THE PRESCRIPTION OF ISOTRETINOIN TO WOMEN - IS EVERY PRECAUTION TAKEN

A questionnaire survey of dermatologists practising in Scotland was ca rried out to assess strategies for the management of women prescribed isotretinoin for acne. The results of the study suggested that the pre vention of pregnancy during treatment is of considerable concern to de rmatologists: over 90% routinely asked women about sexual activity and 97% routinely gave both verbal and written advice on the need to avoi d 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 t reatment, and when tests were carried out, there was a tendency to rel y 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 pre scribed isotretinoin include taking a sexual history from all women; p roviding clear information on the need to avoid pregnancy during treat ment; obtaining informed consent prior to treatment: recommending the use of effective contraceptive measures; and exclusion of pregnancy pr ior to treatment by means of a suitably timed blood or urine sample an d sensitive assay technique.