Teratogenic, unregulated, vitamin A acne supplements, and Roe v Wade: Response to “The Supreme Court abortion ban impact on dermatology”

To the Editor: We read with great interest the commentary by Yousif et al,1Yousif J. Adlam T. Grant-Kels J.M. Farshchian M. The Supreme Court abortion ban impact on dermatology.J Am Acad Dermatol. 2022; 87: 1225-1226https://doi.org/10.1016/j.jaad.2022.07.026Abstract Full Text Full Text PDF PubMed Scopus (4) Google Scholar which addresses the dermatologic impact of the recent Supreme Court decision to overturn Roe v Wade. The authors posit that abortion bans may limit dermatologists’ use of isotretinoin and result in the prescription of less effective medications (eg, antibiotics), leading to problems, such as increased bacterial resistance. We would like to bring attention to another potential consequence of this verdict: increased use of vitamin A-containing dietary supplements marketed for acne. Dietary supplements are not regulated by the Food and Drug Administration (FDA). Thus, they are not subject to the same rigorous testing requirements as prescription medications and need not demonstrate safety. These products can be easily purchased online and over the counter (OTC).2Zamil D.H. Burns E.K. Perez-Sanchez A. Parke M.A. Katta R. Risk of birth defects from vitamin A “Acne Supplements” sold online.Dermatol Pract Concept. 2021; 11e2021075https://doi.org/10.5826/dpc.1103a75Crossref Scopus (6) Google Scholar Previous studies have reported that, similar to isotretinoin, select acne supplements sold online contain vitamin A doses high enough to pose a teratogenic risk.2Zamil D.H. Burns E.K. Perez-Sanchez A. Parke M.A. Katta R. Risk of birth defects from vitamin A “Acne Supplements” sold online.Dermatol Pract Concept. 2021; 11e2021075https://doi.org/10.5826/dpc.1103a75Crossref Scopus (6) Google Scholar Additionally, consumers can have difficulty calculating a teratogenic threshold for a given vitamin A-containing supplement.2Zamil D.H. Burns E.K. Perez-Sanchez A. Parke M.A. Katta R. Risk of birth defects from vitamin A “Acne Supplements” sold online.Dermatol Pract Concept. 2021; 11e2021075https://doi.org/10.5826/dpc.1103a75Crossref Scopus (6) Google Scholar If dermatologists sparingly prescribe isotretinoin, as mentioned by Yousif et al,1Yousif J. Adlam T. Grant-Kels J.M. Farshchian M. The Supreme Court abortion ban impact on dermatology.J Am Acad Dermatol. 2022; 87: 1225-1226https://doi.org/10.1016/j.jaad.2022.07.026Abstract Full Text Full Text PDF PubMed Scopus (4) Google Scholar patients with acne may turn to OTC vitamin A supplements that have unregulated claims and contents. Even with a dermatologist willing to prescribe isotretinoin, patients – particularly women of childbearing potential – must fulfill burdensome iPLEDGE program requirements, including obtaining 2 negative pregnancy tests results before initiation of isotretinoin and monthly thereafter, using 2 forms of contraception, presenting for monthly visits, and completing monthly comprehension questions.1Yousif J. Adlam T. Grant-Kels J.M. Farshchian M. The Supreme Court abortion ban impact on dermatology.J Am Acad Dermatol. 2022; 87: 1225-1226https://doi.org/10.1016/j.jaad.2022.07.026Abstract Full Text Full Text PDF PubMed Scopus (4) Google Scholar Considering the overturning of Roe v Wade and the barriers to isotretinoin access for female patients of reproductive age, patients with acne may feel inclined to shift from isotretinoin to OTC options or out-of-pocket cosmetic treatments.1Yousif J. Adlam T. Grant-Kels J.M. Farshchian M. The Supreme Court abortion ban impact on dermatology.J Am Acad Dermatol. 2022; 87: 1225-1226https://doi.org/10.1016/j.jaad.2022.07.026Abstract Full Text Full Text PDF PubMed Scopus (4) Google Scholar Because individuals of lower socioeconomic status may not be able to afford costly cosmetic treatments,1Yousif J. Adlam T. Grant-Kels J.M. Farshchian M. The Supreme Court abortion ban impact on dermatology.J Am Acad Dermatol. 2022; 87: 1225-1226https://doi.org/10.1016/j.jaad.2022.07.026Abstract Full Text Full Text PDF PubMed Scopus (4) Google Scholar they may be more likely to turn to alternatives, such as unregulated vitamin A supplements. Thus, OTC vitamin A supplements for acne may pose an increased risk of fetal defects in these individuals. It is imperative for dermatologists to recognize these implications in a post-Roe world. Given the ease of obtaining vitamin A supplements and their lack of regulation by the FDA, we may see patients increasingly turning to these products as an alternative to isotretinoin. Moreover, patients may be unaware of the teratogenic effects of these products and are predisposed to suffer resultant consequences, given the inability to terminate pregnancies in certain states.1Yousif J. Adlam T. Grant-Kels J.M. Farshchian M. The Supreme Court abortion ban impact on dermatology.J Am Acad Dermatol. 2022; 87: 1225-1226https://doi.org/10.1016/j.jaad.2022.07.026Abstract Full Text Full Text PDF PubMed Scopus (4) Google Scholar,2Zamil D.H. Burns E.K. Perez-Sanchez A. Parke M.A. Katta R. Risk of birth defects from vitamin A “Acne Supplements” sold online.Dermatol Pract Concept. 2021; 11e2021075https://doi.org/10.5826/dpc.1103a75Crossref Scopus (6) Google Scholar Dermatologists may find themselves increasingly turning to antibiotics, intralesional and oral steroids, chemical peels, and lasers.1Yousif J. Adlam T. Grant-Kels J.M. Farshchian M. The Supreme Court abortion ban impact on dermatology.J Am Acad Dermatol. 2022; 87: 1225-1226https://doi.org/10.1016/j.jaad.2022.07.026Abstract Full Text Full Text PDF PubMed Scopus (4) Google Scholar Familiarity with these alternative acne treatments and awareness of the latest OTC supplements will allow for effective patient counseling and help prevent unintended health consequences. None disclosed.