Background
Systemic isotretinoin is a highly effective treatment for severe and refractory acne but carries risk for serious adverse effects such as teratogenicity. The United States’ risk mitigation system, iPLEDGE, requires all patients on isotretinoin therapy to complete monthly tasks including follow-up visits with their prescriber, and patients with childbearing potential must additionally undergo monthly pregnancy testing. The onset of the COVID-19 pandemic presented an opportunity to reduce the isotretinoin gender gap, as updated regulations shifted to permit at-home pregnancy testing and telehealth visits for monthly follow-ups.

Methods
We performed a single-center analysis to determine whether gender differences in isotretinoin prescription changed at our institution during the initial months of the pandemic. Data was obtained from an institutional database. Inclusion criteria were dermatology encounters during which an adult patient (age>18) was prescribed isotretinoin or topical retinoids for acne. Gender identity originated from patient-reported demographics. Fisher’s exact tests with alpha set to 0.05 were used to compare odds of isotretinoin prescription for male and female patients, with control groups comprised of patients receiving topical retinoids for acne. Odds ratios were compared for the pandemic period (June 1, 2020 to January 22, 2021) versus the pre-pandemic period (June 1, 2019 to January 22, 2020). Odds ratios were also compared between telehealth visits and in-person visits during the pandemic period.

Results
We found that male predominance of isotretinoin prescriptions was greater during the pandemic compared to pre-pandemic (odds ratios: 4.13 vs. 2.86). Furthermore, male patients were more likely to utilize telehealth compared to in-person visits relative to female patients (odds ratios: 6.00 vs. 3.62).

Conclusion
Despite the newly introduced flexibilities of telehealth and remote pregnancy testing, gender inequity in receiving isotretinoin treatment persisted during the pandemic. Many factors may influence the relative decreased access to isotretinoin among female patients including patient and provider preference. Future work should examine factors influencing the prescription of isotretinoin to female patients, as well as identify opportunities to improve policies that promote safe isotretinoin use while minimizing gender inequity.

Differences in isotretinoin access by gender during the initial months of the COVID-19 pandemic

Public Health and Health Policy | Dermatology

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Differences in isotretinoin access by gender during the initial months of the COVID-19 pandemic

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