Isotretinoin is a vitamin A derivative and can affect many parts of the skin including the epidermis, sebaceous gland, and even collagen formation. The diverse affects of isotretinoin on wound healing have generated a long debate about whether patients who use isotretinoin are more likely to have poor wound healing or worse yet – develop a keloid or hypertrophic scar – if they undergo surgery or a procedure on the skin.
In fact, the US FDA advises against patients having laser resurfacing procedures within 6 months of use of isotretinoin.
The general recommendations to avoid surgical procedures have been called into question by various experts around the world in the last few years.
Tattooing in the Eyebrow Region in FFA
It appears that tattooing in the eyebrow area is likely to be safe in patients with FFA who use low doses of isotretinoin (under 10 mg daily). One should be aware that large scale studied have not been conducted in FFA but certainly we have had many stable patients on low doses of isotretinoin undergo various tattooing procedures without issue.
For those who question the safety, a thorough review of two articles would be advised:
Spring et al, 2017
In 2017 a panel of experts (Spring et al 2017) put forth recommendations on the safety of isotretinoin in various dermatological procedures. Thirty-two relevant publications reported outcomes of 1485 procedures. Overall, the authors concluded that “there was insufficient evidence to support delaying manual dermabrasion, superficial chemical peels, cutaneous surgery, laser hair removal, and fractional ablative and nonablative laser procedures for patients currently receiving or having recently completed isotretinoin therapy. Based on the available literature, mechanical dermabrasion and fully ablative laser are not recommended in the setting of systemic isotretinoin treatment” (Source: Spring et al 2017).
Mysore et al, 2017
In 2017, the Association of Cutaneous Surgeons of India also put forth a recommendation “that microneedling and microdermabrasion treatment can safely be performed in patients administered with isotretinoin”. The level of evidence was 2+ (backed up by well conducted case control studies or cohort studies) and the grade of the recommendation was given a C rating.
The formal view of the Association of Cutaneous Surgeons of India was that “there is insufficient evidence to support the current protocol of avoiding and delaying treatments in the patient group under consideration and recommends that the current practice should be discontinued. The task force concludes 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.
