Facial Plast Surg 2018; 34(01): 075-081
DOI: 10.1055/s-0037-1617446
Original Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Indications and Use of Isotretinoin in Facial Plastic Surgery

Markus V. Heppt*
1   Department of Dermatology and Allergy, University Hospital, LMU Munich, Munich, Germany
,
Michael C. Kirchberger*
2   Department of Dermatology, University Hospital Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg (FAU), Erlangen, Germany
,
Thomas Ruzicka
1   Department of Dermatology and Allergy, University Hospital, LMU Munich, Munich, Germany
,
Carola Berking
1   Department of Dermatology and Allergy, University Hospital, LMU Munich, Munich, Germany
,
Werner J. Heppt
3   Skin and Face Clinic, Baden-Baden, Germany
› Author Affiliations
Further Information

Publication History

Publication Date:
06 February 2018 (online)

Abstract

Isotretinoin is a first generation retinoid with pleiotropic effects on keratinocyte differentiation, proliferation, and activity of sebaceous glands. For years, there has been intense debate on whether the use of isotretinoin combined with cosmetic or surgical procedures is safe and potentially more efficient than either therapy alone. Due to delays in wound healing and keloid formation, conservative recommendations were not to combine isotretinoin with any plastic surgery or local treatment at 6 to 12 months after discontinuation of the drug. However, there is increasing evidence that a combination approach is not only safe, but may also provide excellent cosmetic outcomes in acne scars, sebaceous gland hyperplasia, and thick-skinned patients undergoing facial plastic surgery. In particular, low-dose regimens of isotretinoin may offer advantages over standard dosage treatments because of better tolerability and safety in long-term use adjunct with surgical interventions. In this article, the authors aim to summarize the current evidence on the use of isotretinoin in facial plastic surgery and to share their experience from selected patients.

* Both authors have contributed equally to this article.


 
  • References

  • 1 Amann PM, Merk HF, Baron JM. [Retinoids in dermatopharmacology]. Hautarzt 2014; 65 (02) 98-105
  • 2 Bruno NP, Beacham BE, Burnett JW. Adverse effects of isotretinoin therapy. Cutis 1984; 33 (05) 484-486, 489
  • 3 Wootton CI, Cartwright RP, Manning P, Williams HC. Should isotretinoin be stopped prior to surgery? A critically appraised topic. Br J Dermatol 2014; 170 (02) 239-244
  • 4 Sharma J, Thiboutot DM, Zaenglein AL. The effects of isotretinoin on wisdom tooth extraction. J Am Acad Dermatol 2012; 67 (04) 794-795
  • 5 Ungarelli LF, Hetem CM, Farina Junior JA. Is it safe to operate on patients taking isotretinoin?. Aesthetic Plast Surg 2016; 40 (01) 139-148
  • 6 On SC, Zeichner J. Isotretinoin updates. Dermatol Ther (Heidelb) 2013; 26 (05) 377-389
  • 7 Cobo R, Vitery L. Isotretinoin use in thick-skinned rhinoplasty patients. Facial Plast Surg 2016; 32 (06) 656-661
  • 8 Amichai B, Shemer A, Grunwald MH. Low-dose isotretinoin in the treatment of acne vulgaris. J Am Acad Dermatol 2006; 54 (04) 644-646
  • 9 Lee JW, Yoo KH, Park KY. , et al. Effectiveness of conventional, low-dose and intermittent oral isotretinoin in the treatment of acne: a randomized, controlled comparative study. Br J Dermatol 2011; 164 (06) 1369-1375
  • 10 Mehra T, Borelli C, Burgdorf W, Röcken M, Schaller M. Treatment of severe acne with low-dose isotretinoin. Acta Derm Venereol 2012; 92 (03) 247-248
  • 11 Sardana K, Garg VK. Low-dose isotretinoin in acne vulgaris: a critical review. Br J Dermatol 2011; 165 (03) 698-700
  • 12 Palmer RA, Sidhu S, Goodwin PG. ‘Microdose’ isotretinoin. Br J Dermatol 2000; 143 (01) 205-206
  • 13 Sehgal VN, Srivastava G, Aggarwal AK, Sardana K, Jain M. Efficacy of isotretinoin in pityriasis rubra pilaris: unapproved use. Int J Dermatol 2006; 45 (10) 1238-1240
  • 14 Sehgal VN, Srivastava G, Sardana K. Isotretinoin--unapproved indications/uses and dosage: a physician's reference. Int J Dermatol 2006; 45 (06) 772-777
  • 15 Warren EW, Khanderia U. Use of retinoids in the treatment of psoriasis. Clin Pharm 1989; 8 (05) 344-351
  • 16 Segurado-Miravalles G, Camacho-Martínez FM, Arias-Santiago S. , et al. Epidemiology, clinical presentation and therapeutic approach in a multicentre series of dissecting cellulitis of the scalp. J Eur Acad Dermatol Venereol 2017; 31 (04) e199-e200
  • 17 Tietze JK, Heppt MV, von Preußen A. , et al. Oral isotretinoin as the most effective treatment in folliculitis decalvans: a retrospective comparison of different treatment regimens in 28 patients. J Eur Acad Dermatol Venereol 2015; 29 (09) 1816-1821
  • 18 Bjellerup M, Wallengren J. Familial perifolliculitis capitis abscedens et suffodiens in two brothers successfully treated with isotretinoin. J Am Acad Dermatol 1990; 23 (4 Pt 1): 752-753
  • 19 Rademaker M. Isotretinoin: dose, duration and relapse. What does 30 years of usage tell us?. Australas J Dermatol 2013; 54 (03) 157-162
  • 20 Kar BR, Tripathy S, Panda M. Comparative study of oral isotretinoin versus oral isotretinoin + 20% salicylic acid peel in the treatment of active acne. J Cutan Aesthet Surg 2013; 6 (04) 204-208
  • 21 Picosse FR, Yarak S, Cabral NC, Bagatin E. Early chemabrasion for acne scars after treatment with oral isotretinoin. Dermatol Surg 2012; 38 (09) 1521-1526
  • 22 Hernandez-Perez E, Khawaja HA, Alvarez TY. Oral isotretinoin as part of the treatment of cutaneous aging. Dermatol Surg 2000; 26 (07) 649-652
  • 23 Mahadevappa OH, Mysore V, Viswanath V. , et al. Surgical outcome in patients taking concomitant or recent intake of oral isotretinoin: a multicentric Study-ISO-AIMS Study. J Cutan Aesthet Surg 2016; 9 (02) 106-114
  • 24 Spring LK, Krakowski AC, Alam M. , et al. Isotretinoin and timing of procedural interventions: a systematic review with consensus recommendations. JAMA Dermatol 2017; 153 (08) 802-809
  • 25 Waldman A, Bolotin D, Arndt KA. , et al. ASDS guidelines task force: consensus recommendations regarding the safety of lasers, dermabrasion, chemical peels, energy devices, and skin surgery during and after isotretinoin use. Dermatol Surg 2017; 43 (10) 1249-1262
  • 26 Saluja SS, Walker ML, Summers EM, Tristani-Firouzi P, Smart DR. Safety of non-ablative fractional laser for acne scars within 1 month after treatment with oral isotretinoin: a randomized split-face controlled trial. Lasers Surg Med 2017
  • 27 Yoon JH, Park EJ, Kwon IH. , et al. Concomitant use of an infrared fractional laser with low-dose isotretinoin for the treatment of acne and acne scars. J Dermatolog Treat 2014; 25 (02) 142-146
  • 28 Bernestein LJ, Geronemus RG. Keloid formation with the 585-nm pulsed dye laser during isotretinoin treatment. Arch Dermatol 1997; 133 (01) 111-112
  • 29 Khatri KA, Iqbal N, Bhawan J. Laser skin resurfacing during isotretinoin therapy. Dermatol Surg 2015; 41 (06) 758-759
  • 30 Kim HW, Chang SE, Kim JE, Ko JY, Ro YS. The safe delivery of fractional ablative carbon dioxide laser treatment for acne scars in Asian patients receiving oral isotretinoin. Dermatol Surg 2014; 40 (12) 1361-1366
  • 31 Noh S, Shin JU, Jung JY, Lee JH. A case of sebaceous hyperplasia maintained on low-dose isotretinoin after carbon dioxide laser treatment. Int J Dermatol 2014; 53 (02) e151-e153
  • 32 Park HC, Kim EJ, Kim JE, Ro YS, Ko JY. Treatment of multiple eccrine hidrocystomas with isotretinoin followed by carbon dioxide laser. J Dermatol 2013; 40 (05) 414-415
  • 33 Roenigk Jr HH, Pinski JB, Robinson JK, Hanke CW. Acne, retinoids, and dermabrasion. J Dermatol Surg Oncol 1985; 11 (04) 396-398
  • 34 Rubenstein R, Roenigk Jr HH, Stegman SJ, Hanke CW. Atypical keloids after dermabrasion of patients taking isotretinoin. J Am Acad Dermatol 1986; 15 (2 Pt 1): 280-285
  • 35 Zachariae H. Delayed wound healing and keloid formation following argon laser treatment or dermabrasion during isotretinoin treatment. Br J Dermatol 1988; 118 (05) 703-706
  • 36 Katz BE, Mac Farlane DF. Atypical facial scarring after isotretinoin therapy in a patient with previous dermabrasion. J Am Acad Dermatol 1994; 30 (5 Pt 2): 852-853
  • 37 Bagatin E, dos Santos Guadanhim LR, Yarak S, Kamamoto CS, de Almeida FA. Dermabrasion for acne scars during treatment with oral isotretinoin. Dermatol Surg 2010; 36 (04) 483-489
  • 38 Jansen T, Plewig G. Clinical and histological variants of rhinophyma, including nonsurgical treatment modalities. Facial Plast Surg 1998; 14 (04) 241-253
  • 39 Allen BC, Rhee JS. Complications associated with isotretinoin use after rhinoplasty. Aesthetic Plast Surg 2005; 29 (02) 102-106
  • 40 Guyuron B, Lee M. An effective algorithm for management of noses with thick skin. Aesthetic Plast Surg 2017; 41 (02) 381-387
  • 41 Fiallo P. Reduced therapeutic activity of warfarin during treatment with oral isotretinoin. Br J Dermatol 2004; 150 (01) 164
  • 42 Ostlere LS, Langtry JA, Jones S, Staughton RC. Reduced therapeutic effect of warfarin caused by etretinate. Br J Dermatol 1991; 124 (05) 505
  • 43 DiGiovanna JJ. Isotretinoin effects on bone. J Am Acad Dermatol 2001; 45 (05) S176-S182
  • 44 Trauner MA, Ruben BS. Isotretinoin induced rhabdomyolysis? A case report. Dermatol Online J 1999; 5 (02) 2
  • 45 Kaymak Y. Creatine phosphokinase values during isotretinoin treatment for acne. Int J Dermatol 2008; 47 (04) 398-401
  • 46 Layton A. The use of isotretinoin in acne. Dermatoendocrinol 2009; 1 (03) 162-169