Pregnancy isotretinoin

General contraindications include salicylate hypersensitivity unrealistic patient expectations active inflammation/dermatitis of the site to be peeled acute viral infection pregnancy isotretinoin therapy within 6 months of peeling or history of poor or delayed wound healing. Having peeled more than 1,000 patients with sahcyhc acid, the author has observed no cases of salicylate hypersensitivity from topical peeling. 

Must be capable of complying with mandatory contraceptive measures required for isotretinoin therapy and understand behaviors associated with an increased risk of pregnancy, and... 

Must have selected and has committed to using 2 forms of effective contraception simultaneously, at least 1 of which must be a primary form, unless absolute abstinence is the chosen method, or the patient has undergone a hysterectomy. Patients must use 2 forms of effective contraception for at least 1 month prior to initiation of isotretinoin therapy, during isotretinoin therapy, and for 1 month after discontinuing isotretinoin therapy. Counseling about contraception and behaviors associated with an increased risk of pregnancy must be repeated on a monthly basis. 

Retinoids are strongly teratogenic (21). Pregnancy should be ruled out and an effective form of contraception must be used for at least 1 month before starting therapy, during therapy, and for at least 1 month (isotretinoin) or 2 years (acitretin) after therapy is stopped. Retinoid-induced teratogenicity has been reviewed (22,23). 

A baby was born missing its right ear and external auditory canal. At 20 months an MRI scan of the brain showed focal atrophy and encephalomalacia of the right parieto-occipital lobe. His mother had used topical tretinoin (Retin A 0.025%) on her face and a large surface of the back before conception and during the first 2-3 months of pregnancy. His father had used oral isotretinoin before conception. 

Dai WS, LaBraico JM, Stern RS. Epidemiology of isotretinoin exposure during pregnancy. J Am Acad Dermatol 1992 26(4) 599-606. 

Isotretinoin is a retinoid, the class of natural and synthetic compounds that exhibit vitamin A activity. It is a naturally occurring metabolite of vitamin A that inhibits sebum production. The US Food and Drug Administration classifies it as Pregnancy Risk Category X. 

S.M.A.R.T. ) and the Accutane Pregnancy Prevention Protocol (PPP) to be used in conjunction with the prescription of Accutane. Management of toxic effects involves monitoring by the appropriate specialist and discontinuation of the exposure where indicated. Isotretinoin-related depression may require long-term monitoring. 

Example Isotretinoin (Accutane) Route PO Pregnancy category X Pharmacokinetic Absorption enhanced when taken with a high-fat meal. It binds to plasma proteins (albumin), metabolized in the liver and excreted in feces and urine. 

AA, azelaic acid AN, oral antiandrogen blank, N/A BPO, benzoyl peroxide lab, CBC, chem screen, urinalysis OA, oral antibiotic Ol, oral isotretinoin PA, physical assessment PT, pregnancy test SLA, serum lipid analysis TA, topical antimicrobial TR, topical retinoid. 

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