Isotretinoin is the most effective antiacne therapy, but its teratogenicity is well known. Many initial risk-reduction efforts were ineffective, and the US Food and Drug Administration strictly regulates its distribution to female patients of childbearing potential. In this survey study, Werner et al document women’s experiences with isotretinoin risk-reduction counseling. While women clearly understood the teratogenic potential of isotretinoin, they had less understanding of contraceptive methods that effectively prevent pregnancy. For many, iPLEDGE was their first introduction to contraception. Patients may benefit from revision of iPLEDGE education materials, updates to prescribing physicians, or referral to local family planning specialists.