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 i Pledge compliance program. A female patient recently presented to my office for a case of dry lips and acne flare-ups. We were discussing her therapy and within the first minute or two of the discussion, she said, “I’ve been on this pill I’ve been getting online called Accutane and I’m on my third month.” Upon inquiring about where she’d gotten the drug and who her dermatologist was, she said she didn’t have a prescription and had been getting it online, and that the process was simple. 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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