Isotretinoin and Wound Healing

Should isotretinoin be stopped prior to surgery to prevent complications with wound healing? This is the question researchers C.I. Wootton, et al, set out answer in their critical appraisal of pre-operative isotretionoin use that was published in the February 2014 issue of the British Journal of Dermatology.

In total, 16 case reports and cohort studies were reviewed. The procedures undergone by patients using isotretioin included rhinoplasty, wisdom tooth extraction, chemical peels, laser resurfacing or hair removal, and otolaryngological surgery. The case reports and studies often presented conflicting data--in one study, patients who began istotretinoin following rhinoplasty experienced complications, even though they were not on the medication prior to surgery; while others showed no significant increase in post-surgery complications.

The researchers noted that the small number of patients undergoing surgery while on isotretinoin led to under-powered studies. In the few larger studies, the risk of poor wound healing in this patient group was “relatively small or absent,” they write. In addition, the majority of surgeries reviewed involved the face or mouth, making it difficult to provide a recommendation for surgical wounds on other parts of the body.

Based on the evidence uncovered, Wootton and colleagues chose to stop isotretinoin usage prior to surgery in the cases that the medication is not essential to the patient’s health, but were unable to provide a clear recommendation in regard to post-surgical risks.