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Chemabrasion after treating acne with isotretinoin allowed normal healing

Normal wound healing was observed after manual chemabrasion of facial areas in patients with acne scars who had undergone oral isotretinoin treatment 1 to 3 months earlier, according to study results.

Researchers in Brazil evaluated 10 patients (mean age, 20.6 years; six males) with depressed facial scars who had completed oral isotretinoin treatment 1 month and 5 days to 3 months earlier. Fitzpatrick skin types ranged from 2 to 5; eight patients were white, one was black and one was Asian. Patients’ entire faces were treated with a medium-depth chemical peel of Jessner solution combined with 35% trichloroacetic acid. Manual sandpaper dermabrasion (numbers 100, 150, 180 and 220 sequentially) was performed to scarred areas until bloody dew resulted. At 6 months follow-up, reepithelization was conducted.

Normal cicatrization was observed in all patients; researchers rated depressed acne scar revisions as satisfactory. Seven days after chemabrasion, all patients showed complete reepithelization of the ablated areas, with five patients exhibiting moderate or intense erythema. The patients were treated with topical corticosteroid 3 to 5 times weekly for 3 to 6 weeks. Two patients developed postinflammatory hyperpigmentation on the edges of the treated area at day 30 and were assigned triple combination cream. There was no indication of hypertrophic scars or keloids at 90 and 180 days, and complete resolution and satisfactory results of depressed acne scar revision were observed on day 180.

“The long-lasting metabolite 4-oxo-isotretinoin disappears from the bloodstream 2 weeks after drug discontinuation,” the researchers said. “Therefore, because there is no evidence from population, case-control or cohort studies, it is our opinion that the management of acne scars may be initiated 1 month after oral isotretinoin use.”

“Other studies are necessary to reevaluate the current recommendation of a 6- to 12-month waiting period after oral isotretinoin treatment before performing dermabrasion or fractional ablative laser for acne scar revision.”