Abortion restrictions could impact isotretinoin prescriptions

A recent U.S. Supreme Court decision sending abortion rights back to the states could have serious implications for patients on isotretinoin and other dermatologic drugs.

“There are serious ethical, moral and emotional consequences to this Supreme Court decision for patients taking medications that are prescribed to them that could hurt their developing fetus,” Jane M. Grant-Kels, MD, FAAD, vice chair of the department of dermatology and professor of dermatology, pathology and pediatrics at the University of Connecticut School of Medicine and Health Center, told Healio.

The Dobbs v. Jackson Women’s Health Organization decision on June 24 effectively overruled the Roe v. Wade decision of 1972, which had declared abortion a constitutional right. With this new decision, the matter of abortion was sent back to the states, where several had “trigger laws” in place to immediately outlaw the practice and, for many others, legislation is now pending to do the same.

Grant-Kels, who is also the founding director of the cutaneous oncology center and melanoma program and associate director of the University of Connecticut School of Medicine and Health’s dermatology residency program, is one of a group of dermatologists speaking out about how practices may have to change their approach to certain medications due to this decision.

Isotretinoin, commonly prescribed for severe acne, is teratogenic, meaning it can cause serious malformations to a fetus. There is a 20% to 35% risk for congenital abnormalities in pregnant patients on isotretinoin, according to Grant-Kels and colleagues. The Dobbs v. Jackson Women’s Health Organization decision affects a host of other dermatological medications; however, isotretinoin is one most often prescribed in the dermatology world that will be affected by this ruling.

Patients of childbearing age are counseled throughout isotretinoin use to use regular birth control and are required to take monthly pregnancy tests. However, with no form of birth control being 100% effective except for complete abstinence, pregnancies do still occur. If a patient does become pregnant while on isotretinoin, termination is often recommended due to the risks to the fetus, according to Grant-Kels and colleagues.

“In those states where abortion is not an option, if a young girl on isotretinoin for acne gets pregnant, she will not have a local option for an abortion to terminate her pregnancy,” Grant-Kels said. “This is going to alter in certain states the medications we choose to use or not use. It also takes autonomy, or the right to have control over your own health care, away from these women.”

Isotretinoin is efficacious in treating severe, scarring acne, according to Grant-Kels and colleagues. Without abortion available, many dermatologists may stop prescribing it to women of childbearing age, leaving these patients with lifelong scars.

“If you take isotretinoin out of my toolbox, there are women who are going to walk around with permanent scars from acne for the rest of their lives. And if you have a child with fetal abnormalities, it can mean financial and emotional turmoil for a family,” Grant-Kels said.

In light of this decision, dermatologists need to find a new algorithm for acne treatment in the states where abortion is not available. Many dermatologists may choose not to prescribe isotretinoin if abortion access is limited, meaning patients will have to rely on other less effective medications or treatments, Grant-Kels and colleagues wrote.

These options could include long-term antibiotics, which could lead to antibiotic resistance; topical medications or cosmetic treatments such as pulsed dye lasers, radiofrequency devices or intense pulsed light sources; and photodynamic therapy.

Since many of these products are not covered by insurance, a disparity arises between those who can afford these treatments out-of-pocket and those who cannot.

“I think we need to have very long discussions with patients now,” Grant-Kels said. “There’s a whole list of medications, most of which could be lifesaving and certainly life altering, and to remove them from our toolbox, which this law does, takes away physician autonomy and patient autonomy.”