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We had been talking about her dry lips and her acne flare-ups, and I had been thinking that she was in need of therapy—but she was already on her third month of isotretinoin without being on i Pledge, without any dermatologist supervision, and without any understanding of her dosage protocol or the risks involved if she had gotten pregnant or had any problems with her serological profile. 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. I, like a growing number of health officials, now know that patients can get a six-month supply of istoretinoin without a prescription by just using their credit card and their mailing address. 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