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Cited by 1Acne and Rosacea Treatments and EffectsDermatology and Skin DiseasesDermatologic Treatments and Research

Wax Stripping and Isotretinoin Treatment: A Warning Not to Be Missed

Open access
Zlotogorski, Abraham·2021·Cutis
DOI 10.12788/cutis.0213
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Abstract

To the Editor: Oral isotretinoin is a widely used treatment modality in dermatologic practice that is highly effective for severe and recalcitrant acne vulgaris in addition to other conditions.Its use is accompanied by a variety of side effects that are mainly mucocutaneous.These dose-dependent side effects are experienced by almost all patients treated with this medication. 1 A generally healthy 14-year-old adolescent girl presented with severe widespread erosions located in a linear pattern corresponding to areas of wax depilation on the shins and thighs (Figure).Approximately 5 months prior, the patient started oral isotretinoin 40 mg daily for severe and recalcitrant acne vulgaris.She was not taking other medications.After 4 months of treatment, during which the acne lesions improved and the patient experienced only mild xerosis and cheilitis, the dosage was increased to 60 mg daily.Three weeks later, the patient underwent wax depilation, which resulted in the erosions.Oral isotretinoin treatment leads to structural and functional changes to the skin, related to epidermal dyscohesion and sebo-suppression.Although these changes may not be clinically evident in all patients, they still make the skin much more sensitive to external mechanical stimuli. 1 Wax depilation commonly is used for treating excess hair on the body.Because it exerts remarkable mechanical stress on the epidermis, it may lead to epidermal stripping in patients taking isotretinoin, manifesting as widespread erosions and resulting in notable patient distress.Dermatologists typically advise patients to avoid wax epilation while being treated with isotretinoin; however, some patients do not adhere to this recommendation.Also, there are dermatologists who are not aware of this potential side effect.In one survey (N=54), only 4% of Wax Stripping and Isotretinoin Treatment: A Warning Not to Be Missed

AI snapshot

Written from the paper’s full text.

TL;DR

A case report describes a 14-year-old girl on oral isotretinoin who developed severe widespread linear erosions after wax depilation. The authors remind clinicians that wax epilation should be avoided during isotretinoin treatment and for 6 months after stopping.

Key findings

  • A generally healthy 14-year-old girl with severe recalcitrant acne vulgaris started isotretinoin 40 mg daily; after 4 months, acne improved with only mild xerosis and cheilitis, and the dose was increased to 60 mg daily.
  • Three weeks after the dose increase, wax depilation caused severe widespread erosions in a linear pattern corresponding to wax depilation areas on the shins and thighs.
  • Isotretinoin causes structural and functional skin changes related to epidermal dyscohesion and sebo-suppression, making skin more sensitive to external mechanical stimuli; waxing can therefore lead to epidermal stripping.
  • In one cited survey (N=54), only 4% of consulting dermatologists were aware of this complication, and a PubMed/MEDLINE search found only 4 prior reports of this severe side effect with isotretinoin and wax.

Methods

  • Case report/letter describing one patient: a 14-year-old girl who developed erosions after wax depilation while taking isotretinoin.
  • Literature search using PubMed/MEDLINE with the terms isotretinoin and wax, plus citation of a survey (N=54) and isotretinoin prescribing information.
  • No formal study design or statistical analysis; the report is a clinical case description with literature context.

Limitations

  • The paper does not state limitations.
  • Evident from the text: it is a single case report with no control or comparative data, so causality rests on temporal association and known isotretinoin-related skin changes.
  • The cited survey (N=54) and prior reports are mentioned only briefly, and no patient follow-up or outcome after the erosions is reported.

Model-written summary. Check it against the paper before relying on it.

Integrity signals

Registry

Crossref · 10.12788/cutis.0213

Cites

5 of 5 references verified0 citation errors · 0 not checkable

Statistics

Nothing to recompute.

Claims the paper makes

0 of 6 cited sources checked · 0 supported · 0 flagged

  • Findingown data
    § Abstract

    A PubMed search of articles indexed for MEDLINE using the terms isotretinoin and wax revealed that this severe side effect with isotretinoin has been reported only 4 times in the medical literature.

    “A PubMed search of articles indexed for MEDLINE using the terms isotretinoin and wax revealed that this severe side effect with isotretinoin has been reported only 4 times in the medical literature.[2][3][4][5]”
    Quote in the paperNot a substantial claim0 of 3 sources checked
    • cites [2]

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

    • cites [3]

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

    • cites [4]

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • Findingnone given
    § Abstract

    After 4 months of treatment, the patient experienced only mild xerosis and cheilitis.

    “the patient experienced only mild xerosis and cheilitis”
    Quote in the paperNot a substantial claim
  • Findingnone given
    § Abstract

    The fact that wax epilation should be avoided during isotretinoin treatment previously was not included in the prescribing information.

    “The fact that wax epilation should be avoided during isotretinoin treatment previously was not included in the prescribing information.”
    Quote in the paperSubstantial claim
  • Findingnone given
    § Abstract

    A generally healthy 14-year-old adolescent girl presented with severe widespread erosions located in a linear pattern corresponding to areas of wax depilation on the shins and thighs.

    “A generally healthy 14-year-old adolescent girl presented with severe widespread erosions located in a linear pattern corresponding to areas of wax depilation on the shins and thighs (Figure).”
    Quote in the paperSubstantial claim
  • Interpretationreasoning
    § Abstract

    The wax depilation resulted in the erosions.

    “which resulted in the erosions”
    Quote in the paperSubstantial claim
    • Rests on an assumption: Wax depilation exerts remarkable mechanical stress on the epidermis.
  • Classified as probably not a substantial claim. 4
  • The quote only partly states this claim. 1

  • Classified as probably not a substantial claim.

    Findingnone given
    § Abstract

    Approximately 5 months prior, the patient started oral isotretinoin 40 mg daily for severe and recalcitrant acne vulgaris.

    “Approximately 5 months prior, the patient started oral isotretinoin 40 mg daily for severe and recalcitrant acne vulgaris.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingnone given
    § Abstract

    She was not taking other medications.

    “She was not taking other medications.”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim.

    Findingnone given
    § Abstract

    Three weeks later, the patient underwent wax depilation.

    “Three weeks later, the patient underwent wax depilation”
    Quote in the paperSubstantial claim

  • Classified as probably not a substantial claim. The quote only partly states this claim.

    Findingnone given
    § Abstract

    After 4 months of treatment, the dosage was increased to 60 mg daily.

    “the dosage was increased to 60 mg daily”
    Quote in the paperSubstantial claim
4 of 4

  • The paper relies on this without support.

    Wax depilation exerts remarkable mechanical stress on the epidermis.

    “it exerts remarkable mechanical stress on the epidermis”
1 of 1

Cites

Flagged first, then by citations

Cited by

Still being checked.

Related

Authors
Zlotogorski, A.
Affiliations
Hebrew University of Jerusalem (IL)
Corresponding author
Zlotogorski, Abraham
ORCID
Zlotogorski, Abraham
Venue
Cutis
Publisher
Frontline Medical Communications, Inc.
Published
2021-03-19
Volume
107
Issue
Volume 107 Issue 3
Pages
E10-E11
ISSN
0011-4162 (ISSN-L)
DOI
10.12788/cutis.0213
OpenAlex
W3146394796
Semantic Scholar
b913747c480b5f797050a93e5b6cb7c6fb61a600
Cited by
1
References
5
Citations by year
2022: 1
FWCI
0.18
Type
journal article
Language
en
Open access
Locations
  • Cutis (publishedVersion)
  • PubMed (publishedVersion)
Topics
  • Health Sciences › Medicine › Dermatology › Acne and Rosacea Treatments and Effects
  • Health Sciences › Medicine › Dermatology › Dermatology and Skin Diseases
  • Health Sciences › Medicine › Dermatology › Dermatologic Treatments and Research
Keywords
isotretinoin, skin erosion, acne, mechanical skin injury, adverse drug reactions
MeSH terms
Acne Vulgaris, Humans, Skin, Isotretinoin

About these checks

Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

Claims read by deepseek-v4.1-flash under definition version 3 (extract-v3) on 2026-10-09.

Classified by jev-1.13-20260917 (gold-guideline-v0.2) on 2026-10-09.

Statistics and arithmetic are recomputed, not judged.

Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.

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