The prescription of isotretinoin to women: is every precaution taken?

A questionnaire survey of dermatologists practising in Scotland was carried out to assess strategies for the management of women prescribed isotretinoin for acne. The results of the study suggested that the prevention of pregnancy during treatment is of considerable concern to dermatologists: over 90% routinely asked women about sexual activity and 97% routinely gave both verbal and written advice on the need to avoid pregnancy during treatment. However, clinical practices which might place women at risk of pregnancy were identified: only 30% of trainees and 51% of consultants routinely carried out pregnancy tests before treatment, and when tests were carried out, there was a tendency to rely on potentially insensitive urine assays. Additionally, there was an apparent lack of recognition of the possibility of sexual activity in girls aged under 16 years. Suggestions for the management of women prescribed isotretinoin include taking a sexual history from all women; providing clear information on the need to avoid pregnancy during treatment; obtaining informed consent prior to treatment; recommending the use of effective contraceptive measures; and exclusion of pregnancy prior to treatment by means of a suitably timed blood or urine sample and sensitive assay technique.