A pilot study has successfully challenged the current non-evidenced medical recommendation that patients with acne scars should wait six to12 months after completion of oral isotretinoin treatment before the safe initiation of nonablative fractional laser resurfacing.
“The current recommendation is gleaned from case reports of poor healing and atypical scarring in patients treated with dermabrasion who were taking or who recently took oral isotretinoin,” says principal investigator Sandeep Saluja, M.D., a dermatology resident at the University of Utah in Salt Lake City. “It is important to note, however, that these reports date back to the 1980s and 1990s, and none of these reports include the more recently introduced 1550 nm nonablative fractional laser [NAFL] technology.”
Dr. Saluja was inspired to undertake the study last year while treating an 18-year-old patient with severe acne. After completing a course of oral isotretinoin, the patient’s main concern was the lingering acne scarring, especially as she was starting college in the fall. “Even though I knew she would be a great candidate for laser resurfacing, all I could tell her was that my hands are tied, given the current recommendation,” Dr. Saluja says.
All 10 study patients had mild-to-moderate acne scars and had recently finished a course of oral isotretinoin therapy (with a total cumulative dose of at least 120 mg/kg). Within one month of completing their last isotretinoin dose, patients began the first of three NAFL treatments, spaced four weeks apart.
The randomized split-face controlled trial, in which one side of the face was treated with laser and the other side received no treatment, evaluated the safety of NAFL treatment for acne scars within one month after completion of isotretinoin therapy.
The Fraxel DUAL laser system (Solta Medical) was employed at a fluence between 35 to 40 mJ/microthermal zone, along with treatment coverage of 20 to 35%, with total energies of 2-3 kilojoules delivered per session.