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
- 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.
- 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.
- Picosse et al. Early chemabrasion for acne scars after treatment with oral isotretinoin. Dermatol Surg. 2012 Sep;38(9):1521-6.
- 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.
- Spring et al. Isotretinoin and timing of procedural interventions: a systematic review with consensus recommendations. JAMA Dermatol. 2017;153:802–09.
