A young adult female has severe cystic acne and is requesting treatment with Accutane (isotretinoin) after failing many therapies under your care. The appropriate response is to:

Prescribe isotretinoin (Accutane) after obtaining a thyroid stimulating hormone level

Refer her to a dermatologist for evaluation and potential treatment

Discuss that isotretinoin (Accutane) is contraindicated in females and prescribe an oral tetracycline

Educate that her response is typical and it does not require treatment escalation