Isotretinoin Use during Chemical Skin Resurfacing: A Review of Complications

Introduction: There is a great deal of concern when it comes to resurfacing the skin of patients who have recently taken or are taking isotretinoin. Much of the concern arises from reports of abnormal and keloidal scarring postdermabrasion, Argon laser, and pulsed dye laser. This study was designed to retrospectively evaluate the complication rate of patients undergoing chemical resurfacing within 2 years of taking isotretinoin and to see if timing of the medication and depth of peel correlated. Materials and Methods: This is a retrospective chart review of 91 patients (14 men, 77 women) who had 123 peels documented. Patients were assigned to 1 of the following 4 groups based on the timing of isotretinoin use to the chemical peel: prepeel, perioperative, pre- and postpeel, and postoperative. Complications, isotretinoin dose, patient age and race, peel depth, and presence of keloids before surgery were recorded. Results: A total of 123 peels were documented in 91 patients: 51 prepeel, 13 perioperative, 22 pre- and postpeel, and 37 postoperative. The complications recorded were prolonged erythema (0.8%), atrophic scarring (0.8%), altered texture (0.8%), delayed healing (3.25%), and hypertrophic scarring (2.44%). Delayed healing was observed only in patients taking isotretinoin before or at the time of surgery. Two of 3 patients who developed hypertrophic scarring had taken isotretinoin during the postoperative stage. Discussion: Although previous case reports suggest a correlation between isotretinoin use and abnormal or keloidal scarring after dermabrasion, Argon laser, and pulsed dye laser, the occurrence of hypertrophic scarring remained low in the chemical-peel group of patients. We suggest avoiding isotretinoin for 3 months preoperatively and delaying postoperative use of isotretinoin until dermal regeneration is complete (3 months). Further studies are needed to determine if the use of refrigerants in dermabrasion and the heat generated by lasers cause temperature alterations that predispose to scarring in patients taking isotretinoin.