Abstract
BACKGROUND: Isotretinoin is a highly effective treatment for acne but poses significant teratogenic risks. In India, due to the absence of stringent prescription guidelines for isotretinoin, the responsibility for preventing isotretinoin embryopathy falls on treating physicians. AIM AND OBJECTIVES: To assess dermatologists' knowledge, prescribing practices, and adherence to international Pregnancy Prevention Program (PPP) guidelines when prescribing isotretinoin. MATERIALS AND METHODS: A cross-sectional survey was conducted among qualified dermatologists using a validated online questionnaire based on components of the iPLEDGE program. The questionnaire was distributed via email and WhatsApp. Data were analyzed using Statistical Package for the Social Sciences (SPSS) for Windows. RESULTS: A total of 189 dermatologists responded. Among them, 91.5% had prescribed isotretinoin, and 78% had done so for women of reproductive age. Although 94.7% of the respondents were aware of PPP guidelines, only 33.3% consistently conducted pretreatment pregnancy testing. While 74.8% of the dermatologists advised dual contraception, only 12.6% of them obtained written consent regarding teratogenic risks, and 19.3% regarding contraception. Six dermatologists reported isotretinoin exposed pregnancies, which resulted in two spontaneous abortions, three medical terminations, and one healthy live birth. After the survey, 91.3% of the respondents reported improved awareness, and 85% of them expressed willingness to follow PPP guidelines. LIMITATION: Regional variations in practice may limit the generalizability of findings to the nation. CONCLUSION: Despite high awareness, significant lapses exist in the implementation of pregnancy prevention practices while prescribing isotretinoin, highlighting a need for formulating prescription guidelines to standardize its use in India.