How safe is Subcision, TCA Cross or Intracel RF microneedling while on low dose Accutane?

Thank you for your question. A 2017 research has concluded that performing procedures such as laser hair removal, fractional lasers for aging and acne scarring, lasers for pigmented skin lesions, fractional radio-frequency microneedling, superficial and medium-depth peels, microdermabrasion, dermaroller, biopsies, radio-frequency ablation, and superficial excisions is safe in patients with concurrent or recent isotretinoin administration.

Of course, the risk of complications after resurfacing procedures for acne scars vary among individuals and may be different for different skin types, tone and condition.

Besides the dose of isotreitinoin you are on, it is also important to control your acne before you embark on scar treatment for better results.

Do consult a trusted doctor for more information and a review of your skin before proceeding further.

Best regards,

Dr Joanna Chan

Sorry to hear that you are suffering from severe 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.

How safe is Subcision, TCA Cross or Intracel RF microneedling while on low dose Accutane?

It is safe to proceed with subcision, TCA CROSS or RF microneedling while on low dose Accutane.

Previously, patients on isotretinoin were told to wait till 6 months after stopping isotretinoin before undergoing any elective procedures. This warning came about because 11 cases of atypical scarring in patients on isotretinoin were reported in the 1980s.

Technology and treatment protocols have come a long way since then.

Many studies have been carried out to investigate whether it is necessary to delay procedures in patients that have taken or are taking isotretinoin but did not find sufficient, compelling evidence to support the previous recommendation.

Scarring should be treated as early as possible. It is necessary to control acne concurrently, however, in my opinion, it is not necessary to wait for acne to be controlled before treating the scarring. This is especially so as some of the energy-based treatments such as fractional microneedling radiofrequency, fractional lasers, fractional radiofrequency actually help both the active acne and the scarring.

In my practice, I would not hesitate to begin scarring treatments on patients taking low dose isotretinoin. In fact, I often start patients on treatments and low dose isotretinoin at the same time.

Do discuss with a doctor who will be able to share more with you on their experience treating scarring in patients taking low dose isotretinoin.

Hope this helps!

Warmest regards,

Dr Wan Chee Kwang

References

1. Xia et al. Concomitant Use of 1,550-nm Nonablative Fractional Laser With Low-Dose Isotretinoin for the Treatment of Acne Vulgaris in Asian Patients: A Randomized Split-Face Controlled Study. Dermatol Surg. 2018 Sep;44(9):1201-1208.
2. Saluja et al. Safety of non-ablative fractional laser for acne scars within 1 month after treatment with oral isotretinoin: A randomized split-face coantrolled trial. Lasers Surg Med. 2017 Dec;49(10):886-890.
3. Picosse et al. Early chemabrasion for acne scars after treatment with oral isotretinoin. Dermatol Surg. 2012 Sep;38(9):1521-6.
4. Mahadevappa 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 Apr-Jun;9(2):106-14.
5. Spring et al. Isotretinoin and timing of procedural interventions: a systematic review with consensus recommendations. JAMA Dermatol. 2017;153:802–09.

It is safe to undergo subcision, TCA Cross or RF microneedling while on low dose isotretinoin.

There is a published paper/guidelines by the American Society for Dermatologic Surgery in October 2017 that elucidated this.

The task force concluded that it is safe to undergo superficial chemical peels, nonablative lasers, including hair removal lasers and lights, vascular lasers, and nonablative fractional devices for patients currently or recently exposed to isotretinoin.

In fact, the paper further highlighted that there are potential benefits while on isotretinoin and undergoing scar treatments. These include earlier access to scar treatments for many patients who are at high risk for further acne scarring and thereby improving patient quality of life.

In my practice, I focus on both reducing acne and treatment of scars concurrently. This usually involves a detailed assessment and review of the underlying causes of the acne, and a customised treatment plan which can include a good skincare regime and balanced diet and lifestyle, as well as topical therapy, oral medications and procedures like lasers, RF needling, subcision, TCA cross and chemical peels to treat the different types of acne scars.

This is a very good question.

The answer is: Yes. It is safe to do lasers/micro-needling/TCA while on Accutane.

The latest research published in February 2018 concluded that "a 6-month delay is not necessary for all procedures".

A US research study published in Dec 2017 proved the safety of non-ablative fractional laser 1 month after stopping Isotretinoin - "All patients demonstrated normal wound healing post NAFL treatments, and neither hypertrophic scars nor keloids were observed. Acne scar improvement was satisfactory."

This latest research supersedes the older guidelines of waiting 6 months post-accutane for Laser procedure.

This is a Game-changer because there is no longer a need to delay Acne scar Laser treatments.

Early treatments will give better final results.

Hope that this helps!

Best regards,

Dr Justin Boey

I feel the practise may depend on the doctor's risk appetite as well. For myself, at 10mg/day or 70mg/week, I would probably be most comfortable with subcision with or without fillers.

TCA Cross and intracel RF do have a superficial injury to the skin, and my personal opinion is that isotretinoin at your current dose may impact on skin recovery or increase the risk of post-inflammatory hyper pigmentation.

It's just cautious me talking.

Winston