Keloid Formation and Any Skin Complications in Patients Treated With Isotretinoin and Undergone Any Skin-Related Procedures.

Background: Isotretinoin is widely used for moderate to severe acne vulgaris. Despite its broad application, isotretinoin carries a risk of permanent scarring and keloid formation following various skin procedures. As a result, a delay of at least 6-12 months after completing or discontinuing isotretinoin treatment is commonly recommended before undergoing skin procedures.

Aims: This study aims to evaluate the necessity of delaying skin procedures performed concurrently with or soon after isotretinoin treatment at different dosages in patients with acne vulgaris, based on the dermatological side effects associated with combination therapy.

Methods: A literature search was conducted using PubMed, Scopus, Web of Science, and Embase databases for original studies up until June 2023.

Results: A total of 34 eligible studies, including 1563 patients treated with isotretinoin, were reviewed to assess the timing of various skin procedures, safe dosages, and potential adverse effects, such as keloid formation and persistent hyperpigmentation which were reported in a few cases.

Conclusions: Based on our review, there is insufficient evidence to support delaying laser hair removal, ablative fractional lasers, nonablative fractional lasers, superficial to medium-depth chemical peels, manual dermabrasion, cutaneous surgeries, fractional microneedling radiofrequency, microdermabrasion, and dermaroller treatments. However, fully ablative lasers, mechanical dermabrasion, and ablative radiofrequency procedures are not recommended during isotretinoin use. Further studies are needed to establish the safety and optimal interval for these procedures. For all skin procedures, especially more aggressive and deeper ones, a lower dose of isotretinoin is recommended.