Dermatologists' level of compliance with the prescription guidelines of isotretinoin for females of childbearing potential.

BACKGROUND

Potent teratogenicity limits the use of isotretinoin among females of childbearing potential (FCBP).

OBJECTIVE

To explore the current practice of dermatologists for pregnancy prevention when prescribing isotretinoin for FCBP.

MATERIALS AND

METHODS

A self-administered questionnaire was distributed to 160 dermatologists attending a national conference in Riyadh, Saudi Arabia, in 2008. The survey was designed to capture the details of precautions taken by dermatologists to prevent pregnancy among isotretinoin users.

RESULTS

Ultimately, 134 dermatologists completed the questionnaire (84% response rate). Their mean age was 39 ± 9.5 years. A total of 82 were female (65%). The median number of FCBP for whom isotretinoin was prescribed by each dermatologist during the previous 12 months was two (range from 0 to 30). Of the 792 total FCBP, seven were reported to have become pregnant (incidence rate of 8.8/1000) while on isotretinoin. Out of those seven, three women terminated the pregnancy (elective abortions: 42.7%). The majority of the dermatologists (79%) always obtained written consent and discussed teratogenic risks (98%); 44% provided written information about potential isotretinoin teratogenicity, and 30% offered printed information on contraception. Survey results also revealed that 62% recommended double contraception for FCBP, 60% always recommended pregnancy testing prior to therapy, but only 16% requested monthly pregnancy tests. In general, 62.4% avoided isotretinoin prescription to FCBP, which was independent of dermatologists' gender, years of experience, or having a previous incident of isotretinoin-exposed pregnancy.

CONCLUSION

Some dermatologists still do not follow the recommendations for isotretinoin prescription to FCBP. This needs to be corrected, especially in countries with restrictions on abortion.