DR ANUP KUMAR LAHIRY MD;DD CONSULTANT DERMATOLOGIST SKIN AND LASER CLINIC HYDERABAD

ISOTRETINOIN AND ABLATIVE PROCEDURES

THE FEAR: WORSENING OF HYPERTROPHIC SCARS AND KELOIDS AFTER DERMABRASION AND DISTURBANCE IN HEALING PROCESS WAS REPORTED BETWEEN 1986-1999,IN PATIENTS WHO WERE ON ISOTRETINOIN BEFORE OR DURING THE PROCEDURE.

Reports Early chemabrasion for acne scar after treatment with oral isotretinoin. Dermatol surg;2012 sep,38(9):1521-6 - NO ADVERSE AFFECT. Dermabrasion for Acne scars during treatment with oral isotretinoin. Dermatol surg;2010 apr;36(4):483-9. -NORMAL WOUND HEALING-suggested re evaluating 6 months wait for scar revision. Does systemic Isotroin inhibit healing in porcine wound model? Aesthet surg J,2012 nov;32(8):989-98. Invasive surgery might be safely performed even in the presence of recent isotretinoin therapy

FEW CASES WHO WERE ON ISOTRETINOIN,DURING OR BEFORE THE ABLATIVE PROCEDURES ,WERE FOLLOWED UP FOR MORE THAN 6 MONTHS IN THIS CASE SERIES REPORT.

Dermabrasion

Post Dermabrasion-8 months

Co2 laser ablation-Ultrapulse mode

9 Months Post laser

1 year after AFP

1 yr AFTER AFP

CROSS TECHNIQUE: BEFORE AFTER 1 ½ YRS

PATIENT CONDITION KELOID-Y/N PROCEDURE FOLLOW UP OBSERVATION 25 yrs male Post acne scarring Keloids+ Dermabrasion 8 months NO ADVERSE 23 yrs male No Co2 ablation 9 months 25 female AFP + Microdermabrasion 1 yr 27 male AFP+ chemical peel > 1yr NO ADVERS CROSS tech 1 ½ yrs ?DELAY

REASON: Idiosyncratic or individual response to Isotretinoin. Other risk factors-Genetic, Ethnicity and Anatomic area.

CONCLUSION Cumulative data needed to confirm or disprove the side effect. A metabolite of isotretinoin-4-OXO-ISOTRETINOIN IS FOUND IN BLOOD FOR 2 WEEKS, so any ablative procedure if needed could be done after a month.

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