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Back in college, Jennifer Meanley's dermatologist prescribed Accutane for her stubborn breakouts. The pills did the job, and for several years Meanley was in the clear. Over time, though, the large pimples on her cheeks and forehead came back. But she worried that she wouldn't have time for the monthly derm appointments and blood tests required of all patients who take the drug. Do-it-yourself dermatology is generally not a good idea, but taking anti-acne drugs without a doctor's supervision is especially dangerous. Isotretinoin has been associated with depression, elevated cholesterol levels, bowel diseases and liver damage—problems that could go undetected and untreated if you're not seeing a doctor. Another risk: getting pregnant while on Accutane, which has been proven to cause birth defects.

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Dermatologists need to be aware that it is possible for patients to easily purchase isotretinoin online without a prescription, without physician oversight, and without adhering to the FDA-mandated iPledge compliance program. A female patient recently presented to my office for a case of dry lips and acne flare-ups. After my initial tirade and scolding, I discussed the nuts and bolts of managing isotretinoin use with her as well as the consequence of her behavior. There are risks to the patients and risks to the providers. Who is responsible for the bad outcomes if someone gets pregnant, for example, or if they have a liver issue or something else as a result of being on this drug without a prescription and without supervision?

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