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Accutane scarring healing. Will Accutane Remove Acne Scars? |
- Accutane scarring healing
The association between isotretinoin and atypical wound healing remains controversial. It is common practice to delay elective procedures for 6 to 24 months after oral isotretinoin therapy. The studies supporting common practices SCP recommend extending this period to include the 6 to 24 months preceding treatment.
The opposing studies challenging common practices; CCP state that the rate of scarring in isotretinoin patients is low and that delaying elective procedures is unnecessary. These practices impact a large number of dermatology patients undergoing acne treatment. This systematic review compiled articles obtained from online databases and examined data from both SCP and CCP studies. The inconsistencies in the reported data and the methodological flaws in the literature preclude any firm conclusions that can resolve the controversy.
As such, this review demonstrates that there is insufficient evidence to either corroborate or refute delaying elective procedures in isotretinoin acne patients. Although the recent literature trends toward removing the procedural delay, we advocate for clinicians to consider the research presented in this review in the context of their own clinical experience and each individual patient's situation.
The possible negative procedural outcomes must be weighed against the severity of the patient's acne scarring and the psychosocial impact of this scarring on the patient.
Keywords: atypical wound healing; isotretinoin; keloid; procedures; scarring. Abstract The association between isotretinoin and atypical wound healing remains controversial. Publication types Review Systematic Review.
Substances Dermatologic Agents Isotretinoin.
Accutane scarring healing -
Well, this is a very relevant question because research shows that the earlier one starts his or her acne scar treatment, the easier the scar tissue is to remodel, and the better the outcome though even old acne scars can be improved.
Or can you start your treatment even earlier after finishing your Accutane treatment? What is Accutane? How does Accutane work? Are there any side effects? Isotretinoin is sold under the brand name Accutane and Roaccutane among others and is a form of vitamin A.
As you might already know, acne is a skin condition that occurs when your oil glands sebaceous glands and hair follicles of the skin become clogged with oil sebum and dead skin cells keratin.
It often causes whiteheads, blackheads, and pimples, and usually appears on the face, forehead, chest, upper back and shoulders. When the oil glands get clogged, inflammation occurs in the skin which appears as a red pimple that hurts when it is touched. Basically, Accutane has an immense effect on the oil glands by reducing the size of the oil glands, cell shedding and the stickiness of cells in the glands.
And the result…? That is a reduction in acne activity with fewer whiteheads, blackheads, and pimples. YES, the best thing about Accutane is that it prevents acne scarring because it is highly effective in clearing up acne. For me, as a laser and acne scar specialist, there is no doubt that isotretinoin e.
Acne can cause a lot of mental stress and last for years. In my opinion, as a specialist, prescribing Accutane for my patients is not only a question about the severity of the skin disease but also a question about the mental stress which acne causes to the patient.
In most patients, the side effects are so mild e. If otherwise, the side effects are intolerable, then simply discontinue the medication. No harm done! Well, that would be an exaggeration in my eyes so say that Accutane is dangerous! Just think of it this way: Why would doctors all over the world prescribe isotretinoin Accutane for millions of acne patients each year if it was so dangerous [ ref ]?
Personally, I have prescribed Accutane for several hundreds of my patients during my career as an acne scar specialist. And of course, side effects do occur once in a while. Although not all of these side effects may occur, if they do occur and if they are not to endure during the entire course of therapy, then simply stop taking the medicine! The most frequently occurring adverse events are listed below:. Frequent side effects:. However, Accutane is not compatible with pregnancy, because Accutane can lead to birth defects, just as alcohol and other forms of medication can.
Hence, a woman in the childbearing years should be aware to use an appropriate birth control method for 1 month before therapy begins, during the entire course of therapy, and for 2 full months after therapy stops. Pregnancy tests should be taken every month during the entire course of treatment. Usually, oral isotretinoin should be taken until it clears acne.
This corresponds to a daily dosage of mg during the course of some months. Part 2: Isotretinoin and Timing of Procedural Interventions. You might ask yourself why early procedural intervention, e. The well-known result of moderately to severely inflammatory acne is disfiguring, life-altering scarring, which should be treated as soon as possible. Hence, patients with acne scarring experience both physical and mental sequelae of acne scarring [ ref ].
There is even evidence that supports a better cosmetic outcome when treating acne scars early on. The fact is that laser intervention at an early state simply provides more controlled scarring as evidenced in a randomized split-wound trial where one-half of surgical scars were treated with a fraction laser and significantly improved both wound healing and cosmetic outcome as shown in the photo below [ ref ].
For years it has inappropriately been taught and practiced that acne scar revision has to be delayed at least months after finishing a course of isotretinoin e.
This practice was based on 3 very small case series including only some few patients from the mids in other words, the evidence was very weak. Therefore, a panel of independent dermatologists and plastic surgeons set up to investigate the evidence gathered since the s.
This was published in two systematic reviews in [ 1 ] [ 2 ] including a total of procedures. The conclusion was crystal clear that there was insufficient evidence to support delaying laser treatment of acne scars in patients currently receiving or who have recently completed isotretinoin therapy.
The investigated procedures included fractional CO2 laser treatment, other fractional ablative laser procedures as well as non-ablative laser procedures. Hence, these procedures can be performed in patients currently receiving or who have recently completed isotretinoin therapy without any increased risk of adverse events.
Nevertheless, it will take years for the old dogma to fade out of clinical practice, and at many centers around the world the old dogma is still practiced even this day today.
There are many case series and 1 randomized clinical trial demonstrating normal wound healing after treatment with ablative and nonablative fractional lasers in patients receiving systemic isotretinoin. For instance, in a randomized study 60 patients were treated with a non-ablative fractionated laser for acne scarring. Half of the patients were treated while taking isotretinoin and the other half of the patients had completed a course of isotretinoin treatment more than 6 months prior.
There was no difference in either the recovery process or the final cosmetic improvement between the 2 groups. Table 1 below summarizes the available literature regarding early procedural intervention with ablative and non-ablative lasers. Basically, all the literature supports early procedural intervention such as acne scar revision with fractional CO2 laser [ ref ].
In other words, the evidence supporting acne scar revision in patients currently receiving or who have recently completed isotretinoin therapy is much stronger than the few small cases series from the mids which inappropriately have formed the foundation for delayed acne scar revision since then. The panel of independent dermatologists and plastic surgeons also investigated the literature regarding other procedures and concluded that neither was there any evidence to support delayed procedural intervention with manual dermabrasion, superficial chemical peels, cutaneous surgery, nor laser hair removal.
There are many different kinds of lasers that can be used to treat and improve acne scars. The figure below shows the difference between a fully-ablative non-fractional laser leftnon-ablative fractional laser middle and an ablative fractional laser right. However, the evidence is currently insufficient to support the use of a fully-ablative laser in patients currently receiving or who have recently completed isotretinoin therapy.
Planning to have your acne scars managed, you should look for a skilled acne scar specialist who has a variety of methods rather than which lasers he uses.
There are a lot of good lasers out there which can all improve acne scars. The important thing is how the lasers are used by the specialist rather than the laser itself. My approach is unique in that way that I always use the best methods for each individual acne scar. My first step when I consult a patient in my clinic who suffers from acne scars is to analyze the skin and identify the acne scar type of each individual acne scar.
This is done in tangential lighting. When I have performed my initial skin analysis of each individual acne scar, mapping and photographing the scars are done. This is the foundation for the planning of the acne scar revision program which I tailor for each individual patient. I rarely use only a single method to manage all acne scars in a patient, since most patients have a variety of different acne scar types including enlarged pores, ice pick scars, boxcar scars, rolling scars, tethered scars, etc.
Hence, different methods are matched to each individual acne scar type to achieve the highest possible cure rate, and each individual acne scar has to be individually managed. My approach is to treat the most obvious and deepest acne scars first. These are the acne scars which the patient typically is most anxious about. Combining different methods is necessary when treating deep acne scars including TCA cross for enlarged pores, ice pick scars and narrow boxcar scars; subcision for tethered and anchored rolling scars and boxcar scars; and punch excision for wide boxcar scars and very deep ice pick scars.
When the deep acne scars have been managed, the final step is to treat the superficial acne scars. This can be done with a laser, e. Most of these methods can be done in the same session to achieve results within a reasonable time horizon. As mentioned earlier, I always tailor an individual acne scar revision program to each individual patient. A program might last between months and sometimes longerbut typically between months. Norddigesvej 4, 1st floor Risskov, Denmark, DK.
What is isotretinoin and how does it work? Does Accutane really prevent acne scarring? Should I take isotretinoin? Accutane or Roaccutane for Acne. Though an increase in liver enzymes and lipids might occur, that is usually not any worse than the increase that occurs after consumption of a beer or two. How long is a course of Isotretinoin Accutane or Roaccutane?
Why should you start you acne scar revision early on? Severe acne scarring can be avoided when relevant treatment is given early on. Please note, that the left side t was treated with a fractional laser while the right side c was not treated at all. The bottom picture shows the result several weeks after the laser treatment. The treated t side healed much better than the untreated side c. When can I start acne scar revision with fractional lasers after finishing Accutane treatment?
What is the evidence behind early procedural intervention with fractional lasers versus delayed intervention 6 months or more after finishing isotretinoin treatment? The evidence supports early acne scar revision. What other procedures can be done without an increased risk of adverse events? Which lasers can be used to manage acne scarring without delay during or after discontinuation of oral isotretinoin?
Which laser should I choose for my acne scar management? Knap about his approach. Why is my approach unique? Best Regards. Ulrik Knap, MD. E-mail: mail knapmd. Scroll to Top.
❾-50%}isotretinoin for acne (Accutane & Roaccutane).
In other words, the evidence supporting acne scar revision in patients currently receiving or who have recently completed isotretinoin therapy is much stronger than the few small cases series from the mids which inappropriately have formed the foundation for delayed acne scar revision since then. The panel of independent dermatologists and plastic surgeons also investigated the literature regarding other procedures and concluded that neither was there any evidence to support delayed procedural intervention with manual dermabrasion, superficial chemical peels, cutaneous surgery, nor laser hair removal.
There are many different kinds of lasers that can be used to treat and improve acne scars. The figure below shows the difference between a fully-ablative non-fractional laser left , non-ablative fractional laser middle and an ablative fractional laser right.
However, the evidence is currently insufficient to support the use of a fully-ablative laser in patients currently receiving or who have recently completed isotretinoin therapy. Planning to have your acne scars managed, you should look for a skilled acne scar specialist who has a variety of methods rather than which lasers he uses. There are a lot of good lasers out there which can all improve acne scars.
The important thing is how the lasers are used by the specialist rather than the laser itself. My approach is unique in that way that I always use the best methods for each individual acne scar. My first step when I consult a patient in my clinic who suffers from acne scars is to analyze the skin and identify the acne scar type of each individual acne scar.
This is done in tangential lighting. When I have performed my initial skin analysis of each individual acne scar, mapping and photographing the scars are done. This is the foundation for the planning of the acne scar revision program which I tailor for each individual patient.
I rarely use only a single method to manage all acne scars in a patient, since most patients have a variety of different acne scar types including enlarged pores, ice pick scars, boxcar scars, rolling scars, tethered scars, etc.
Hence, different methods are matched to each individual acne scar type to achieve the highest possible cure rate, and each individual acne scar has to be individually managed.
My approach is to treat the most obvious and deepest acne scars first. These are the acne scars which the patient typically is most anxious about. Combining different methods is necessary when treating deep acne scars including TCA cross for enlarged pores, ice pick scars and narrow boxcar scars; subcision for tethered and anchored rolling scars and boxcar scars; and punch excision for wide boxcar scars and very deep ice pick scars.
When the deep acne scars have been managed, the final step is to treat the superficial acne scars. This can be done with a laser, e. Most of these methods can be done in the same session to achieve results within a reasonable time horizon. As mentioned earlier, I always tailor an individual acne scar revision program to each individual patient. A program might last between months and sometimes longer , but typically between months. Norddigesvej 4, 1st floor Risskov, Denmark, DK. What is isotretinoin and how does it work?
Does Accutane really prevent acne scarring? Should I take isotretinoin? Accutane or Roaccutane for Acne. Though an increase in liver enzymes and lipids might occur, that is usually not any worse than the increase that occurs after consumption of a beer or two. How long is a course of Isotretinoin Accutane or Roaccutane? Why should you start you acne scar revision early on?
Severe acne scarring can be avoided when relevant treatment is given early on. Usually, monthly treatments are required and you will likely see excellent results. The atrophic scars on your cheeks can be treated by fractional CO2 laser to resurface the skin and improve collagen remodelling.
Both of these lasers are usually suitable for use even when you are on Accutane treatment, although your doctor will need to assess your skin closely and ascertain if they are happy to proceed as such. Other treatments such as TCA Cross or punch excision for deeper scars can also be considered, although the appropriate timing to do so will need to be discussed with your doctor further.
Hope this helps. Sorry to hear that you are suffering from acne scars. Low dose isotretinoin Accutane is increasingly being used for acne. Many patients on isotretinoin also have scarring from previous acne. It is best to start scarring treatment early, but there remains some concern with abnormal scarring while on isotretinoin. Can you undergo fractional CO2 or Infini treatment while on low dose Isotretinoin?
It is safe to proceed with fractional CO2 laser or radiofrequency microneedling while on low dose Isotretinoin. Hi Aaron — I completely agree with whatever your doctor has done. I had asked about accutane but my doctor was hesitant in prescribing to me due to my history with depression. As such, this review demonstrates that there is insufficient evidence to either corroborate or refute delaying elective procedures in isotretinoin acne patients.
Although the recent literature trends toward removing the procedural delay, we advocate for clinicians to consider the research presented in this review in the context of their own clinical experience and each individual patient's situation. The possible negative procedural outcomes must be weighed against the severity of the patient's acne scarring and the psychosocial impact of this scarring on the patient.
Keywords: atypical wound healing; isotretinoin; keloid; procedures; scarring.
A common question that we receive at the Advanced Acne Institute is whether Accutane can treat acne scars. At first this seems like a pretty straightforward question.
However, it is actually more complicated than you may think. First of all, acne sufferers think of acne scars in different ways. The discoloration left by pimples is technically referred to as post inflammatory hyperpigmentation or post inflammatory pigment alteration, in which the discoloration can be darker than the normal skin color or appear persistently reddish even after the initial pimple has healed. In the field of acne treatment, we typically refer to these different types of acne scars as boxcar scars which have a rectangular depression with fairly defined borders, and ice-pick scars which are small, deep holes in the skin or rolling scars which are areas of uneven skin surface.
Hypertrophic scars are acne scars that are raised above the skin surface. A comprehensive discussion of the different types of acne scars can be found here. One of the important considerations in answering the question whether Accutane can treat acne scars must take into consideration how each acne sufferer defines the term.
Only then can this question be answered appropriately for each individual. For example, is it the skin imperfection that is bothering them or is it the discoloration? Furthermore, red or dark discoloration often accompanies the actual physical scars. Therefore it is often necessary to tease apart the feature that is most unsettling for each patient. Is it the scar itself or is it the discoloration within the scar?
So the first objective is to develop a mutual understanding of what is meant by a scar. And then it is vital to understand whether the patient is bothered by the redness or discoloration within the scar or if it is only the skin depression or the hole within the surface of the skin or the unevenness of the skin surface.
Only after achieving common ground as to what the real concern is can a treatment plan be effectively formulated and the role of Accutane considered. To be more clear, if an acne sufferer is concerned mostly about how visible the scar is, this can often be addressed by targeting the discoloration without having to actually treat the actual scar itself.
In other words, if we use Accutane treatment to prevent new breakouts from erupting, this will prevent new spots of discoloration and allow the old marks to simply fade away with time.
The effectiveness of waiting for discoloration to fade should not be under-appreciated. In reality, the fading can occur relatively quickly and the patient can be very happy with the results. In this way, Accutane can be a very effective treatment to gain control over the troubling appearance of redness or discoloration that so often occurs within acne scars.
Another important consideration is that Accutane is the most effective way to prevent further acne scarring. That is, by preventing more breakouts, Accutane is a very effective treatment which can limit the risk of additional scars forming. This is a vital part of any treatment or discussion regarding acne scar treatment.
Once this is explained and once an acne sufferer understands that the persistent discoloration will disappear completely over time as long as we can prevent new breakouts from forming, expectations are better managed and hopefulness can be achieved once again. So in this scenario, a patient who is seeking treatment for acne scars may be best helped by explaining the difference between scars and discoloration and by further targeting what is actually the source of their frustration.
The Advanced Acne Institute is a unique dermatology practice located in Miami, Florida specializing only in the treatment of acne. We focus solely on providing the most effective treatments to help our patients achieve clear skin. We are pleased to share our insights and perspectives in acne treatment as an educational service, however this information is provided strictly for educational purposes only and should not be considered medical advice and is not a substitute for seeking the advice and treatment by an appropriate medical professional.
Acne Treatment Miami. Request Appointment Login Stopping Further Acne Scarring Another important consideration is that Accutane is the most effective way to prevent further acne scarring.
Accutane is a retinoid and retinoids can improve the appearance of scars as they cause remodelling of the skin. After you have been off Accutane for about 6. localhost › medical-answers › isotretino. The issue of treating acne scars with lasers or other forms of phototherapy while on Accutane has always been the perceived increased risk of wound healing. Official answer: Previous scarring is not improved with Isotretinoin (brand name is Accutane). Acne often gets worse around week 3 or 4. Accutane is a retinoid and retinoids can improve the appearance of scars as they cause remodelling of the skin. After you have been off Accutane for about 6. Of these patients, only 2 developed keloid scarring following argon for rosacea and pulsed dye laser treatment for a capillary malformation while taking isotretinoin. As mentioned earlier, I always tailor an individual acne scar revision program to each individual patient.The use of isotretinoin for acne is now well-established in dermatology practice, and its therapeutic effects and primary side effects are well-established.
The potential of isotretinoin impairing wound healing or inducing hypertrophic scarring has led many dermatologists to recommend avoiding laser and dermabrasion treatments during and for 6 months after isotretinoin therapy. A literature review was performed to ascertain the evidence of atypical wound healing in association with isotretinoin 19 relevant papers, including 1 randomized controlled trial and a selection of cohort studies, case series, and case reports.
The randomized controlled trial identified 3 out of 94 patients receiving isotretinoin who had surgery or healing wounds during the trial period. Of these, 2 underwent otolaryngologic surgery and stopped their isotretinoin 2 days prior to surgery. Both recovered normally. The other case reported slow wound healing but no details were provided. The other articles looking at wound healing following surgery included a case series of 3 post-rhinoplasty patients who all developed nasal tip deformities, and a case report of a patient undergoing pilonidal sinus excision without any problems with wound healing.
Six studies 25 patients included in 2 cohorts, 3 case series, 1 case report dealt with dermabrasion and isotretinoin therapy. Additionally, an addendum to one of the case series states that 2 subsequent patients, not included in the series, developed keloid scarring following dermabrasion after recent isotretinoin therapy.
Nine studies patients included in 4 cohorts, 3 case series, 2 case reports examined wound healing following laser therapy and isotretinoin use.
Of these patients, only 2 developed keloid scarring following argon for rosacea and pulsed dye laser treatment for a capillary malformation while taking isotretinoin.
Both of these cases were from individual case reports. One further retrospective cohort study of 25 patients having wisdom tooth extraction while on isotretinoin or within 3 months of treatment cessation found that 3 experienced a dry socket postoperatively.
No other complications were reported. Despite the large numbers of patients taking isotretinoin worldwide, very limited data are available regarding wound healing during or within 6 months of treatment. Of the patients assessed within the 19 studies reviewed in this paper, 15 were described as having atypical, hypertrophic, or keloidal scarring following rhinoplasty 3 , dermabrasion 9 , and laser treatment 2 , and 1 patient had delayed wound healing from an unknown cause.
Most of the complications with wound healing have been reported in case reports with a very high possibility of selection and publication bias and lack of consideration for confounding variables. The lack of high-quality clinical evidence makes it impossible to come to a firm conclusion regarding the risk of isotretinoin leading to impaired wound healing.
Given its widespread use, it is reassuring that no significant issues related to wound healing have been consistently demonstrated. Of course, the absence of evidence of harm cannot be equated with evidence of no harm. We advise patients that there is some doubt that patients taking isotretinoin will heal normally; but, the overall risk appears to be relatively small.
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