Women's experiences with isotretinoin risk reduction counseling.

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.

Compliance with pregnancy prevention measures during isotretinoin therapy.

BACKGROUND: Approximately 150 women annually become pregnant while taking isotretinoin despite participation in the iPLEDGE program. Noncompliance with the requirement to be abstinent or use 2 contraceptive methods may be a contributing factor. OBJECTIVE: We sought to determine the degree of adherence to contraception or abstinence among women taking isotretinoin. METHODS: We conducted an anonymous survey of women of childbearing potential taking isotretinoin for at least 2 months. RESULTS: Among 75 participants, 21 (28%) chose abstinence as their primary means of pregnancy prevention, of whom 4 (19%) were sexually active during treatment. The most commonly chosen contraceptive methods among the 39 women who were sexually active were condoms (35, 90%) and oral contraceptive pills (18, 46%). Twelve women (31%) admitted to having intercourse at least once using 1 or fewer forms of contraception; 10 failed to use condoms, and 1 reported completely unprotected intercourse. Among sexually active oral contraceptive pill users, 7 (39%) reported missing 1 or more pills in the previous month. LIMITATIONS: Data were self-reported, thus participants may have inaccurately reported contraception use. CONCLUSIONS: Encouraging the use of highly effective, patient-independent contraception and limiting abstinence to women who have never been sexually active may further reduce the rate of isotretinoin-exposed pregnancies.

Isotretinoin: update on controversial issues.

Acne vulgaris is a commonly seen dermatologic condition that plagues millions and can be very psychosocially disabling. Severe and recalcitrant acne is typically treated with isotretinoin. Isotretinoin is a synthetic vitamin A derivative that has been available since 1982.This therapeutic option has been the most effective at putting severe and recalcitrant acne vulgaris into remission. Despite its effectiveness,it has been associated with inflammatory bowel disease, depression, suicidality, and teratogenicity. We review the current literature on isotretinoin's role in inflammatory bowel disease, depression, and suicidality. In addition, we review whether or not the iPledge program has been successful at reducing pregnancy rates while on isotretinoin.

Unna sleeve for neurotic excoriations.

Neurotic excoriations are self-induced skin lesions produced because of compulsive scratching or picking. We present the successful use of the venerable technique of an Unna boot used as an Unna sleeve for neurotic excoriations of the upper extremities.

Xanthotrichia (yellow hair) due to selenium sulfide and dihydroxyacetone.

Hair shaft discoloration has been documented to be caused by disease states, medications, and exogenous chemicals. After researching the literature, xanthotrichia or yellow hair has been determined to be caused predominately by exogenous chemicals. Two cases of new chemicals causing yellow hair shaft discoloration are reported. The chemicals include selenium sulfide 2.5% shampoo and dihydroxyacetone.

Case reports: red scrotal syndrome: a localized phenotypical expression of erythromelalgia.

We report a case of red scrotal syndrome responding to oral gabapentin, a neuropathic mediator that is commonly used in the treatment of primary erythromelalgia. The positive response to oral gabapentin and the resemblance of these 2 conditions supports that red scrotal syndrome is a phenotypical expression of localized primary erythromelalgia.

Palliative treatment of fingernail lichen planus.

Lichen planus of the nails is a destructive inflammatory onychodystrophy that is often difficult to treat. We report a case of treatment with combined topical therapy of tazarotene gel and clobetasol gel. This modality may be effective for patients with nail lichen planus without the potential adverse affects of systemic treatments.