Dermatol Surg. 2026 Jul 7. doi: 10.1097/DSS.0000000000005260. Online ahead of print.
ABSTRACT
BACKGROUND: Procedures have traditionally been delayed 6 to 12 months after isotretinoin because of concerns about abnormal scarring; evidence for fractional ablative CO2 laser is limited in higher Fitzpatrick skin types.
OBJECTIVE: To assess the safety and effectiveness of ablative fractional CO2 laser (AFCL) for atrophic acne scars during and after oral isotretinoin.
METHODS: This was a single-center retrospective cohort of 106 patients (188 AFCL sessions) grouped as concurrent isotretinoin, ≤90 days since discontinuation, 91 to 180 days, or >180 days (control). Outcomes included abnormal scarring, delayed re-epithelialization (>14 days), postinflammatory hyperpigmentation (PIH) at 1 and 3 months, and scar-score change. Overall group comparisons and adjusted patient-level and session-level models were performed.
RESULTS: Abnormal scarring occurred in 3/106 patients (2.8%) with no significant between-group difference (p = .762). Delayed re-epithelialization >14 days occurred in 11/106 patients (10.4%) and was numerically highest in the concurrent isotretinoin group (6/31 [19.4%]); however, the overall four-group comparison was not significant (p = .243), and concurrent isotretinoin was not statistically significant in an adjusted session-level generalized estimating equation model (OR: 4.79, 95% confidence interval: 0.79-29.13; p = .089). PIH at 3 months was higher in the ≤90-day group versus controls (adjusted OR: 6.03, 95% confidence interval: 1.55-23.52; p = .010). Concurrent isotretinoin was not associated with increased PIH or abnormal scarring. Higher density predicted delayed re-epithelialization.
CONCLUSION: AFCL during low-dose isotretinoin or within 6 months after isotretinoin discontinuation was not associated with increased abnormal scarring. Because delayed re-epithelialization was numerically more frequent during concurrent isotretinoin and density was associated with slower healing, conservative density selection and careful counseling remain appropriate. PIH risk was elevated when treatment occurred within 90 days after discontinuation.
PMID:42430738 | DOI:10.1097/DSS.0000000000005260
