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Original Investigation |

Women’s Experiences With Isotretinoin Risk Reduction Counseling

Carly A. Werner, BA1; Melissa J. Papic, BS2; Laura K. Ferris, MD, PhD3; Jessica K. Lee, MD4; Sonya Borrero, MD2,5; Noel Prevost, PA3; Eleanor Bimla Schwarz, MD, MS2,4,5
[+] Author Affiliations
1School of Medicine, University of Pittsburgh, Pittsbugh, Pennsylvania
2Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
3Department of Dermatology, University of Pittsburgh, Pittsburgh, Pennsylvania
4Department of Obstetrics and Gynecology, University of Pittsburgh, Pittsburgh, Pennsylvania
5Women’s Health Services Research Unit, Center for Research on Health Care, University of Pittsburgh, Pittsburgh, Pennsylvania
JAMA Dermatol. 2014;150(4):366-371. doi:10.1001/jamadermatol.2013.6862.
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Importance  Isotretinoin, an effective anti-acne therapy, is a known teratogen that is strictly regulated through the iPLEDGE program. However, since this program has not significantly reduced rates of pregnancies exposed to isotretinoin, new strategies for reducing rates of isotretinoin-exposed pregnancies are needed.

Objective  To explore women’s experiences with counseling about isotretinoin risk reduction.

Design, Setting, and Participants  Structured interviews were conducted between January and September 2012. Two independent coders performed content analysis using a grounded theory approach. The study participants were 16 women who had used isotretinoin to treat severe skin disease and who were recruited from a single urban community via flyers displayed on college campuses, at dermatology clinics, and at student health facilities.

Main Outcomes and Measures  Perceptions of isotretinoin-associated risks and understanding of ways teratogenic risks can be avoided.

Results  Participants clearly understood that isotretinoin is teratogenic but had less understanding of contraceptive methods that effectively prevent pregnancy. Most described the counseling they received as anxiety provoking. Few were counseled about highly effective reversible contraceptives such as the subdermal implant or intrauterine contraception; most counseling focused on oral contraceptives. Women cited multiple influences on their contraceptive choices, including friends, family, physicians, the internet, and other media; however, some expressed concerns about the accuracy of these sources of information. For many, iPLEDGE was their first introduction to contraception. When presented with evidence-based information on the relative effectiveness of available contraceptives, participants expressed surprise that this was not part of the iPLEDGE materials.

Conclusions and Relevance  Since few clinicians provide women information on highly effective (ie, intrauterine or subdermal) contraceptives, the iPLEDGE program increases anxiety about isotretinoin more than it helps women feel protected from the teratogenic risks of isotretinoin.

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