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ORLANDO, Fla. — For decades, patient package inserts for oral isotretinoin, the gold standard of treatment for severe acne, have advised that people avoid undergoing facial resurfacing treatments, including laser treatments, for at least 6 months after stopping the drug. 

The advice arose from concerns that this might increase the risk of scarring and delayed healing if lasers were used in combination. Dermatologists, in turn, worried about the legal risk of ignoring the advice and using lasers sooner. But many have since come to see waiting as unnecessary.

In 2017, the American Society for Dermatologic Surgery published a consensus statement concluding that there is insufficient evidence supporting the packaging recommendation and that nonablative lasers and fractional devices can be safely used in patients taking isotretinoin or who have recently stopped treatment. Further, a 2024 randomized prospective split-face trial found that concurrent treatment with isotretinoin and fractional ablative carbon dioxide laser was associated with better scar outcomes than when laser therapy was delayed until 6 months after stopping isotretinoin. 

At the recent American Society for Laser Medicine and Surgery (ASLMS) 2025 Annual Meeting, presenters offered additional evidence for the safe concurrent use of lasers and medications, including isotretinoin. Importantly, the studies enrolled people with darker skin tones, for whom laser procedures carry special concerns about hyperpigmentation, hypopigmentation, or worsening of scarring.

Timothy Holland, DO, dermatology resident at the Naval Medical Center San Diego, San Diego, presented a small case study of three patients with Fitzpatrick skin types IV-VI, who were taking between 60 mg and 80 mg isotretinoin per day. Each underwent a series of four laser treatments for acne scars over 4 months during treatment. Laser treatment was administered on only one side of the face using a 1565-nm nonablative fractional laser.

“We used conservative treatment settings, and these were increased in a stepwise approach at every month of follow-up,” Holland said at the conference. Primary endpoints were new or worsening hyper- or hypopigmentation and scarring or worsening of existing scars. 

“Our results were great,” Holland said. “We did not see any adverse events for the treated side compared to the control side, and each patient described at least some improvement over isotretinoin.”

In an interview with Medscape Medical News, Holland explained that the results not only add to evidence supporting concurrent isotretinoin and laser treatment in patients of color but also help address a timing issue often seen in the military. “We have active-duty patients who might be at this duty station for a year but will deploy the next year and may not have access to a dermatologist. They would like us to start treating their acne scarring while they can,” he said.

Commenting at the conference about Holland’s study, David Goldberg, MD, JD, of the Icahn School of Medicine at Mount Sinai in New York City, said the results reflected a consensus. “Dr Khatri showed us almost 20 years ago that you can safely use an [810-nm diode] laser hair removal system within a month of stopping isotretinoin or even while they were on it,” he said, referring to a 2006 paper by Khalil Khatri, MD, New Hampshire–based dermatologist. “The evidence is there for all these nonablative devices, which is really what [Holland] showed.” 

Goldberg, who is also a lawyer, cautioned that in the event of a complication resulting in a lawsuit, plaintiff’s attorneys may cite the package inserts for isotretinoin. Nonetheless, he said, “you will have no trouble finding an expert who will defend the fact that you used such a device because everybody’s doing this.”

At the conference, Goldberg, too, presented evidence supporting the concurrent use of a laser treatment — in this case, a 1726-nm laser designed to treat acne — in people taking medications for moderate to severe acne. In that study, 125 patients aged 15-35 years (60% women) with Fitzpatrick skin types I-V received three laser treatments at monthly intervals followed by follow-up visitsthrough 2 years. 

Participants who were on an acne treatment regimen prior to the study were required to maintain the same dosage and routine for the first two treatments. Three were taking isotretinoin. Other participant regimens included oral antibiotics, steroids, and/or topical treatments. No unexpected adverse events from the laser treatments occurred among people taking medications or combinations of medications, Goldberg reported. 

Holland had no financial disclosures. Goldberg disclosed conducting contracted research for Cutera, the manufacturer of the 1726-nm laser used in his study.