however, it is based on 3 small case series from the mid-1980s. OBJECTIVE: To evaluate the body of literature to provide evidence-based recommendations regarding the safety of procedural interventions performed either concurrently with, or immediately following the cessation of systemic isotretinoin therapy. EVIDENCE REVIEW: A panel of national experts in pediatric dermatology, procedural/cosmetic dermatology, plastic surgery, scars, wound healing, acne, and isotretinoin was convened. A systematic PubMed review of English-language articles published from 1982 to 2017 was performed using the following search terms: isotretinoin, 13-cis-retinoic acid, Accutane, retinoids, acitretin, surgery, surgical, laser, ablative laser, nonablative laser, laser hair removal, chemical peel, dermabrasion, wound healing, safety, scarring, hypertrophic scar, and keloid. Evidence was graded, and expert consensus was obtained. FINDINGS: Thirty-two relevant publications reported 1485 procedures. There was insufficient evidence to support delaying manual dermabrasion, superficial chemical peels, cutaneous surgery, laser hair removal, and fractional ablative and nonablative laser procedures for patients currently receiving or having recently completed isotretinoin therapy. Based on the available literature, mechanical dermabrasion and fully ablative laser are not recommended in the setting of systemic isotretinoin treatment. CONCLUSIONS AND RELEVANCE: Physicians and patients may have an evidence-based discussion regarding the known risk of cutaneous surgical procedures in the setting of systemic isotretinoin therapy. For some patients and some conditions, an informed decision may lead to earlier and potentially more effective interventions.
language: eng
source:
identifier: ISSN: 2168-6068 ; E-ISSN: 2168-6084 ; DOI: 10.1001/jamadermatol.2017.2077
fulltext: fulltext
issn:
  • 2168-6068
  • 21686068
  • 2168-6084
  • 21686084
url: Link


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titleIsotretinoin and Timing of Procedural Interventions: A Systematic Review With Consensus Recommendations
creatorSpring, Leah K ; Krakowski, Andrew C ; Alam, Murad ; Bhatia, Ashish ; Brauer, Jeremy ; Cohen, Joel ; Del Rosso, James Q ; Diaz, Lucia ; Dover, Jeffrey ; Eichenfield, Lawrence F ; Gurtner, Geoffrey C ; Hanke, C. William ; Jahnke, Marla N ; Kelly, Kristen M ; Khetarpal, Shilpi ; Kinney, Megan A ; Levy, Moise L ; Leyden, James ; Longaker, Michael T ; Munavalli, Girish S ; Ozog, David M ; Prather, Heidi ; Shumaker, Peter R ; Tanzi, Elizabeth ; Torres, Abel ; Velez, Mara Weinstein ; Waldman, Abigail B ; Yan, Albert C ; Zaenglein, Andrea L
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descriptionIMPORTANCE: The notion that systemic isotretinoin taken within 6 to 12 months of cutaneous surgery contributes to abnormal scarring or delayed wound healing is widely taught and practiced; however, it is based on 3 small case series from the mid-1980s. OBJECTIVE: To evaluate the body of literature to provide evidence-based recommendations regarding the safety of procedural interventions performed either concurrently with, or immediately following the cessation of systemic isotretinoin therapy. EVIDENCE REVIEW: A panel of national experts in pediatric dermatology, procedural/cosmetic dermatology, plastic surgery, scars, wound healing, acne, and isotretinoin was convened. A systematic PubMed review of English-language articles published from 1982 to 2017 was performed using the following search terms: isotretinoin, 13-cis-retinoic acid, Accutane, retinoids, acitretin, surgery, surgical, laser, ablative laser, nonablative laser, laser hair removal, chemical peel, dermabrasion, wound healing, safety, scarring, hypertrophic scar, and keloid. Evidence was graded, and expert consensus was obtained. FINDINGS: Thirty-two relevant publications reported 1485 procedures. There was insufficient evidence to support delaying manual dermabrasion, superficial chemical peels, cutaneous surgery, laser hair removal, and fractional ablative and nonablative laser procedures for patients currently receiving or having recently completed isotretinoin therapy. Based on the available literature, mechanical dermabrasion and fully ablative laser are not recommended in the setting of systemic isotretinoin treatment. CONCLUSIONS AND RELEVANCE: Physicians and patients may have an evidence-based discussion regarding the known risk of cutaneous surgical procedures in the setting of systemic isotretinoin therapy. For some patients and some conditions, an informed decision may lead to earlier and potentially more effective interventions.
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titleIsotretinoin and Timing of Procedural Interventions: A Systematic Review With Consensus Recommendations
description

IMPORTANCE: The notion that systemic isotretinoin taken within 6 to 12 months of cutaneous surgery contributes to abnormal scarring or delayed wound healing is widely taught and practiced; however, it is based on 3 small case series from the mid-1980s. OBJECTIVE: To evaluate the body of literature to provide evidence-based recommendations regarding the safety of procedural interventions performed either concurrently with, or immediately following the cessation of systemic isotretinoin therapy. EVIDENCE REVIEW: A panel of national experts in pediatric dermatology, procedural/cosmetic dermatology, plastic surgery, scars, wound healing, acne, and isotretinoin was convened. A systematic PubMed review of English-language articles published from 1982 to 2017 was performed using the following search terms: isotretinoin, 13-cis-retinoic acid, Accutane, retinoids, acitretin, surgery, surgical, laser, ablative laser, nonablative laser, laser hair removal, chemical peel, dermabrasion, wound healing, safety, scarring, hypertrophic scar, and keloid. Evidence was graded, and expert consensus was obtained. FINDINGS: Thirty-two relevant publications reported 1485 procedures. There was insufficient evidence to support delaying manual dermabrasion, superficial chemical peels, cutaneous surgery, laser hair removal, and fractional ablative and nonablative laser procedures for patients currently receiving or having recently completed isotretinoin therapy. Based on the available literature, mechanical dermabrasion and fully ablative laser are not recommended in the setting of systemic isotretinoin treatment. CONCLUSIONS AND RELEVANCE: Physicians and patients may have an evidence-based discussion regarding the known risk of cutaneous surgical procedures in the setting of systemic isotretinoin therapy. For some patients and some conditions, an informed decision may lead to earlier and potentially more effective interventions.

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abstract

IMPORTANCE: The notion that systemic isotretinoin taken within 6 to 12 months of cutaneous surgery contributes to abnormal scarring or delayed wound healing is widely taught and practiced; however, it is based on 3 small case series from the mid-1980s. OBJECTIVE: To evaluate the body of literature to provide evidence-based recommendations regarding the safety of procedural interventions performed either concurrently with, or immediately following the cessation of systemic isotretinoin therapy. EVIDENCE REVIEW: A panel of national experts in pediatric dermatology, procedural/cosmetic dermatology, plastic surgery, scars, wound healing, acne, and isotretinoin was convened. A systematic PubMed review of English-language articles published from 1982 to 2017 was performed using the following search terms: isotretinoin, 13-cis-retinoic acid, Accutane, retinoids, acitretin, surgery, surgical, laser, ablative laser, nonablative laser, laser hair removal, chemical peel, dermabrasion, wound healing, safety, scarring, hypertrophic scar, and keloid. Evidence was graded, and expert consensus was obtained. FINDINGS: Thirty-two relevant publications reported 1485 procedures. There was insufficient evidence to support delaying manual dermabrasion, superficial chemical peels, cutaneous surgery, laser hair removal, and fractional ablative and nonablative laser procedures for patients currently receiving or having recently completed isotretinoin therapy. Based on the available literature, mechanical dermabrasion and fully ablative laser are not recommended in the setting of systemic isotretinoin treatment. CONCLUSIONS AND RELEVANCE: Physicians and patients may have an evidence-based discussion regarding the known risk of cutaneous surgical procedures in the setting of systemic isotretinoin therapy. For some patients and some conditions, an informed decision may lead to earlier and potentially more effective interventions.

pubAmerican Medical Association
doi10.1001/jamadermatol.2017.2077
date2017-08-01