Concurrent Isotretinoin-Fractional Radiofrequency Treatment Outperforms Delayed FRF Therapy 6 Months After ITN Cessation

In patients with acne scarring, concurrent treatment with isotretinoin and fractional radiofrequency (FRF) significantly outperformed delayed treatment with FRF 6 months after stopping use of isotretinoin, according to a clinical report published in Lasers in Surgery and Medicine.¹

Researchers reported that concurrent treatment led to significant reductions in acne scar volume from baseline versus patients receiving monotherapy.

Image Credit: © Budimir Jevtic - stock.adobe.com

Background and Methods

While oral isotretinoin is an effective treatment for acne, scarring poses a considerable therapeutic challenge. FRF has emerged as a promising modality for managing acne scars with minimal downtime, generating tissue thermolysis, promoting collagen synthesis, and facilitating dermal remodeling.²

Historically, a conventional approach advocated delaying scar treatment until at least 6 months post-isotretinoin cessation. However, recent analyses, including that of the American Society for Dermatologic Surgery (ASDS), have questioned the validity of this practice.³

In this current, prospective, randomized, controlled, comparative clinical study, researchers sought to evaluate the safety and efficacy of concurrent isotretinoin-FRF treatment for acne scars. The primary outcome measures included scar reduction and assessment of delayed healing parameters such as edema, erythema, crusting, pain, and postinflammatory hyperpigmentation.

Forty-two patients with moderate to severe acne were enrolled in the study, meeting inclusion criteria of a minimum of 2 months on isotretinoin therapy. Patients were randomized into 1 of 3 treatment cohorts: concurrent isotretinoin-FRF treatment, isotretinoin monotherapy without FRF, and delayed FRF post-isotretinoin cessation.

Various assessments were performed, including high-definition digital photography, three-dimensional imaging, dermatology life quality index (DLQI) questionnaire, and subjective efficacy assessments.

Findings

Thirty-eight patients completed the study, with the isotretinoin-FRF cohort demonstrating superior reduction in acne scar volume compared to the delayed FRF and isotretinoin monotherapy cohorts. Cosmesis was significantly improved in the isotretinoin-FRF cohort, as evidenced by lower Echelle d'Evaluation Clinique des Cicatrices d'Acne (ECCA) scores and higher investigator scores.

Patient satisfaction and DLQI improvements were also notably higher in the concurrent isotretinoin-FRF group.

Transient erythema, edema, and crusting were common adverse effects reported in both FRF-receiving cohorts, with slightly longer downtimes observed in the concurrent isotretinoin-FRF group. However, no serious adverse events were reported, and all resolved without intervention.

Conclusions

The study findings support the efficacy and safety of concurrent isotretinoin-FRF treatment for acne scars, challenging previous recommendations to delay scar treatment post-isotretinoin therapy.

Limitations of the study include its limited sample size, which included patients exclusively of Fitzpatrick skin types II or III. Additionally, the use of photography assessments may have impacted findings, making the potential for a lack of objectivity a concern.

These results contribute to existing literature on combined therapeutic modalities for acne and its sequelae, emphasizing the importance of tailored, multidimensional treatment approaches in dermatological practice, according to study authors Gallo et al.

"This prospective study supports the ASDS' conclusion negating previous dogma to delay procedures by at least 6 months post-[isotretinoin] therapy," they wrote. "Concurrent [isotretinoin] and FRF is safe and effective in minimizing acne scars with significant patient satisfaction and minimal side effects."

References

1. Gallo ES, Katz U, Artzi O. Fractional radiofrequency and oral isotretinoin—A prospective randomized controlled split-face trial comparing concurrent versus delayed fractional radiofrequency treatment for acne scars. Lasers Surg Med. Published online June 18, 2024. https://doi.org/10.1002/lsm.23811
2. Kim JE, Lee HW, Kim JK, et al. Objective evaluation of the clinical efficacy of fractional radiofrequency treatment for acne scars and enlarged pores in Asian skin. Dermatol Surg. 40, no. 9 (September 2014): 988–995, https://doi.org/10.1097/01.DSS.0000452625.0188
3. Waldman A, Bolotin D, Arndt KA, et al. ASDS guidelines task force: Consensus recommendations regarding the safety of lasers, dermabrasion, chemical peels, energy devices, and skin surgery during and after isotretinoin use. Dermatol Surg. 43, no. 10 (October 2017): 1249–1262, https://doi.org/10.1097/DSS.0000000000001166.