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Invited Commentary
Practice Gaps
April 2015

Promoting Safe Use of Isotretinoin by Increasing Contraceptive Knowledge

Author Affiliations
  • 1Ronald O. Perelman Department of Dermatology, New York University, New York
JAMA Dermatol. 2015;151(4):393-394. doi:10.1001/jamadermatol.2014.4158

Isotretinoin is a rewarding medication to prescribe. With an efficacy rate of 60% to 85%, it is the only option that dermatologists have to offer an acne “cure.”1

Preventing pregnancies for women receiving isotretinoin is a challenging aspect of patient management. In the United States, monitoring systems such as SMART (System to Manage Accutane-Related Teratogenicity) and iPLEDGE have attempted to address this. These elaborate systems have resulted in a decrease in overall isotretinoin prescriptions and have disproportionately affected the treatment of acne in women. At Kaiser Permanente, after the implementation of iPLEDGE, prescriptions for women declined by 36% compared with 20% for men. Federal monitoring has not, however, been shown to decrease pregnancies.2