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

Abstract

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.