Sorry to hear that you are suffering from Post-Inflammatory Erythema (PIE). Post-Inflammatory Erythema resents as localized skin redness following any type of skin inflammation, and may progress to scarring. Facial Post-Inflammatory Erythema improves with time, but very slowly, and in some cases, complete clearance of Post-Inflammatory Erythema cannot be achieved. Acne erythema should be understood as a scar with erythematous components and not as a simple erythematous or vascular lesion.
Low dose isotretinoin (Accutane) is increasingly being used for acne. Many patients on isotretinoin also have scars and marks from previous acne. It is best to start scarring treatment early, but there remains some concern with abnormal scarring while on isotretinoin.
Can you do lasers while on low dose Accutane?
It is safe to proceed with lasers while on low dose Isotretinoin.
Previously, patients on isotretinoin were told to wait until six months after stopping isotretinoin had passed, 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.
The mainstay of treatment for Post-Inflammatory Erythema are energy based devices such as:
• Long pulsed light or laser therapy such as Intense Pulsed Light (IPL) with vascular filters, or vascular lasers such as Yellow Laser, Pulsed Dye Laser, Quasi/Long Pulsed Nd:YAG Laser, 940nm Diode Laser, long pulsed KTP Laser - these work by targeting the haemoglobin inside skin blood vessels. The laser energy is absorbed and converted into heat causing the vessels to shrink and close up, improving the redness.
• Fractional Resurfacing treatments such as Fractional Radiofrequency, Fractional Lasers, Fractional Microneedling Radiofrequency. These target water and can produce photothermal damage to deeper dermal vasculature as well as potential anti-inflammatory and anti-angiogenetic properties.
I own and use both Long Pulsed and Fractional devices. Personally, I prefer to use Fractional Resurfacing treatments as they improve concomitant scarring or active acne often present in patients with PIE. Long Pulsed Lasers do however have advantages in having less downtime.
In my practice, I would not hesitate to begin treatments on patients taking low dose isotretinoin. In fact, I often start patients on treatments and low dose isotretinoin at the same time. If you have excessive dryness from isotretinoin, it could possibly slow down recovery from the peeling phase of the fractional laser but in my opinion, that is a minor effect.
Do discuss with a doctor who will be able to share more with you on their personal experience treating Post-Inflammatory Erythema in patients taking low-dose isotretinoin for acne.
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 controlled 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.
6. Minu L. Mathew et al. Intense Pulsed Light Therapy for Acne-induced Post-inflammatory Erythema. Indian Dermatol Online J. 2018 May-Jun; 9(3): 159–164.
7. Yoon-Soo Cindy Bae-Harboe et al. Easy as PIE (Postinflammatory Erythema). J Clin Aesthet Dermatol. 2013 Sep; 6(9): 46–47.
8. Park KY et al. Comparison of fractional, nonablative, 1550-nm laser and 595-nm pulsed dye laser for the treatment of facial erythema resulting from acne: a split-face, evaluator-blinded, randomized pilot study. J Cosmet Laser Ther. 2014 Jun;16(3):120-3.
9. Glaich, A. S. et al. Fractional Photothermolysis for the Treatment of Postinflammatory Erythema Resulting from Acne Vulgaris. Dermatologic Surgery, 33(7), 842–846.
10. Min S et al. Fractional Microneedling Radiofrequency Treatment for Acne-related Post-inflammatory Erythema. Acta Derm Venereol. 2016 Jan;96(1):87-91.
