Skip to main content

Advertisement

SpringerLink
Log in

Is It Safe to Operate on Patients Taking Isotretinoin?

  • Original Article
  • Experimental/Special Topics
  • Published:
Aesthetic Plastic Surgery Aims and scope Submit manuscript

Abstract

Background

Oral isotretinoin is increasingly being used to treat acne and other dermatological conditions. The number of patients who take isotretinoin and wish or need to undergo plastic surgery may be following a similar pattern. Although skin healing is an important concern in the case of patients who use isotretinoin, it is definitely not the only relevant issue when planning surgical intervention.

Methods

Eleven important points regarding surgery safety in patients taking oral isotretinoin were defined. A literature search of the PubMed database was conducted by employing the keywords isotretinoin OR 13-cis-retinoic acid. This returned the largest possible number of studies about isotretinoin.

Results

Forty-seven studies matched the selection criteria. Most animal experimental models suggested that isotretinoin at doses commonly used to treat acne is not detrimental to wound healing. Human studies are controversial. However, healing of skeletal muscle could be at increased risk of necrosis.

Conclusions

Association between isotretinoin and problematic skin healing after surgery is being challenged. Also, recommended time between discontinuation of isotretinoin and surgery should be reviewed. While muscle flaps may be endangered in patients taking isotretinoin, healing of other tissues and systemic effects that could compromise surgery safety are rare or detectable before surgery.

Level of Evidence V

This journal requires that the authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Wysowski DK, Swann J, Vega A (2002) Use of isotretinoin (Accutane) in the United States:rapid increase from 1992 through 2000. J Am Acad Dermatol 46(4):505–509

    Article  PubMed  Google Scholar 

  2. Ellis CN, Krach KJ (2001) Uses and complications of isotretinoin therapy. J Am Acad Dermatol 45(5):S150–S157

    Article  CAS  PubMed  Google Scholar 

  3. Rademaker M (2013) Isotretinoin: dose duration and relapse. What does 30 years of usage tell us? Australas J Dermatol 54(3):157–162

    Article  PubMed  Google Scholar 

  4. Katz BE, MacFarlane DF (1994) A typical facial scarring after isotretinoin therapy in a patient with previous dermabrasion. J Am Acad Dermatol 30(5 Pt 2):852–853

    Article  CAS  PubMed  Google Scholar 

  5. Ginarte M, Peteiro C, Toribio J (1999) Keloid formation induced by isotretinoin therapy. Int J Dermatol 38(3):228–229

    Article  CAS  PubMed  Google Scholar 

  6. Dogan G (2006) Possible isotretinoin-induced keloids in a patient with Behçet’s disease. Clin Ex Dermatol 31(4):535–537

    Article  CAS  Google Scholar 

  7. Bagatin E, Guadanhim LR, Yarak S, Kamamoto CS, Almeida FA (2010) Dermabrasion for acne scars during treatment with oral isotretinoin. Dermatol Surg 36(4):483–489

    Article  CAS  PubMed  Google Scholar 

  8. Roenigk HH, Pinski JB, Robinson JK (1985) Acne, retinoids, and dermabrasion. J Dermatol Surg Oncol 11(4):396–398

    Article  PubMed  Google Scholar 

  9. Larson DL, Flugstad NA, O’Connor E, Kluesner KA, Plaza JA (2012) Does systemic isotretinoin inhibit healing in a porcine wound model? Aesthet Surg J 32(8):989–998

    Article  PubMed  Google Scholar 

  10. Abdelmalek M, Spencer J (2006) Retinoids and wound healing. Dermatol Surg 32(10):1219–1230

    CAS  PubMed  Google Scholar 

  11. Wiegand U, Chou RC (1998) Pharmacokinetics of oral isotretinoin. J Am Acad Dermatol 39(2 Pt 3):S8–S12

    Article  CAS  PubMed  Google Scholar 

  12. GrØnhØj Larsen F, Jakobsen P, GrØnhØj Larsen C, Heidenheim M, Held E, Nielsen-Kudsk F (2009) The metabolism and pharmacokinetics of isotretinoin in patients with acne and rosacea are not influenced by ethanol. Br J Dermatol 161(3):664–670

    Article  PubMed  Google Scholar 

  13. Lee SM, Kim HM, Lee JS, Yoon CS, Park MS, Park KI, Namgung R, Lee C (2009) A case of suspected isotretinoin-induced malformation in a baby of a mother who became pregnant one month after discontinuation of the drug. Yonsei Med J 50(3):445–447

    Article  PubMed Central  PubMed  Google Scholar 

  14. Bécherel PA, Mossalayi MD, LeGoff L, Francès C, Chosidow O, Debré P, Arock M (1994) Mechanism of anti-inflammatory action of retinoids on keratinocytes. Lancet 344(8936):1570–1571

    Article  PubMed  Google Scholar 

  15. Gencoglan G, Tosun M, Gencoglan O (2010) Isotretinoin-induced effects of mast cells on wound healing. J Drugs Dermatol 9(10):1207–1210

    PubMed  Google Scholar 

  16. Fong EP, Chie LT, Tan WTL (1999) Keloids: time to dispel the myths? Plast Reconstr Surg 104(4):1199–1202

    Article  CAS  PubMed  Google Scholar 

  17. Zouboulis CC (2006) Isotretinoin revisited: pluripotent effects on human sebaceous gland cells. J Invest Dermatol 126(10):2154–2155

    Article  CAS  PubMed  Google Scholar 

  18. Frosch PJ, Czarnetzki BM (1989) Effect of retinoids on wound healing in diabetic rats. Arch Dermatol Res 281(6):424–426

    Article  CAS  PubMed  Google Scholar 

  19. Moy RL, Moy LS, Bennet RG (1990) Systemic isotretinoin: effects on dermal wound healing in a rabbit model in vivo. J Dermatol Surg Oncol 16(12):1142–1146

    Article  CAS  PubMed  Google Scholar 

  20. Dzubow LM, Miller WH (1987) The effect of 13-cis-retinoic acid on wound healing in dogs. J Dermatol Surg Oncol 13(3):265–268

    Article  CAS  PubMed  Google Scholar 

  21. Arboleda B, Cruz NI (1990) The effect of systemic isotretinoin on wound contraction in guinea pigs. Plast Reconstr Surg 83(1):118–121

    Article  Google Scholar 

  22. On SC, Zeichner J (2013) Isotretinoin updates. Dermatol Ther 26(5):377–389

    Article  PubMed  Google Scholar 

  23. Hillmer MP, Macleod SM (2002) Experimental keloid scar models: a review of methodological issues. J Cutan Med Surg 6(4):354–359

    Article  CAS  PubMed  Google Scholar 

  24. Hochman B, Vilas Bôas FC, Mariano M, Ferreira LM (2005) Keloid heterograft in the hamster (Mesocricetus auratus) cheeck pouch. Brazil Acta Cir Bras 20(3):200–212

    Article  PubMed  Google Scholar 

  25. Köse O, Waseem A (2008) Keloids and hypertrophic scars: are they two different sides of the same coin? Dermatol Surg 34(3):336–346

    PubMed  Google Scholar 

  26. Aksoy MH, Vargel I, Canter IH, Erk Y, Sargon M, Pinar A, Tezel GG (2002) A new experimental hypertrophic scar model in guinea pigs. Aesthet Plast Surg 26(5):388–396

    Article  Google Scholar 

  27. Rubenstein R, Roenigk H, Stegman SJ (1986) Atypical keloids after dermabrasion of patients taking isotretinoin. J Am Acad Dermatol 15(2 Pt 1):280–285

    Article  CAS  PubMed  Google Scholar 

  28. Dunkin CS, Pleat JM, Gillespie PH, Tyler MP, Roberts AH, McGrouther DA (2007) Scarring occurs at a critical depth of skin injury: precise measurement in a graduated dermal scratch in human volunteers. Plast Reconstr Surg 119(6):1722–1732

    Article  CAS  PubMed  Google Scholar 

  29. Wooton CI, Cartwright RP, Manning P, Williams HC (2014) Should isotretinoin be stopped prior to surgery? A critically appraised topic. Br J Dermatol 170(2):239–244

    Article  Google Scholar 

  30. Allen BC, Rhee JS (2005) Complications associated with isotretinoin use after rhinoplasty. Aesthetic Plast Surg 29(20):102–106

    Article  PubMed  Google Scholar 

  31. Bergoli RD, Chagas Júnior OL, Souza CE, Vogt BF, Oliveira HT, Etges A, Silva DN (2011) Isotretinoin effect on alveolar repair after exodontia–a study in rats. Oral Maxillofac Surg 15(2):85–92

    Article  PubMed  Google Scholar 

  32. Oliveira HT, Bergoli RD, Hirsch WD, Chagas OL Jr, Heitz C, Silva DN (2013) Isotretinoin effect on the repair of bone defects - a study in rat calvaria. J Craniomaxillofac Surg 41(7):581–585

    Article  PubMed  Google Scholar 

  33. Sharma J, Thiboutot DM, Zaenglein AL (2012) The effects of isotretinoin on wisdom tooth extraction. J Am Acad Dermatol 67(4):794–795

    Article  CAS  PubMed  Google Scholar 

  34. DiGiovanna JJ (2001) Isotretinoin effects on bone. J Am Acad Dermatol 45(5):S176–S182

    Article  CAS  PubMed  Google Scholar 

  35. Novick NL, Lawson W, Schwartz IS (1984) Bilateral nasal bone osteophytosis associated with short-term oral isotretinoin therapy forcystic acne vulgaris. Am J Med 77(4):736–739

    Article  CAS  PubMed  Google Scholar 

  36. Landau M, Mesterman R, Ophir J, Mevorah B, Alcalay J, Harel A, Nevo Y (2001) Clinical significance of markedly elevated serum creatine kinase levels in patients with acne on isotretinoin. Acta Derm Venereol 81(5):350–352

    Article  CAS  PubMed  Google Scholar 

  37. Kaymak Y (2008) Creatine phosphokinase values during isotretinoin treatment for acne. Int J Dermatol 47(4):398–401

    Article  CAS  PubMed  Google Scholar 

  38. Guttman-Yassky E, Hayek T, Muchnik L, Bergman R (2003) Acute rhabdomyolysis and myoglobinuria associated with isotretinoin treatment. Int J Dermatol 42(6):499–500

    Article  CAS  PubMed  Google Scholar 

  39. Hartung B, Merk HF, Huckenbeck W, Daldrup T, Neuen-Jacob E, Ritz-Timme S (2012) Severe generalised rhabdomyolysis with fatal outcome associated with isotretinoin. Int J Legal Med 126(6):953–956

    Article  PubMed  Google Scholar 

  40. Coto-Segura P, Galache C, Santos-Juanes J, Mallo-García S, Curto-Iglesias JR (2008) Transient thrombocytopenia probably induced by isotretinoin. Actas Dermosifiliogr 99(9):743–744

    Article  CAS  PubMed  Google Scholar 

  41. Moeller KE, Touma SC (2003) Prolonged thrombocytopenia associated with isotretinoin. Ann Pharmacother 37(11):1622–1624

    Article  PubMed  Google Scholar 

  42. Ataseven A, Bilgin U (2014) Effects of isotretinoin on the platelet counts and the mean platelet volume in patients with acne vulgaris. ScientificWorldJournal 29(2014):156464. doi:10.1155/2014/156464

    Google Scholar 

  43. Jansen T, Altmeyer P (2000) Thrombocytosis induced by low-dose isotretinoin. Int J Dermatol 39(12):956–957

    Article  CAS  PubMed  Google Scholar 

  44. Kaptanoglu AF, Uncu M, Ozyurt S, Hincal E (2013) Effect of isotretinoin on prothrombin time (PT), international normalized ratio (INR), and activated partial thromboplastin time (aPTT). J Dermatolog Treat 24(4):272–274

    Article  CAS  PubMed  Google Scholar 

  45. Fiallo P (2004) Reduced therapeutic activity of warfarin during treatment with oral isotretinoin. Br J Dermatol 150(1):164

    Article  CAS  PubMed  Google Scholar 

  46. Armaly Z, Haj S, Bowirrat A, Alhaj M, Jabbour A, Fahoum Y, Abassi Z (2013) Acute kidney injury following isotretinoin treatment. Am J Case Rep 27(14):554–556. doi:10.12659/AJCR.889693

    Google Scholar 

  47. Schaier M, Lehrke I, Schade K, Morath C, Shimizu F, Kawachi H, Gröne HJ, Ritz E, Wagner J (2001) Isotretinoin alleviates renal damage in rat chronic glomerulonephritis. Kidney Int 60(6):2222–2234

    Article  CAS  PubMed  Google Scholar 

  48. Kiss E, Adams J, Gröne HJ, Wagner J (2003) Isotretinoin ameliorates renal damage in experimental acute renal allograft rejection. Transplantation 76(3):480–489

    Article  CAS  PubMed  Google Scholar 

  49. Dresden G (2007) Atrial tachycardia associated with isotretinoin use. Arch Dermatol 143(8):1084–1085

    Article  PubMed  Google Scholar 

  50. Selcoki Y, Gorpelioglu C, Turgut F, Sarifakioglu E, Ozkara A, Tekin O, Kanbay M, Akcay A (2008) Isotretinoin: is there any arrhythmic effect? Int J Dermatol 47(2):195–197

    Article  PubMed  Google Scholar 

  51. Greenstein R, Brown LSS (2012) Vitamins A & D inhibit the growth of mycobacteria in radiometric culture. PLoS One 7(1):e29631. doi:10.1371/journal.pone.0029631

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  52. Basak PY, Cetin ES, Gürses I, Ozseven AG (2013) The effects of systemic isotretinoin and antibiotic therapy on the microbial floras in patients with acne vulgaris. J Eur Acad Dermatol Venereol 27(3):332–336

    Article  CAS  PubMed  Google Scholar 

  53. Ozuguz P, Callioglu EE, Tulaci KG, Kacar SD, Balta I, Asik G, Karatas S, Karaca S (2014) Evaluation of nasal and oropharyngeal flora in patients with acne vulgaris according to treatment options. Int J Dermatol 53(11):1404–1408

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Division of Plastic Surgery, Department of Surgery and Anatomy, Ribeirão Preto Medical School, University of São Paulo, Campus Universitário S/N, 14048-900, Ribeirão Preto, SP, Brazil

    Luís Fernando Ungarelli & Cristina Marly Cunha Hetem

  2. Division of Plastic Surgery, Department of Surgery and Anatomy, Ribeirão Preto Medical School, University of São Paulo, São Paulo, Brazil

    Jayme Adriano Farina Junior

Authors
  1. Luís Fernando Ungarelli
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Cristina Marly Cunha Hetem
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Jayme Adriano Farina Junior
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Luís Fernando Ungarelli.

Ethics declarations

Conflict of interest

The authors have no financial interest to declare in relation to the content of this article.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Ungarelli, L.F., Hetem, C.M.C. & Junior, J.A.F. Is It Safe to Operate on Patients Taking Isotretinoin?. Aesth Plast Surg 40, 139–148 (2016). https://doi.org/10.1007/s00266-015-0588-3

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00266-015-0588-3

Keywords

Search

Navigation