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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. Who is going https://www.healthgrades.com to manage that. And more importantly, will there now be a discrepancy in how many dermatologists use the iPledge system. Are dermatologists who may be frustrated with the system and the requirements of iPledge going to tell their patients to go ahead and buy isotretinoin online and bypass the whole system, especially considering situations such as female patients who are on low-dose, long-term regimens, or patients who are using isotretinoin long-term for off-label indications such as treating rosacea. Are these patients going to be going to the Internet and getting isotretinoin without regulation, and, if so, is there going to be an increase in the number of bad outcomes we will need to deal with. We not only really need to protect our patients who may not know what's best for themselves, but we also need to protect ourselves.

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