QWhat do you tell your patients about microneedling while on isotretinoin?

A
Richard Winkelmann, DO

Richard Winkelmann, DO

Director for Dermatology and Mohs Surgery
Optum Care
Los Angeles, CA

The package insert for a common form of isotretinoin states “Do not have cosmetic procedures to smooth your skin, including waxing, dermabrasion, or laser procedures, while you are using Accutane and for at least 6 months after you stop.”1 This recommendation stems from case reports in the 1980s and 1990s that reported scarring with invasive cosmetic procedures in patients on oral isotretinoin and in-vitro studies demonstrating delated wound healing.2 The  consideration to reduce potential for scarring was subsequently included in major dermatology textbooks and has been followed by practitioners for over two decades. However, in recent years, dermatologists contend this dogma stating there is little evidence to support the increased stated risk.2,3

The evidence for scarring risk and oral isotretinoin is limited to studies in a small number of patients, or isolated case reports of an inadequate number of procedures that were mostly aggressive procedures or conducted with early generation laser devices. There is now strong evidence that there is little risk for scarring from superficial, minimally invasive cosmetic interventions like chemical peels, microneedling, and microdermabrasion.2 By consensus, ablative measures like full face CO2 laser resurfacing and dermabrasion are not recommended until after six months of discontinuation of oral isotretinoin.

Patients ask me frequently about how to address acne scarring while on isotretinoin therapy. I believe there is modest improvement of scarring from oral isotretinoin due to increased collagen formation. Although I generally recommend waiting until after finishing a course of isotretinoin, if the patient is very motivated, I do approve a trial of superficial chemical peels and/or microneedling by an experienced practitioner. I will recommend waiting the full 6 months following therapy before trying fractionated or fully ablative CO2 lasers and other more invasive interventions.

References:

  1. Accutane package insert. Roche Laboratories Inc. 2008
  2. Waldman et al. Dermatol Surg. 2017
  3. Mysore et al. J Cutan Aesthet Surg. 2017