Scar Revision On Accutane At A Glance
- Best Results2-6 treatments
- Treatment Recovery0-3 days
- Procedure Time10 min
- Skin SpecialistDermal therapist, Nurse
- Duration of ResultsLong lasting
- AnaestheticNil required
- Back to WorkImmediately to 2 days
- Cost$-$$
Acne Scar Treatments On Accutane / Oratane
The recent global revision of Oratane / Accutane guidelines in 2016 in peer reviewed medical journals has given the green light for most forms of scar revision whilst on Accutane. Early & effective management of acne mitigates acne scar formation. Effective treatment of early scars can reduce the requirement for more invasive surgical procedures.
FactsFacts on treating acne scarring whilst on Accutane / Oratane
- Treating acne & acne scarring simultaneously can reduce both conditions
- Patients on low dose isotretinoin can undertake most revision procedures
- Procedures allowed include focal peels, fractional & vascular lasers, microneedling & RFM in addition to Tixel resurfacing
- Early scar remodelling can reduce the requirement for surgical scar revision procedures
Why revise scars early?
Early scar remodelling can reduce the severity of acne scars. Early scars can be defined as scars less than 4 months old. Using less invasive techniques such as TIxel, vascular & fractional lasers, dermatologists can remodel & repair scars effectively.
How would I know what is the best treatment for my type of acne scars?
Your specialist will guide you if you are a suitable candidate for revision. I employ methods including the use of TCA (chemical peel) in addition to lasers & energy devices. The optional treatment depends on your scar pattern.
Red scars do best with vascular lasers. Deep ice pick scars do best with focal peels, whilst shallow atrophic scars can be treated with fractional lasers or Tixel.
A slightly acidic skin environment optimizes skin barrier function & reduces the chances of infections as a low (ish) pH is disadvantageous to pathogens
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👉What about very low pH ingredients? Some formulations such as #ascorbic acid, lactic, glycolic, salicylic, mandelic, citric, and beta hydroxy acids function best in a low pH formulation as this increases bioavailability & skin penetration. Not an issue for most skin types, but maybe an issue for those with compromised skin barrier function- namely acne, rosacea, dermatitis-eczema patients.
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👉What about higher pH products? Fortunately the days of alkaline washes/cleansers/soaps are limited. Mainstream brands such as La Roche Posay, Paula’s Choice & CeraVe have cleansers ranging between pH 5.1 to 5.4.
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😎Davin Lim
Dermatologist
Brisbane/Sydney🇦🇺
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#skincare #skincarescience #skinscience #dermaltherapy #dermatology
#healthyskin #skinhealth #drdavinlim #davinlim #dermatoloigstsydney #brisbanedermatology
Picosecond fractional resurfacing with Picosure Pro, 2 sessions spaced 4 weeks apart
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👉Indication: Pigment in all skin types. Our pilot study suggests that off label picosecond laser in the 755 wavelength, delivered in full beam to select spots & high powered fractional is superior to IPL & non-ablative fractional laser resurfacing💯
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👉Cons: It’s off label. Downtime of 48+ hours (still less than 1927 Fraxel & IPL). With the marked cytokine release, I now give a short sharp application of topical CS post treatment to reduce post treatment swelling. For patients with pigment > solar dysplasia, I prefer pico to thulium lasers (& TCA-Jesser peels). The Picosure Pro by #Cynosure is really that good👍🏻
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😎Davin Lim
Dermatologist
Brisbane/Sydney🇦🇺
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#picosure #skinscience #dermatology #picosurepro #picolasers #skinrejuvenation
#drdavinlim #davinlim #dermatoloigstsydney #brisbanedermatology
What treatments are not indicated for patients on Isotretinoin - Accutane - Oratane?
The JAMA guidelines state the fully ablative laser resurfacing & segmental or global deep peels do not have enough safety data in the context of concurrent use with oral isotretinoin. On this basis I do not perform these procedures whilst on isotretinoin. In most cases I give patients a 3 month ‘wash out’ period before deep resurfacing.
Note: Fully ablative laser resurfacing is vastly different from fractional laser resurfacing. The former treats all of the skin’s surface, whist in the context of scar revision, fractional laser treats 3-20% of surface area. The same applies to deep focal peels, compared to segmental peels.
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What dose of Roaccutane/ Oratane/ Isotretinoin is considered safe for scar revision procedures?
Whilst an absolute ‘safe dose’ has not been globally defined, most laser & procedural dermatologist would be comfortable with doses ranging from 0.1 to 0.5 mg per kg. In contrast, the maximum recommended dose of Accutane – Oratane is 1 mg/kg daily.
I also base the dosing on the individual mucocuttaneous side effects, namely side effects such as thinning or fragile skin surfaces. I also take into consideration location of scars, age, family history & ethnicity. These factors all have bearing on the safety profile of procedures.
What if I am not on Accutane / Oratane?
Most cases of acne can be treated with antibiotics retinoids, & simple washes. Female patients who experience flare-ups with their period cycle can benefit from hormonal control such as the oral contraceptive pill.
For patients who are these medications, there are no restrictions regarding scar revision procedures.
The caveat is that if you still have low level grumbling acne, your scar revision journey may not be optimal. This is because your body’s immune system is fighting nearby inflammation, distracting the cells to repair scars.
How many scar revision treatments will I require?
Most patients will benefit from a series of 2-4 sessions, depending on the age, severity, & location of acne scars. In the context of concurrent acne & scar management, treatments are minimally invasive.
For established scars longer than 4 months in duration, other procedures maybe optimal, based upon your acne scar type.
How soon will I see results?
Most patients will see results within 4-6 weeks. Scar remodelling takes time, however follow up photographs will show an improvement. Acne activity will decrease over this time period as well.
As protocol we take photographs of all patients, and follow up these photographs during each visit- this way you can see your progress over time!
How much improvement can I expect to see with early management of acne scars?
Remember, there are two issues we are dealing with- acne & acne scarring. Active acne can be effectively treated in over 98% of cases. Depending on acne severity your dermatologist will employ different methods to treat your condition, minimise scars and keep your acne in remission. Your improvement depends largely on compliance.
How much your acne scars improve depends on many factors including the type of scar your exhibit, your medical history, your skin type (skin colour) but most importantly your immune system’s ability to remodel scars.
Are scar revision procedures painful?
Revision treatments are well tolerated. Devices like vascular laser have in-built cooling systems. With other treatments such as fractional lasers or micro needling we use numbing cream prior to any procedure.
How do I book for an appointment to get my acne and my scars treated?
For mild acne scarring, my clinical team of nurses & dermal therapists can assist. They are trained in all non-surgical aspects of scar revision including TCA, microneedling, MRF / microneedling radio frequency, CO2 lasers, non-ablative lasers, pico lasers, vascular lasers, dermal toning lasers & fractional Tixel.
For objectively severe acne scars, please book an appointment to see me for an assessment.
What are objectively severe scars? A good guide is to have a friend or relative assess your scars (not what you see). If scars are highly visible at conversational distances, in normal lighting, chances are you have significant scarring. My work is primarily focused on objectively severe scars. I have no interest in the management of Body Dysmorphic Disorders.
Davin’s Viewpoint on early management of acne scars
The current method of acne management is less than ideal for many patients, especially those who exhibit scarring & active acne. Mainstream management is to treat acne, then revise scars or ignore them. Suboptimal for patients!
With the event of isotretinoin revisions based upon recent (2015-16) papers, the majority of scar revision procedures are allowed. These procedures have been deemed as ‘safe’ in patients on Accutane-Oratane.
Laser revision with vascular devices are quick, painless & not associated with any significant downtime. Ideal for red acne scars, & early scarring.
For contour changes, the use of fractional devices, microneedling, microneedling RF, TCA focal application & surgical revision are deemed safe. The two procedures I do not conduct without a wash out from isotretinoin include fully ablative deep resurfacing & segmental – global medium to deep chemical peels.
The most important factor in scar revision is to control your acne, this often means total remission, especially if you have the propensity to scar. Seek a medical opinion as to the correct procedures for you.
