The overturning of Roe v Wade has threatened the privacy and reproductive freedom of patients who are capable of getting pregnant and has made prescribing and taking isotretinoin for the treatment of mild to moderate and cystic acne more difficult, according to an article published in Allure. Despite being highly effective and affordable, the medication is known to cause a litany of side effects—including dryness of the lips, eyes, and skin; increased liver enzyme and cholesterol levels; inflammatory bowel disease; headaches; loss of appetite; depression; as well as birth defects, miscarriages, or stillbirths for those who are pregnant. These potential adverse reactions have made pregnancy tests a mandatory obligation for those capable of becoming pregnant while on the medication. Mandatory, in-office tests are conducted before beginning isotretinoin and every month while on the drug—which creates permanent menstrual cycle records that can be used as court evidence for patients in states that have banned abortions. “Abortion bans limit patient autonomy by preventing pregnant patients on a teratogenic medication the free and informed decision of terminating their pregnancy … [and giving them] no alternative option if/when contraception fails,” emphasized the authors of a recent commentary published by Yousif et al in the Journal of the American Academy of Dermatology.
In the wake of the new abortion legislation and to avoid potential prosecution for providing standard patient care, dermatologists have begun to consider other acne treatment options—such as laser therapy, antihormonal agents, topical formulas, and the less favorable option of oral antibiotics. The 1,726-nm laser, which shrinks the sebaceous glands, has already demonstrated a response rate of 91% and may offer long-term results. However, the laser may not be as effective for patients with cystic acne and can cost $3,000 for just three sessions. Birth control medication and spironolactone may be effective at limiting sebum production for patients who identify as female. Topical medication combinations such as benzoyl peroxide, retinoids, and clascoterone target bacteria, prevent dead skin cells from clogging the pores, and reduce hormones. Dermatologists noted that these new treatment options will give patients safe and effective alternatives to isotretinoin without the potential side effects.