Information sheet can help women avoid pregnancy and acne medication-related birth defects

An information sheet for women being treated for severe acne improves understanding of contraceptive effectiveness and ways to avoid pregnancy and medication-induced birth defects, a study published today in JAMA Dermatology has found.

Isotretinoin (brand name, Accutane), a medication used to treat severe acne, is well-known for its risk of medication-induced birth defects, which include facial deformities, missing or malformed earlobes, and mental retardation. Although use of isotretinoin has been strictly regulated, pregnancies affected by the medication continue to be reported, because many women who take it rely on contraceptives that may fail.

For the study, conducted between April and May 2014, researchers asked 100 English-speaking women, 18 to 45, seated in the waiting room of one urban dermatology practice to indicate the contraceptives of which they were aware and categorize their effectiveness before and after reviewing a contraceptive information sheet. A research assistant noted how long each participant spent reviewing the information sheet and collected demographic information about each participant.

The study found that prior to receiving the contraceptive information sheet, over half of the women overestimated the typical effectiveness of condoms, contraceptive injections and oral contraceptives, and many had never heard of the subdermal contraceptive implant or the intrauterine device, which are among the most effective contraceptives. Fifty-five percent of participants overestimated the typical effectiveness of condoms and many overestimated the effectiveness of oral contraceptives, which typically fail in 9 percent of women within their first year of use.

"We found that women who spent less than one minute reviewing a contraceptive information sheet while waiting to see their dermatologist demonstrated significant improvement in their knowledge of highly effective contraceptives," said Eleanor Bimla Schwarz, professor of medicine in the UC Davis School of Medicine and the study's senior author.

Physicians who treat women with isotretinoin participate in a program called iPledge, which is aimed at protecting women from pregnancy while taking isotretinoin. Schwarz and her colleagues said the study highlights the need to update the iPledge program materials to ensure that women prescribed isotretinoin receive effectiveness information about their contraceptive options.

She noted that subdermal contraceptives, like all medications that suppress ovulation, improve acne for the majority of women. The study indicates that up-to-date information about modern contraceptives methods, linked with prompt referral to a clinician able to place implants or intra-uterine devices (IUDs), may dramatically decrease rates of medication-induced birth defects related to this powerful acne medication.