A 28-year-old woman of childbearing age is using isotretinoin (a vitamin A derivative) for acne. Evaluate the most appropriate preconception recommendation given the pharmacology and storage properties of vitamin A compounds.

• A. Continue isotretinoin but add dietary beta-carotene and start prenatal vitamins immediately because extra vitamin A will offset any teratogenicity of the drug.
• B. Switch immediately to a high-dose retinol supplement (preformed vitamin A) while attempting conception because more vitamin A reduces acne and will improve pregnancy outcomes.
• C. Stop all topical acne treatments but continue systemic isotretinoin at lower doses without contraception because topical and systemic exposures are equivalent and low dosing is safe for pregnancy planning.
• D. Discontinue isotretinoin under physician supervision well before conception and use reliable contraception until cleared per medical guidance, because vitamin A derivatives are teratogenic and fat-soluble forms can persist and cause fetal toxicity.

Answer: (D)